Meth withdrawal symptoms peak 2 to 3 days after the last use and may last for a week [1]. Then it changes shape rather than ending: after the acute phase, low mood, anxiety and cravings for the drug can continue for several months [1].
That second stretch is the one people are least prepared for, and it is where most returns to use happen.
This page covers what the symptoms are, what the sequence looks like day by day, the one thing about the crash that makes supervision worth arranging, and what has to follow it. Our overview of crystal meth covers the drug itself, and the meth comedown covers the first hours.
What Meth Withdrawal Feels Like
Mostly psychiatric, with a physical layer underneath it.
NIDA lists the symptoms a person may have after repeatedly using methamphetamine and stopping: depression, anxiety, irritability, pain and discomfort, sleep problems, cravings, and trouble concentrating [1]. It adds that a person may experience these even if they do not have stimulant use disorder [1].
The WHO’s guidance for closed settings gives a shorter list with the same shape — agitation and irritability, depression, increased sleeping and appetite, and muscle aches [2]. The increased sleeping and appetite are the part families misread most often, because after weeks of the opposite they look like recovery rather than like withdrawal.
There is one symptom that is not on either list as a feeling, because it is a state. People who use large amounts of stimulants, particularly methamphetamine, can develop psychotic symptoms such as paranoia, disordered thoughts and hallucinations; the person may be distressed and agitated, and they may be at risk of harming themselves or others [2]. Those symptoms can be managed with anti-psychotic medications and will usually resolve within a week of ceasing stimulant use [2].
If you are worried that someone is about to harm themselves, or someone else, call or text 988. If someone is unresponsive or has trouble breathing, call 911.
Our page on withdrawal symptoms sets out how this differs from other drugs.
How Long It Lasts: Three Sources, Three Windows
Three bodies answer slightly different questions, and this page says which is which rather than averaging them.
NIDA gives the acute course, and it is the figure this page leads with. Symptoms peak 2 to 3 days after the last use and may last for a week [1].
The WHO’s closed-settings guidance gives the start and a tighter acute window. Symptoms begin within 24 hours of last use of stimulants and last for 3 to 5 days [2].
SAMHSA’s detoxification protocol gives the outer bound, citing Coffey and colleagues: the symptoms often disappear after several days of stimulant abstinence but can persist for 3 to 4 weeks [5].
Those are not in conflict. The 3-to-5-day window is the acute phase, the week is how long symptoms may persist past the peak, and the 3-to-4-week figure is the tail on the symptom constellation. The WHO also describes a protracted phase running 1 to 2 months, marked by lethargy, anxiety, unstable emotions, erratic sleep and strong cravings [2], and NIDA says low mood, anxiety and cravings can run for several months [1].
What none of them gives is a date for you. The severity and duration vary with the pattern of use, and the guidance treats the course as something to assess individually rather than read off a chart [2].
The First 24 Hours
Withdrawal begins inside this window: symptoms begin within 24 hours of last use [2].
The dominant feature early on is the crash. Energy collapses. Sleep can be enormous, or absent, and either is normal — the WHO names increased sleeping and appetite among the symptoms [2]. Appetite usually returns sharply.
Mood is the thing to watch. Depression, anxiety and irritability are among the symptoms NIDA names [1]. In the first day they can arrive suddenly and feel total.
Nothing about this stretch is a test of character. The brain has been running on borrowed chemistry and is not getting it back on request. What helps is rest, fluids, food and someone paying attention.
Day 1 to Day 3: The Acute Peak
This is the hardest part and it is also the shortest. Symptoms peak 2 to 3 days after last use [1].
Expect the mood symptoms to be at their worst here. Depression, anxiety, irritability, pain and discomfort, sleep problems, cravings and trouble concentrating are all on NIDA’s list [1].
There is no pharmacological shortcut through it. Because the mainstay of treatment for stimulant withdrawal is symptomatic medication and supportive care, the WHO’s guidance includes no withdrawal scale at all [2]. Something may be offered for sleep or agitation. Nothing removes the peak.
Suicidal Thinking and the Crash
This is the part of meth withdrawal that the federal protocol singles out for close monitoring, and it is not the part most pages lead with.
Stimulant withdrawal does not carry the seizure and delirium risk that alcohol and sedative withdrawal do. What it carries instead is a depression deep enough to be dangerous, arriving fast, in someone who has not slept properly for days. SAMHSA’s detoxification protocol is direct about it: amphetamine users in particular should be monitored closely during detoxification for signs of suicidality, and treated for depression if appropriate [5]. The WHO’s guidance directs that the patient’s mental state be monitored to detect complications such as psychosis, depression and anxiety, and that patients who exhibit severe psychiatric symptoms be referred to a hospital for appropriate assessment and treatment [2].
If you are thinking about suicide, or worried about someone who is, call or text 988. If someone is unresponsive or has trouble breathing, call 911.
That is what supervision is actually for here. Not a drip and a monitor, but somebody in the building through the peak, when judgment is worst and being alone is the risk factor. If withdrawal is happening at home anyway, the single most useful thing is that somebody else is there and knows what they are watching for.
Day 4 to Day 7
The acute phase ends somewhere in here. The WHO puts it at 3 to 5 days [2]; NIDA says symptoms may last for a week [1].
Sleep usually starts to organize itself first, though it stays irregular. Appetite settles. Physical discomfort fades.
Mood lags behind all of it. Someone can look considerably better by day five and still feel flat, slow and joyless. That gap between how a person looks and how they feel is worth naming, because families often read the improvement as finished.
Cravings do not follow a neat downward line either. They tend to come in waves, triggered by people, places and routines rather than by the calendar.
Supervised withdrawal and treatment for stimulant use
The Recovery Village Ridgefield is our campus in Ridgefield, Washington. Its own Levels of Care section cards medical detox, inpatient treatment, partial hospitalization programming, intensive outpatient programming, dual diagnosis treatment and medically-assisted treatment. An assessment establishes what is being used and which of those fits.
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Week Two and Beyond
The acute phase is over and the long one has started. The WHO puts the protracted phase at 1 to 2 months, with lethargy, anxiety, unstable emotions, erratic sleep and strong cravings [2]. NIDA says low mood, anxiety and cravings may run for several months [1].
This is where the timeline stops being useful as a countdown. Nobody is counting down to a day when it lifts, because it lifts unevenly.
Two features cause most of the trouble. Anhedonia means ordinary things stop registering as enjoyable, which makes abstinence feel like a punishment rather than progress. And sleep stays unreliable for weeks, which worsens everything else.
The practical implication is that a plan covering only the first week has covered the easy part. How long rehab takes sets out realistic lengths, and our directory of rehab facilities lists our campuses by state.
What Changes the Timeline
Several factors stretch or compress the acute phase, and none of them is under anyone’s control once withdrawal has started.
How much and how long. The severity and duration of stimulant withdrawal vary with the pattern of use, and the guidance treats the course as something to be assessed individually rather than read off a chart [2]. This page does not put a figure on that difference, because no source we can cite does.
Physical health. Methamphetamine affects many of the body’s organs and systems and can cause severe health problems, especially when it is used frequently [1], and arriving at withdrawal in that condition is harder than arriving in good health. Raise any untreated physical problem at assessment.
Other substances. Very few people use only one thing. If alcohol or a benzodiazepine is in the picture, that withdrawal takes clinical priority, because it is the one that can be fatal. SAMHSA’s protocol draws the line plainly: seizures, delirium tremens and dysregulation of body temperature, pulse and blood pressure are outcomes in severe alcohol dependence that can lead to fatal consequences [5], while uncomplicated opioid withdrawal is not life-threatening [5]. Stimulant withdrawal does not carry the seizure and delirium danger, which is exactly why the alcohol or benzodiazepine side is managed first.
If someone is having a seizure, is unresponsive or has trouble breathing, call 911. For a mental-health crisis call or text 988.
Mental health. A pre-existing condition makes this period both harder and more closely watched, and the WHO’s monitoring instruction above is why [2]. Federal guidance also says it is usually better to treat a substance use disorder and a co-occurring condition at the same time than separately, and that research suggests this can make all the treatments more effective and improve health outcomes [4]. Medication-assisted treatment exists for opioid and alcohol use disorders, where there are FDA-approved medications [4], and someone using more than one substance may need it alongside stimulant treatment.
Why a Supervised Setting Helps
The reason is what the peak does to mood and judgment, and the section above is most of the answer.
A supervised setting provides monitoring during the days when depression is deepest, somewhere to be that is not where use happens, and clinicians who can treat symptoms as they arise [2]. It also removes the decision. At home, ending withdrawal is a matter of leaving the house.
Federal guidance frames detoxification as a set of interventions aimed at managing acute intoxication and withdrawal, and states plainly that detoxification is not substance abuse treatment and rehabilitation [3]. So a supervised detox is not the treatment. It is the thing that makes treatment possible.
Whether that happens in medical detox, in inpatient care or in a structured outpatient program is a clinical decision made at assessment. Our guides to insurance coverage for rehab and what rehab costs set out how benefits are checked and what drives the bill, and how to get into rehab explains what an assessment covers.
What Happens After Detox Ends
Behavioral treatment, because for stimulants that is what the evidence supports.
There is no FDA-approved medication for methamphetamine use disorder, or for any other stimulant use disorder [1]. That is a real gap, and any site implying otherwise is wrong.
What does work is behavioral. The best-studied form of behavioral treatment for methamphetamine use disorder, and the one most associated with treatment success, is contingency management, which offers people small, tangible incentives such as prizes, cash, vouchers or gift cards to keep them from using and to continue treatment [1]. Other evidence-based behavioral approaches include cognitive behavioral therapy, group support and motivational interviewing [1].
That evidence shapes the level of care. Contingency management and therapy need to run for months, not days, which is why the step down from detox into a structured program matters more here than the detox itself. Federal guidance notes that individuals with substance use disorder may require long-term or multiple episodes of treatment to achieve long-term recovery [4]. Our pages on levels of care and outpatient rehab explain the tiers.
Frequently Asked Questions
How long does meth withdrawal last? Symptoms peak 2 to 3 days after the last use and may last for a week. The WHO’s closed-settings guidance gives a slightly tighter acute window, beginning within 24 hours of last use and lasting 3 to 5 days, and SAMHSA’s protocol gives the outer bound, citing Coffey and colleagues: symptoms often disappear after several days but can persist for 3 to 4 weeks. Low mood and cravings can run for several months.
What does meth withdrawal feel like? Mostly psychiatric. NIDA lists depression, anxiety, irritability, pain and discomfort, sleep problems, cravings and trouble concentrating. The WHO adds agitation and irritability, depression, increased sleeping and appetite, and muscle aches. The heavy sleeping and returning appetite are the part families misread, because after weeks of the opposite they look like recovery rather than like withdrawal.
Is meth withdrawal dangerous? Not in the way alcohol withdrawal is, and dangerous for a different reason. SAMHSA says amphetamine users in particular should be monitored closely during detoxification for signs of suicidality and treated for depression if appropriate. The WHO directs that mental state be monitored for psychosis, depression and anxiety, with referral to hospital for severe psychiatric symptoms. If you are thinking about suicide, or worried about someone who is, call or text 988.
Can meth cause psychosis during withdrawal? It can. People who use large amounts of stimulants, particularly methamphetamine, can develop psychotic symptoms such as paranoia, disordered thoughts and hallucinations, and the person may be distressed and agitated and may be at risk of harming themselves or others. Those symptoms can be managed with anti-psychotic medications and will usually resolve within a week of ceasing stimulant use. If someone is at risk now, call or text 988.
Are there medications for meth withdrawal? None are approved for the underlying disorder. There is no FDA-approved medication for methamphetamine use disorder or any other stimulant use disorder. The mainstay of treatment for stimulant withdrawal is symptomatic medication and supportive care, which is why the WHO’s guidance includes no withdrawal scale. Symptoms such as agitation or sleep disturbance may be treated individually by a clinician.
What has to happen after detox? Behavioral treatment, and it needs to run for months. Contingency management is the best-studied form for methamphetamine use disorder and the one most associated with treatment success, alongside cognitive behavioral therapy, group support and motivational interviewing. Detoxification is not substance abuse treatment and rehabilitation, so the plan after it is what determines whether the withdrawal was worth going through.
Sources
- National Institute on Drug Abuse. Methamphetamine. National Institutes of Health. https://nida.nih.gov/research-topics/methamphetamine
- World Health Organization. (2009). Clinical Guidelines for Withdrawal Management and Treatment of Drug Dependence in Closed Settings, Chapter 4.5: Withdrawal Management for Stimulant Dependence. NCBI Bookshelf, National Library of Medicine. https://www.ncbi.nlm.nih.gov/books/NBK310652/
- Center for Substance Abuse Treatment. (2006). Detoxification and Substance Abuse Treatment, Chapter 1: Overview, Essential Concepts, and Definitions in Detoxification. Treatment Improvement Protocol (TIP) Series No. 45. Substance Abuse and Mental Health Services Administration. https://www.ncbi.nlm.nih.gov/books/NBK64119/
- National Institute on Drug Abuse. Treatment. National Institutes of Health. https://nida.nih.gov/research-topics/treatment
- Center for Substance Abuse Treatment. (2006). Detoxification and Substance Abuse Treatment, Chapter 4: Physical Detoxification Services for Withdrawal From Specific Substances. Treatment Improvement Protocol (TIP) Series No. 45. Substance Abuse and Mental Health Services Administration. https://www.ncbi.nlm.nih.gov/books/NBK64116/
This page is for general information and is not medical advice. Only a licensed clinician who knows your history can tell you what is right for you. If you or someone you know is in immediate danger, call 911. For free, confidential support 24/7, call or text 988.
Author
Chief Medical Officer,
The Recovery Village
