Signs and symptoms of addiction - Comedown - Rehab Guide

Signs and symptoms of addiction – Comedown

Signs and symptoms of addiction – Comedown

Rehab Guide

What is a comedown?

Anyone who takes drugs or drinks above the recommended safe drinking limits will face a comedown when the effect of the substance wears off. The most common are cocaine comedown and MDMA comedown.

A comedown is a cluster of symptoms that can vary depending on the substance used and how much was consumed within one episode. It is the crash that follows the high.

A hangover or a drug comedown are caused by the rebound effects of the substance taken.

Drug and alcohol withdrawal differs from a comedown. A comedown is rarely dangerous, and symptoms are short-lived. Nevertheless, symptoms can range from mildly unpleasant to very severe. Following a drug or alcohol binge, symptoms can be debilitating and prolonged.

If you suffer from frequent and severe comedowns you may have an addiction. At the very least, it shows that you may be abusing substances.

If someone you love frequently suffers from hangovers or comedowns to the point that it negatively affects their life, they may have a problem. This is why it is helpful to know the signs of a comedown. If a person spends more time recovering from substance use than is normal, it is a good indication that they need help.

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What are the signs of a come down?

The signs of a comedown can vary depending on the substance that has been used. However, many substances share common hangover symptoms.

The severity of a comedown will depend on how much of the substance has been taken within one period of time.

If you suffer from very bad comedowns, it is likely that you are either intolerant to certain substances or that you are using them to excess.

The common signs of a comedown include:

  • Anxiety
  • Mood swings
  • Dysphoria
  • Headache
  • Reduced motivation
  • Nausea
  • Irritability
  • Unable to think clearly
  • Inability to concentrate and impaired cognition
  • Reduced productivity
  • Lethargy

Alcohol is the most commonly abused substance. Most people who drink alcohol have suffered from the occasional hangover, usually after a night of celebrating. Whilst the odd hangover is not problematic when it becomes a frequent occurrence, then this is when alarm bells should be ringing.

Alcohol misuse is currently the biggest risk factor for death, ill-health and disability among 15-49 year-olds in the UK. This just shows how commonly alcohol is abused.

The rebound effects of alcohol (commonly known as a hangover) include:

  • Anxiety
  • Agitation
  • Nausea
  • Headache
  • Diarrhoea
  • Rapid heart rate
  • Sweating
  • Loss of appetite
  • Restlessness
  • Depression
  • Lethargy
  • Tremors
  • Inability to concentrate

Heroin Comedown Symptoms (+Other Opioids)

Opioids are highly addictive and can cause dependence within as little as 3-5 days of continuous use. In cases where heroin is used, people can become addicted exceptionally quickly. This is due to the powerful euphoria it produces and the severity of heroin’s comedown effects.

Coming down from a heroin high, you may experience:

  • Anxiety
  • Agitation
  • Paranoia
  • Restlessness
  • Increased sweating
  • Dehydration
  • Tremors
  • Strong cravings for more opioids
  • Racing thoughts
  • Nausea
  • Vomiting and diarrhoea
  • Unable to sleep
  • Lethargy

During a Crack, Methamphetamine, Cocaine comedown, you may experience the following symptoms:

  • Anxiety
  • Agitation
  • Depression
  • Dysphoria
  • Headaches
  • Cravings for more crack, cocaine or methamphetamine
  • Nausea
  • Restlessness
  • Dehydration
  • Lack of appetite
  • Have racing thoughts
  • Lethargy
  • Paranoia
  • Aches and pains
  • Irritability
  • Sensitivity to light and noise
  • Demotivation
  • Unable to concentrate
  • Increased sweating
  • Insomnia

Taking Stimulant drugs can make you feel powerful, energetic, confident, euphoric and sexy. These drugs are recreationally used at parties but are also extremely addictive.

Stimulants can lead a person to be very active due to the huge increase in energy levels that they initiate; this can then also impact your comedown. This is why coke comedown and MDMA comedown are the most common. These stimulants are often used to stay awake and energetic for long periods.

Comedown Symptoms from sedatives such as benzodiazepines or sleeping tablets

The rebound effects of a sedative comedown are the polar opposite of the drug’s effects. Sedative hypnotics suppress the Central Nervous System (CNS) and slow down brain activity. This, in turn, makes you feel calm relaxed and may facilitate sleep.

When the effects of a sedative wear off, you will experience rebound insomnia if you use them for more than 10 to 14 days. You may also feel more anxious restless and find you lose your appetite. These symptoms will pass but may it take a few days.

If you have a dependence on sedatives, you should speak to your doctor. It may not be safe for you just to stop them suddenly. Benzodiazepines and sleeping tablets such as Zopiclone quickly build tolerance and dependence. This is why clinical guidelines recommend they should only be prescribed for very short-term use.

Stopping any CNS depressant such as alcohol, sedatives, gabapentinoids or opioids where a dependence has formed can result in life-threatening withdrawal symptoms.

In instances where a drug or alcohol dependence has formed, a full medical detox is clinically recommended as the safest way to stop.

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Coming down from synthetic ‘legal highs’ & Psychedelics

Coming down from a legal high or a psychedelic drug can be very unpredictable. This is because they vary in their effects, chemical compounds, and purity levels.

Any psychoactive drug can produce many effects and can also affect people differently.

Comedown symptoms are never pleasant, regardless of the substance you have used. You are likely to feel anxious and depressed and may feel paranoid. You may struggle to sleep, find you lose your appetite and feel out of sorts. These comedown effects may last for a few days depending on the substance taken and the amounts involved.

You may also experience flashbacks after taking psychedelic drugs.

What causes a comedown?

After any high, there follows a crash when taking substances. The effects of a comedown can be exacerbated by activity and exertion levels whilst intoxicated.

For example, stimulants and certain psychoactive drugs can increase your energy levels and libido. Under their influence, you may have danced for hours or engaged in sexual activity without taking in any food or water. This can lead to feeling exhausted for days after taking the drug. In turn, that will affect your mood and your psychological health.

Following euphoria comes dysphoria. The brain experiences a crash in feel-good chemicals artificially induced by drugs and alcohol. This crash can make you feel very low in mood, to the point where you want to self-harm or even consider suicide.

Everyone reacts to drugs differently. How you feel in yourself mentally on a day-to-day basis can have a big impact on how a drug affects you and how severely you experience a comedown.

If you suffer from a mental health condition, alcohol and drugs should be avoided. The relief they provide will only be temporary. The comedown after will only increase the symptoms of your mental health illness.

How long does a comedown last?

How long a comedown lasts depends on the drug or drugs you took, how much you consumed and what you did while taking them. It follows that if you were doing drugs for several days, then comedown will be longer than if you just did it once.

The length of cocaine comedown will depend partly on how much you took. Also, the comedown for snorted cocaine is a few days but crack cocaine comedown is longer. This can often be because crack cocaine comedown is more intense than regular coke comedown.

This encourages people to take more to deal with the effects and continue the cycle for longer. It can last several weeks until they cannot take any more. A normal cocaine comedown will last from half a day to two days, depending on your physiology and how much you consume.

MDMA come down, on the other hand, depends on the individual physiology. It affects the chemicals in your brain, including serotonin and dopamine. Rises and falls in these chemicals can cause anxiety, depression, and sleeplessness for several days after you stop taking the drug.

Most other drugs, including heroin and other opioids, will take a day, possibly two, to finish the comedown. Resting and staying hydrated and well-fed will speed up the process.

How to avoid a comedown

The best way to avoid a comedown is not to abuse drugs or drink too much alcohol.

You can also reduce the severity of the rebound effects of drugs and alcohol by ensuring you eat a decent meal and stay hydrated on a night out.

Some rebound effects from alcohol and drugs are caused by dehydration. Therefore, it is important to drink plenty of water during your night out and before bed.

Lessening the effects of a comedown – Self-management at home

No one enjoys the effects of a comedown. A whole day, or more, can be wasted feeling very unwell.

Drugs, in particular, stay in your system for longer than alcohol. This may cause you to feel unwell or suffer residual effects for some days after.

Alcohol is metabolised on average at a rate of 1 unit per hour by a healthy liver. If you binge drink, you can still feel under the influence the following day. The comedown will also worsen as your system struggles to process the backlog of alcoholic units.

If you suffer from drug comedown symptoms or a hangover, you can recover quickly if you stay well hydrated and eat little and often. Mild, non-addictive pain relief such as ibuprofen and paracetamol can also help to relieve headaches and aches and pains.

If you have an upset stomach and are vomiting or have severe diarrhoea, consuming an electrolyte drink can help restore balance to your bloodstream.

Fresh air and mild exercise such as a walk can also help to clear your head and provide a distraction from symptoms.

You should avoid driving or operating heavy machinery until you feel alert, rested, and better in yourself.

When to be concerned about someone you love

If someone you love frequently spends days in bed recovering from nights out, this is a sign that they have a problem with alcohol or drugs.

One of the signs of addiction is spending a lot of time either intoxicated or recovering from intoxication.

If a family member or loved one has a drug or alcohol dependence, they won’t suffer from a comedown. Instead, they will experience withdrawal symptoms if they do not have enough substance in their system.

If you know a person dependent on alcohol or drugs, it is important to encourage them to seek professional medical help.

If they want to stop using substances, then a medical detox will help them achieve this safely and comfortably. Following on from any drug or alcohol detox, a comprehensive rehabilitation programme will be required to help the person stay clean and sober.

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Days lost at work due to alcohol use in the UK

Excessive alcohol use is most prevalent in working-age people, especially in the younger generation. This naturally has a huge impact on work-related productivity and days taken off sick due to alcohol comedowns.

Up to 17 million working days are lost each year in the UK because of alcohol-related sick days. This results in employers losing an estimated £1.7 each year due to drug and alcohol use.

A 2007 report commissioned by Norwich Union Healthcare in 2007 found the following alcohol-related workplace issues:

  • One-third of employees admitted to having been to work with a hangover
  • 15% of employees admitted to having been drunk at work
  • 1 in 10 reported hangovers at work once a month.
  • Work problems relating to hangovers (alcohol comedowns) or alcohol use at work included: difficulty concentrating, reduced productivity, tiredness and making mistakes
  • The majority of employers interviewed (77%) viewed alcohol as a major threat to their employees’ wellbeing and a high-risk factor for sickness and absence.

The extent of drug and alcohol misuse in the UK

Drug and alcohol misuse in the UK is even more of a concern than ever before. In 2019, there were 7,544 alcohol-specific deaths in the UK.

Alcoholic liver disease was the most common cause, accounting for 77% of all alcohol-specific deaths. Alcoholic liver disease is a condition that occurs over time and results from repeated alcohol abuse or alcohol dependence.

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In 2019 – 2020, 132,124 people started treatment for drug and alcohol problems.

Of the 132,124 people starting their first treatment experience within the NHS:

  • 59% said they had a problem with alcohol
  • 32% said they had a problem with opiates
  • 22% said they had a problem with crack cocaine
  • 20% said they had a problem with cannabis
  • 16% said they had a problem with cocaine

Cannabis continues to be the most commonly used drug in England and Wales, followed by powdered cocaine (year ending March 2020). This is according to the Office for National Statistics (ONS).

2.1% of all adults in England and Wales aged 16 to 59 years and 4.3% of adults aged 16 to 24 years were classed as “frequent” drug users.

For people seeking treatment for substance abuse in the UK, alcohol remains the most problematic, followed by opiates. The above infographic on people in treatment for substances only gives a snapshot of a much larger scale problem.

In England alone, there are an estimated 600,000 adults who need treatment for alcohol dependence.

Statistics repeatedly show that most people do not seek treatment for a substance use problem. This is especially true of those that suffer from an alcohol use disorder and who do not see themselves as being chronically ill.

When to see help for a comedown

Comedowns are generally not life-threatening, that doesn’t mean that they are not dangerous in some instances.

You should seek medical help for a comedown if:

  • You are seeing or hearing things that are not there
  • Feeling suicidal or want to self-harm
  • You have urges to harm somebody else
  • You feel physically/mentally very unwell and are not sure what you have taken

If drug and alcohol comedowns are affecting other areas of your life, it is important to seek the right professional help. You may be suffering from a drug or alcohol use disorder for which there is a very effective treatment.

Please seek professional addiction treatment help if:

  • Your comedowns are affecting your personal relationships and family
  • You have lost, or are at risk of losing, your job as a result of drug or alcohol use
  • Physically and mentally, you are suffering
  • You want to stop taking drugs and/or alcohol but find you cannot
  • Your comedowns have gotten progressively more frequent and severe over a period of time
  • Family and friends have expressed concern over your substance use
  • You repeatedly swear off alcohol and drugs during a comedown but return to them when you are feeling better
  • You have suffered consequences as a result of drug and/or alcohol use, including; relationship breakdowns, trouble with the law, financial difficulties, occupational difficulties, a decline in mental and physical health, repeated falls or injuries, increased risk-taking or becoming more isolated

Drug and alcohol use disorders can range from mild to severe. Experiencing more frequent comedowns is one of the signs of addiction. The sooner you seek help, the better. Addictive disorders are progressive and only ever get worse over time.

We are here to help.

Suffering from a drug or alcohol problem that you are increasingly losing control over can be frightening. It can be hard to know who to turn to and ask for help.

For a free drug or alcohol use assessment, you can call us in confidence and speak to one of our friendly treatment experts. We can then advise you to get the right help and formulate a bespoke treatment plan if you wish to access professional and private addiction treatment.

We are also here to offer free expert advice and support to family members and partners of those with a drug or alcohol problem.

As a leading, recognised authority in drug and alcohol addiction treatment in the UK, we have helped numerous people to access long term sustainable recovery. Stop the suffering and speak to us today.


Burton, R. et al. (2016). The Public Health Burden of Alcohol and the Effectiveness and Cost-Effectiveness of Alcohol Control Policies: An Evidence Review

IAS Institute of Alcohol Studies Fact sheet – Alcohol in the workplace –

National Institute for Health and Clinical Excellence (June 2010), ‘Business case: Alcohol-use disorders: preventing harmful drinking’, p. 13

Aviva (May 2008), ‘UK employees admit that regular drinking affects their jobs’ <>

Alcohol statistics England

Adult substance misuse treatment statistics 2019 to 2020: report –

Drug misuse in England and Wales: year ending March 2020

Who seeks treatment for alcohol dependence? Findings from the Australian National Survey of Mental Health and Wellbeing –


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