continued on reverse... U.S. DEPARTMENT OF HEALTH AND HUMAN SERVICES 

Substance Abuse and Mental Health Services Administration 

Center for Substance Abuse Treatment 

www.samhsa.gov 

Substance Abuse Treatment 

ADVISORY

News for the Treatment Field 

July 2010 

Volume 9 

Issue 1 

Protracted Withdrawal 

Most clients in treatment for substance use disorders 

(SUDs) do not immediately feel better after stopping 

their substance use. In a pattern unique to each client, 

symptoms related to substance abuse may be felt for 

weeks, months, and sometimes years. Clients may be 

affected by less intense versions of the acute signs 

and symptoms of withdrawal as well as by other 

conditions such as impaired ability to check impulses, 

negative emotional states, sleep disturbances, and 

cravings. These symptoms may lead clients to seek 

relief by returning to substance use, feeding into the 

pattern of repeated relapse and return to treatment.1, 2 

SUD treatment providers can help clients avoid 

this cycle by helping them recognize and manage 

symptoms. 

Some clients in recovery also experience symptoms 

from co-occurring substance use and mental 

disorders. The SUD treatment provider’s challenge is 

to determine which of a client’s abstinence symptoms 

are substance-use related and will resolve over time 

and which indicate a possible co-occurring disorder 

(COD) that calls for a thorough assessment by a 

mental health provider and concurrent care. Treatment 

Improvement Protocol (TIP) 42: Substance Abuse 

Treatment for Persons With Co-Occurring Disorders 

provides more information on CODs and their 

treatment.3 

This Advisory differentiates acute withdrawal from 

protracted withdrawal, provides an overview of 

protracted withdrawal signs and symptoms, and offers 

suggestions on how to help clients manage protracted 

withdrawal in recovery. 

What is acute withdrawal? 

Acute withdrawal is usually referred to simply as 

“withdrawal.” The American Society of Addiction 

Medicine defines withdrawal as “the onset of a 

predictable constellation of signs and symptoms 

following the abrupt discontinuation of, or rapid 

decrease in, dosage of a psychoactive substance.”4 

Such signs and symptoms are generally the opposite 

of the intoxication effects of the particular substance.5 

For example, pupils constrict during opioid 

intoxication and dilate during acute withdrawal. 

These signs and symptoms begin within hours or days 

after last use of the substance and gradually resolve. 

The length of time symptoms last depends on the 

particular substance used. Exhibit 1 lists approximate 

timeframes for acute withdrawal from several 

substances. 

Exhibit 1. Acute Withdrawal Timeframes 

for Specific Substances 

Substance Acute Withdrawal 

Timeframe 

Alcohol6, 7 5–7 days 

Benzodiazepines8, 9 1–4 weeks; 3–5 weeks 

with tapering (i.e., reducing 

dosage gradually) 

Cannabis10 5 days 

Nicotine11 2–4 weeks 

Opioids12 4–10 days (methadone 

withdrawal may last 14–21 

days) 

Stimulants (e.g., 

amphetamines, 

methamphetamine, 

cocaine)13 

1–2 weeks 
July 2010, Volume 9, Issue 1 

Substance Abuse Treatment 

ADVISORY .............................................................................. 
 

What is protracted withdrawal? 

Protracted withdrawal, strictly defined, is the presence of 

substance-specific signs and symptoms common to acute 

withdrawal but persisting beyond the generally expected 

acute withdrawal timeframes noted in Exhibit 1. A 

broader definition of protracted withdrawal, and the one 

used in this Advisory, includes the experiencing of the 

above symptoms and of non-substance-specific signs and 

symptoms that persist, evolve, or appear well past the 

expected timeframe for acute withdrawal. Exhibit 2 lists 

other terms sometimes used for protracted withdrawal. 

Exhibit 2. Synonyms for Protracted 

Withdrawal 

•	Chronic withdrawal 

•	Extended withdrawal 

•	Late withdrawal 

•	Long-term withdrawal 

•	Persistent postuse symptoms 

•	Postacute withdrawal syndrome 

•	Postuse syndrome 

•	Protracted abstinence 

•	Sobriety-based symptoms 

•	Subacute withdrawal 

Despite clinical observation and clients’ reports of 

symptoms experienced past the acute withdrawal stage, 

the research on protracted withdrawal (particularly 

for substances other than alcohol) is limited, and no 

consensus on the term or definition exists. These reasons 

have precluded the Diagnostic and Statistical Manual of 

Mental Disorders from including a protracted withdrawal 

diagnosis for any psychoactive substance.6

 For these 

reasons also, this Advisory does not provide timeframes 

for protracted withdrawal as is done for acute withdrawal 

in Exhibit 1. 

How do protracted withdrawal

symptoms develop? 

Chronic substance use causes molecular, cellular, and 

neurocircuitry changes to the brain that affect emotions 

and behavior and that persist after acute withdrawal has 

ended.14, 15, 16, 17 Adaptive changes in the central nervous 

system may lead to affective changes that persist for 

many weeks or longer beyond acute withdrawal.18 For 

example, repeated use of a substance causes the brain 

to respond more readily to its effects but less readily to 

naturally rewarding activities such as listening to music. 

This state, in which a person’s ability to experience 

pleasure is decreased, is called anhedonia. Pozzi and 

colleagues examined anhedonia in individuals who had 

been abstinent from alcohol, opioids, and/or other drugs 

for a period and who had no identified CODs.19 Their 

study examined whether anhedonia may be linked to 

psychosocial factors in the lives of people recovering 

from SUDs. They conclude that anhedonia appeared to be 

a symptom of protracted withdrawal that was unrelated 

to other clinical and psychosocial features. Martinotti 

and colleagues found that signs and symptoms, including 

anhedonia, lasted the duration of a year-long study of 

people recovering from alcohol use disorders.20 

A variety of other symptoms have been attributed 

to protracted withdrawal, including anxiety, sleep 

difficulties, problems with short-term memory, persistent 

fatigue, difficulty concentrating and making decisions, 

alcohol or drug cravings, and impaired executive control 

(e.g., impulse control, solving problems). 

Are protracted withdrawal

symptoms the same for all

substances? 

No. They are similar but not identical. Each psychoactive 

substance class has different effects on the brain. 

Protracted withdrawal from alcohol has been well 

documented. Common protracted withdrawal symptoms 

include anxiety, hostility, irritability, depression, mood 

2 
	 	 	 	 	 	 	

Protracted Withdrawal 

Substance Abuse Treatment 

ADVISORY .............................................................................. 
 

instability, fatigue, insomnia, difficulties concentrating 

and thinking, reduced interest in sex, and unexplained 

physical complaints especially of pain. Anecdotal 

literature and case studies going back several decades 

suggest that signs and symptoms may last 2 years or 

longer after the last use of alcohol. A review of seven 

sleep studies using polysomnograph recordings of 

the brain while people slept found evidence that sleep 

abnormalities can persist for 1 to 3 years after stopping 

alcohol consumption.21 These abnormalities include 

difficulty falling asleep, decreased total sleep time, and 

sleep apnea. 

Research on drug-specific protracted withdrawal signs 

and symptoms is scarce but indicates the following: 

• Opioids. Symptoms such as anxiety, depression, 

and sleep disturbances can last for weeks or months 

following withdrawal from opioids.22 Other possible 

symptoms include fatigue, dysphoria (i.e., feeling 

down or emotionally blunted), and irritability.12 

A small National Institutes of Health study found 

that subjects who had been abstinent from opioids 

for a prolonged period showed decreased ability to 

focus on a task compared with subjects who had 

never used opioids.23 People in recovery from heroin 

dependence also show deficits in executive control 

functions that may persist for months beyond the 

period of acute withdrawal. 24 

• Methamphetamine. A 2007 review noted that 

studies have shown that deficits in executive control 

functions resulting from amphetamine use also 

persist well into recovery from methamphetamine 

dependence.25 

• Cocaine. Fox and colleagues examined emotional 

regulation issues and problems with impulse 

control in newly abstinent individuals dependent 

on cocaine.26 Significant improvement in several 

aspects of emotional regulation (e.g., understanding 

and managing emotions, ability to develop 

emotional coping strategies) was seen after 4 weeks 

of abstinence. However, impulse control had not 

improved after 4 weeks of abstinence. 

• Marijuana. A review of 19 studies of marijuana 

withdrawal found that sleep difficulties and strange 

dreams persisted at least 45 days into abstinence (the 

longest duration of the studies).27 

• Benzodiazepines. Benzodiazepine protracted 

withdrawal may be difficult to diagnose because of 

difficulty distinguishing it from symptom rebound 

or symptom reemergence (Exhibit 3).28 Protracted 

withdrawal symptoms typically wax and wane in 

intensity and are new to the client (i.e., they do 

not indicate symptom reemergence). Clients also 

may have no symptoms for a time after stopping 

benzodiazepine use and then become extremely 

anxious. Psychological symptoms can mimic 

disorders such as agitated depression; generalized 

anxiety, panic, or obsessive-compulsive disorders; 

and schizophrenia. Fluctuating protracted withdrawal 

symptoms may last for months but gradually subside 

with prolonged abstinence. 

Exhibit 3. Symptom Rebound and 

Symptom Reemergence 

Symptom rebound, the most common 

aftereffect of prolonged benzodiazepine 

use, is the intensified return of acute

withdrawal signs and symptoms. These 

acute symptoms are typically opposite the 

effects of the drug (e.g., anxiety, insomnia, 

restlessness) and tend to abate in a few 

weeks.29 

Symptom reemergence is the return of 

symptoms (e.g., anxiety, muscle tension, 

insomnia) at the same level as those 

experienced before benzodiazepines were 

prescribed or taken. These symptoms 

do not abate with time. Because these 

symptoms were present before the 

substance use began, they suggest the 

presence of an underlying pathology 

needing treatment.30 

3 
	 	 	

	 	 	

 

July 2010, Volume 9, Issue 1 

Substance Abuse Treatment 

ADVISORY .............................................................................. 
 

Do all clients experience 

protracted withdrawal? 

No. Some clients experience no symptoms after the 

acute withdrawal stage, whereas others have lingering 

symptoms. Still others experience an initial clearing of 

symptoms for the first month or two of abstinence and 

then develop unpleasant symptoms again. The intensity 

of symptoms also differs among clients. 

How can providers help clients 

through protracted withdrawal? 

Clients affected by anhedonia and other symptoms 

of protracted withdrawal may want to alleviate those 

symptoms by returning to substance use at a time 

when they may have a weakened ability to resist such 

impulses. Treatment providers can improve their 

clients’ chances for long-term recovery by educating 

clients about protracted withdrawal, offering support 

and understanding, monitoring them regularly, and 

intervening early with clients who seem headed for 

relapse: 

• Educate clients about protracted withdrawal 

and help them develop realistic attitudes toward 

recovery. Remind clients that recovery is a process. 

Help clients understand that it is normal to feel not 

fully recovered within the first weeks and months 

of abstinence. Tell them about possible protracted 

withdrawal symptoms (Exhibit 4) and reassure them 

that these symptoms will not last forever and can be 

managed. Advise clients on how to reduce or cope 

with symptoms and encourage them to focus on 

incremental improvements. Tell clients it takes time 

to undo the damage from substance use but in many 

cases, with long-term abstinence, substance-induced 

brain changes reverse.

• Celebrate each accomplishment (e.g., 

learning a new coping skill) and help clients not 

become discouraged if symptoms recur. Repeat 

encouragements at each meeting, especially with 

clients affected by memory and concentration 

impairments.

Exhibit 4. Possible Symptoms of 

Protracted Withdrawal 

•	 Anxiety 

•	 Sleep difficulties

•	 Problems with short-term memory 

•	 Persistent fatigue 

•	 Difficulty concentrating and making

decisions 

•	 Alcohol or drug cravings 

•	 Impaired executive control 

•	 Anhedonia 

•	 Difficulty focusing on tasks

•	 Dysphoria or depression 

•	 Irritability 

•	 Unexplained physical complaints 

•	 Reduced interest in sex 

• Assess for CODs. The symptoms of protracted 

withdrawal can be similar to those of traumatic brain 

injury (TBI) and CODs. Carefully assess and reassess 

clients as recovery proceeds, including for depression 

and suicidal tendencies. TIP 42,3 TIP 48: Managing 

Depressive Symptoms in Substance Abuse Clients 

During Early Recovery,

31 and TIP 50: Addressing 

Suicidal Thoughts and Behaviors in Substance 

Abuse Treatment32 provide more information on 

CODs and suicide. An Advisory in development will 

provide information on assessing and addressing 

TBI in recovery.33 Appropriate treatment of a COD 

positively affects the course of treatment.34 

• Ask about sleep problems. Make a differential 

diagnosis to determine whether a client’s sleep 

problems likely stem from protracted withdrawal or 

are the result of other causes. Such causes include 

poor sleep habits retained from a substance-using 

lifestyle, CODs, relapse to substance use, stress, or 

4 
Protracted Withdrawal 

Substance Abuse Treatment 

ADVISORY .............................................................................. 
 

side effects of medication (including medication to 

treat SUDs). Educate clients about good sleep habits: 

adopting a regular sleep routine (going to bed and 

getting up at the same times), exercising early in the 

day, minimizing caffeine intake, eating well, and 

avoiding late afternoon naps. Use pharmacological 

treatments with caution to avoid use problems. 

The Substance Abuse and Mental Health Services 

Administration’s (SAMHSA’s) Center for Substance 

Abuse Treatment (CSAT) is developing a Substance 

Abuse in Brief Fact Sheet on sleep problems that will 

provide more information.35 

• Advise clients to be active. Encourage clients to 

engage in physical and mental exercises, which 

improve sleep, promote positive emotional states, 

reduce stress and nervousness, help clients avoid 

triggers, and distract clients’ attention from 

symptoms. Assist clients in adopting habits that help 

them cope with memory and thinking problems (e.g., 

making to-do lists, establishing daily routines).

• Advise clients to be patient. Clients in early 

recovery may try to “make up for lost time” by 

overbooking and generally trying to do too much, 

increasing their overall stress levels and possibly 

exacerbating symptoms. Tell clients that they are 

doing enough by focusing on their recovery and 

regaining their health.

• Prescribe medications as needed to control 

symptoms past the acute withdrawal stage. 

Inform clients recovering from alcohol addiction 

that treatment medications, such as acamprosate, 

might relieve some protracted withdrawal symptoms. 

Although acamprosate’s mechanism of action is 

not well understood, it may reduce uncomfortable 

symptoms such as anxiety and sleep disturbances 

that clients feel after they have stopped drinking. 

SAMHSA’s CSAT Advisory on acamprosate 

provides more information.36 Consider methadone 

or buprenorphine replacement treatment for clients 

who find that protracted opioid withdrawal symptoms 

are too powerful and for whom the risk of relapse is 

high.37 

• Encourage clients to join mutual support groups. 

Tell clients that participation in mutual support 

groups such as Alcoholics Anonymous or Women in 

Sobriety is associated with long periods of recovery. 

Make clients aware of population-specific support 

groups (e.g., adolescents- or women-only groups). 

Direct clients in medicated-assisted treatment to 

support groups that accept the use of prescribed 

medications for substance abuse treatment. Tell 

clients that they may need to visit several groups over 

several weeks to find groups with which they feel 

comfortable. SAMHSA’s CSAT Substance Abuse in 

Brief Fact Sheet on mutual support groups provides 

more information.38 

• Include interventions that help clients strengthen 

executive control functions. Provide interventions 

such as cognitive–behavioral therapy to help clients 

manage problems with impulse control, solve 

problems, and make decisions.39 

• Monitor clients for symptoms during continuing 

care. Provide clients with opportunities to obtain 

professional guidance on such issues as lapses and 

relapses, stress, triggers, and activities to maintain 

abstinence. Monitoring can be through periodic office 

visits or by telephone or email. Arrange for transition 

to a case manager as needed.40 

SAMHSA Resources 

Several publications are available free of charge from 

SAMHSA’s Health Information Network. The resources 

listed on page 6 can be ordered at http://www.samhsa. 

gov/shin. Or, please call 1-877-SAMHSA-7 (1-877-726­

4727). The publications also can be downloaded from the 

Knowledge Application Program Web site at 

http://www.kap.samhsa.gov. 

5 
July 2010, Volume 9, Issue 1 

Substance Abuse Treatment

ADVISORY .............................................................................. 
 

Resources for professionals 

Substance Abuse Treatment Advisory, Acamprosate: 

A New Medication for Alcohol Use Disorders. (2005). 

HHS Publication No. (SMA) 05-4114. 

TIP 42: Substance Abuse Treatment for Persons With 

Co-Occurring Disorders. (2005). HHS Publication No. 

(SMA) 05-3992. 

TIP 43: Medication-Assisted Treatment for Opioid 

Addiction in Opioid Treatment Programs. (2005). 

HHS Publication No. (SMA) 05-4048. 

TIP 45: Detoxification and Substance Abuse Treatment. 

(2006). HHS Publication No. (SMA) 06-4131. 

TIP 48: Managing Depressive Symptoms in Substance 

Abuse Clients During Early Recovery. (2008). 

HHS Publication No. (SMA) 08-4353. 

TIP 50: Addressing Suicidal Thoughts and Behaviors in 

Substance Abuse Treatment. (2009). HHS Publication 

No. (SMA) 09-4381.
 

Resources for clients 

The Facts About Buprenorphine for Treatment of Opioid 

Addiction. (2009). HHS Publication No. (SMA) 09-4442. 

The Facts About Naltrexone for Treatment of Opioid 

Addiction. (2009). HHS Publication No. (SMA) 09-4444. 

Medication-Assisted Treatment for Opioid Addiction: 

Facts for Families and Friends. (2009). HHS Publication 

No. (SMA) 09-4443. 

What Is Substance Abuse Treatment? A Booklet for 

Families. (2004). HHS Publication No. (SMA) 08-4126. 

Notes 

1

 Scott, C., Foss, M., & Dennis, M. (2005). Pathways in the 

relapse–treatment–recovery cycle over 3 years. Journal of 

Substance Abuse Treatment, 28, S63–S72. 

2

 Office of Applied Studies. (2002). The DASIS Report: New and 

repeat admissions to substance abuse treatment. Rockville, MD: 

Substance Abuse and Mental Health Services Administration. 

3

 Center for Substance Abuse Treatment. (2005). Substance 

abuse treatment for persons with co-occurring disorders. 

Treatment Improvement Protocol 42. HHS Publication No. 

(SMA) 05-3992. Rockville, MD: Substance Abuse and Mental 

Health Services Administration. 

4

 Ries, R. K., Miller, S. C., Fiellin, D. A., & Saitz, R. (Eds.). 

(2009). Appendix 1: ASAM addiction terminology. In Principles 

of addiction medicine (4th ed.). Chevy Chase, MD: American 

Society of Addiction Medicine. 

5 Wright, T. M., Culver, J. S., & Myrick, H. (2009). Management 

of intoxication and withdrawal: General principles. In R. K. 

Ries, S. C. Miller, D. A. Fiellin, & R. Saitz (Eds.), Principles of 

addiction medicine (4th ed., pp. 552–558). Chevy Chase, MD: 

American Society of Addiction Medicine. 

6 American Psychiatric Association. (2000). Diagnostic and 

statistical manual of mental disorders (4th ed., text revision). 

Washington, DC: Author. 

7

 Center for Substance Abuse Treatment. (2006). Detoxification 

and substance abuse treatment. Treatment Improvement Protocol 

45. HHS Publication No. (SMA) 06-4131. Rockville, MD: 

Substance Abuse and Mental Health Services Administration. 

8

 Dickinson, W. E., Mayo-Smith, M. F., & Eickelberg, S. J. 

(2003). Management of sedative-hypnotic intoxication and 

withdrawal. In A. W. Graham, T. K. Schultz, M. F. Mayo-Smith, 

R. K. Ries, & B. B. Wilford (Eds.), Principles of addiction 

medicine (3rd ed., pp. 633–639). Chevy Chase, MD: American 

Society of Addiction Medicine. 

9

 Juergens, S. T., & Cowley, D. S. (2003). The pharmacology of 

benzodiazepines and other sedative-hypnotics. In A. W. Graham, 

T. K. Schultz, M. F. Mayo-Smith, R. K. Ries, & B. B. Wilford 

(Eds.), Principles of addiction medicine (3rd ed., pp. 119–138). 

Chevy Chase, MD: American Society of Addiction Medicine. 

10 Welch, S. P., & Martin, B. R. (2003). The pharmacology of 

marijuana. In A. W. Graham, T. K. Schultz, M. F. Mayo-Smith, 

R. K. Ries, & B. B. Wilford (Eds.), Principles of addiction 

medicine (3rd ed., pp. 249–270). Chevy Chase, MD: American 

Society of Addiction Medicine. 

6 
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ADVISORY .............................................................................. 
 

11 Hughes, J. R. (2007). Effects of abstinence from tobacco: 

Valid symptoms and time course. Nicotine & Tobacco Research, 

9(1), 315–327. 

12 Collins, E. D., & Kleber, H. D. (2004). Opioids: 

Detoxification. In M. Galanter & H. D. Kleber (Eds.), Textbook 

of substance abuse treatment (3rd ed., 265–289). Washington, 

DC: American Psychiatric Publishing. 

13 Wilkins, J. N., Danovitch, I., & Gorelick, D. A. (2009). 

Management of stimulant, hallucinogen, marijuana, 

phencyclidine, and club drug intoxication and withdrawal. In R. 

K. Ries, S. C. Miller, D. A. Fiellin, & R. Saitz (Eds.), Principles 

of addiction medicine (4th ed., 607–628). Chevy Chase, MD: 

American Society of Addiction Medicine. 

14 Aston-Jones, G., & Harris, G. C. (2004). Brain substrates 

for increased drug seeking during protracted withdrawal. 

Neuropharmacology, 47(Suppl 1), 167–179. 

15 Goldstein, R. Z., & Volkow, N. D. (2002). Drug addiction and 

its underlying neurobiological basis: Neuroimaging evidence 

for the involvement of the frontal cortex. American Journal of 

Psychiatry, 159(101), 1642–1652. 

16 Koob, G. F. (2008). Neurobiological substrates for the dark 

side of compulsivity in addiction. Neuropharmacology, 56(Suppl 

1), 18–31. 

17 Koob, G. F., & Le Moal, M. (2001). Drug addiction, 

dysregulation of reward, and allostasis. Neuropsychopharmacology, 24(20), 97–129. 

18 Weiss, F., Ciccocioppo, R., Parsons, L. H., Katner, S., Liu, X., 

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19 Pozzi, G., Martinotti, G., Reina, D., Dario, T., Frustaci, A., 

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Substance Use & Misuse, 43(5), 722–732. 

20 Martinotti, G., Di Nicola, M., Reina, D., Andreoli, S., Focà, 

F., Cunniff, A., et al. (2008). Alcohol protracted withdrawal 

syndrome: The role of anhedonia. Substance Use & Misuse, 

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21 Brower, K. J. (2001). Alcohol’s effects on sleep in alcoholics. 

Alcohol Research & Health, 25(2), 110–125. 

22 Satel, S. L., Kosten, T. R., Schuckit, M. A., & Fischman, M. 

W. (1993). Should protracted withdrawal from drugs be included 

in DSM-IV? American Journal of Psychiatry, 150(5), 695–704. 

23 Prosser, J., London, E. D., & Galynkera, I. I. (2009). 

Sustained attention in patients receiving and abstinent following 

methadone maintenance treatment for opiate dependence: 

Performance and neuroimaging results. Drug and Alcohol 

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24 Li-ping, F., Guo-hua, B., Zhi-tong, Z., Yan, W., En-mao, Y., 

Lin, M., et al. (2008). Impaired response inhibition function 

in abstinent heroin dependents: An fMRI study. Neuroscience 

Letters, 438, 322–326. 

25 Baicy, K., & London, E. D. (2007). Corticolimbic 

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26 Fox, H. C., Axelrod, S. R., Paliwal, P. J., Sleeper, J., & Sinha, 

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298–301. 

27 Budney, A. J., Hughes, J. R., Moore, B. A., & Vandrey, R. 

G. (2004). Review of the validity and significance of cannabis 

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1967–1977. 

28 Smith, D. E., & Wesson, D. R. (2004). Benzodiazepines and 

other sedative-hypnotics. In M. Galanter & H. D. Kleber (Eds.), 

Textbook of substance abuse treatment (3rd ed., pp. 239–242). 

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29 Salzman, C. (1991). The APA task force report on 

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30 Wesson, D. R., Smith, D. E., & Ling, W. (2003). 

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31 Center for Substance Abuse Treatment. (2008). Managing 

depressive symptoms in substance abuse clients during early 

recovery. Treatment Improvement Protocol 48. HHS Publication

No. (SMA) 08-4353. Rockville, MD: Substance Abuse and 

Mental Health Services Administration.

32 Center for Substance Abuse Treatment. (2009). Addressing 

suicidal thoughts and behaviors in substance abuse treatment. 

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Health Services Administration. 

33 Center for Substance Abuse Treatment. (planned). Treating 

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34 Quello, S. B., Brady, K. T., & Sonne, S. C. (2005). Mood 

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35 Center for Substance Abuse Treatment. (planned). Treating 

sleep problems of people in recovery from substance use 

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36 Center for Substance Abuse Treatment. (2005). Acamprosate: 

A new medication for alcohol use disorders. Substance Abuse 

Treatment Advisory, 4(1). 

37 Center for Substance Abuse Treatment. (2005). Medicationassisted treatment for opioid addiction in opioid treatment 

programs. Treatment Improvement Protocol 43. HHS 

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Abuse and Mental Health Services Administration. 

38 Center for Substance Abuse Treatment. (2008, Spring). An 

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39 Volkow, N. D., Fowler, J. S., & Wang, G. J. (2003). The 

addicted human brain: Insights from imaging studies. Journal of 

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40 Dennis, M., & Scott, C. K. (2007). Managing addiction as a 

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Substance Abuse Treatment Advisory

This Substance Abuse Treatment Advisory was written and produced under contract numbers 270-04-7049 and 270-09-0307 

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Electronic Access and Copies of Publication: This publication may be downloaded or ordered from http://www.samhsa.

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can be downloaded from the KAP Web site at 

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Recommended Citation: Center for Substance Abuse 

Treatment. (2010). Protracted Withdrawal. Substance Abuse 

Treatment Advisory, Volume 9, Issue 1.

HHS Publication No. (SMA) 10-4554 

Printed 2010

Substance Abuse Treatment Advisory 

Protracted Withdrawal