Physical withdrawal
Tremor, sweating, racing heart, rising blood pressure, nausea, insomnia, overwhelming anxiety. It starts a few hours after the last dose and usually peaks between the second and third day.
Withdrawal is not
a lack of willpower.Rehab and psychiatric care in Tunis
It is a physiological event: measurable, sometimes dangerous — and treatable. Medically supervised withdrawal and psychiatric care, provided at Clinique Espoir, El Menzah 9, Tunis.
- Alcohol, cannabis (zatla), cocaine, opioids, pregabalin, solvents, tobacco
- And the psychiatric disorder that is often hiding underneath
- Open 24/7 — a doctor reachable at any hour
What the body does when the substance stops.
Prolonged use shifts the balance of the nervous system. The brain is permanently compensating for the substance; when the substance goes, that compensation is left running alone. That is withdrawal — and depending on the substance it ranges from severe discomfort to a threat to life.
The severe forms
For alcohol and benzodiazepines, stopping abruptly can cause seizures and delirium tremens — confusion, hallucinations, fever, dehydration. That is a medical emergency, not a rough night to get through.
Craving
Once the body is detoxified, the compulsion remains. It is triggered by places, people, times of day, an emotion. It is what causes relapse, and it is what the therapeutic work is aimed at.
Why not to stop alone
Alcohol or benzodiazepine withdrawal carried out without medical supervision exposes you to seizures, delirium tremens and cardiac or metabolic complications. Supervised withdrawal treats those risks before they appear: monitoring of vital signs, an adapted protocol, hydration, vitamin B1. It also makes the ordeal markedly less painful — which changes everything about what follows.
Every substance has its own withdrawal.
Every substance is treated — alcohol, drugs, diverted medicines, tobacco — as well as addictions with no substance at all. The durations below are indicative: they vary with how long use has gone on, the quantities, age and general health. The protocol is decided after examination.
Alcohol
- Withdrawal signs
- Tremor, sweating, anxiety, nausea, insomnia from 6 to 12 hours. Seizures possible within 48 hours, delirium tremens between 48 and 96 hours.
- Treatment
- Inpatient withdrawal, benzodiazepines on a tapering dose under monitoring, hydration, vitamin B1 to prevent neurological complications.
- Duration
- Acute phase 5 to 7 days; fatigue and disturbed sleep for several weeks.
Benzodiazepines and sleeping pills
- Withdrawal signs
- Rebound anxiety, severe insomnia, muscle pain, perceptual disturbance. A real seizure risk if stopped abruptly.
- Treatment
- Never a hard stop: switch to a long half-life molecule, then a slow, planned taper, step by step, with the anxiety treated alongside.
- Duration
- Several weeks to several months. Slowness is not failure here; it is the protocol.
Opioids — heroin, tramadol, codeine
- Withdrawal signs
- Diffuse pain, cramps, diarrhoea, watering eyes, yawning, shivering, insomnia, dread. Rarely fatal, but very hard to get through alone.
- Treatment
- Symptomatic treatment, or substitution treatment (methadone, buprenorphine) where indicated, with close follow-up.
- Duration
- Acute phase 5 to 10 days; sleep and mood disturbance for longer.
Cannabis — “zatla”
- Withdrawal signs
- Irritability, anger, anxiety, insomnia and vivid dreams, loss of appetite, low mood. In some people it reveals or worsens psychotic symptoms.
- Treatment
- Support for sleep and anxiety, motivational interviewing, a psychiatric assessment if symptoms outlast the withdrawal.
- Duration
- 1 to 3 weeks for the worst of it; the craving is worked on afterwards.
Cocaine, amphetamines, MDMA
- Withdrawal signs
- Mood collapse, hypersomnia, slowing, intense hunger, violent craving. The main risk is depressive and suicidal, not cardiovascular.
- Treatment
- Monitoring of mood and suicide risk, restarting sleep, treatment of a depressive episode if one sets in, therapy for craving.
- Duration
- The crash lasts 3 to 10 days; depressive vulnerability for several weeks.
Tobacco
- Withdrawal signs
- Irritability, difficulty concentrating, restlessness, increased appetite, very strong but short-lived urges.
- Treatment
- Correctly dosed nicotine replacement, management of trigger situations, attention to interactions with psychiatric medication.
- Duration
- Physical withdrawal 2 to 4 weeks; the gesture and the habit last longer.
Gambling, screens, spending
- Withdrawal signs
- No physical withdrawal, but irritability, restlessness, invasive urges — and often finances or a family already damaged.
- Treatment
- Cognitive behavioural therapy, concrete exposure and control measures, work on shame, work with those around the person.
- Duration
- A programme of several months, as an outpatient or in day hospital.
Pregabalin and diverted medicines
- Withdrawal signs
- Intense anxiety, insomnia, sweating, pain, nausea, agitation. Stopping high-dose pregabalin abruptly can cause seizures. Trihexyphenidyl produces confusion and hallucinations both in excess and on stopping.
- Treatment
- A taper planned over several weeks, never a hard stop, treatment of anxiety and sleep, and a systematic search for the pain or the disorder that started the prescription.
- Duration
- A 4 to 12 week taper depending on dose and duration of use.
Ketamine and nitrous oxide
- Withdrawal signs
- No classic withdrawal syndrome, but strong craving, low mood and anxiety. The damage is elsewhere: bladder injury from ketamine, vitamin B12 deficiency and nerve damage from nitrous oxide — pins and needles, weakness in the legs.
- Treatment
- Neurological and urological assessment, vitamin B12 supplementation where needed, craving therapy, treatment of the associated depression.
- Duration
- Marked craving for 2 to 6 weeks; the physical damage is treated separately.
Hallucinogens and new substances
- Withdrawal signs
- LSD, mushrooms, synthetic cathinones: no physical dependence, but persistent anxiety, flashbacks and, in vulnerable people, a psychotic episode that does not stop when the substance does.
- Treatment
- A safe place for the acute episode, antipsychotic treatment if symptoms persist, a full psychiatric assessment.
- Duration
- A few days for the acute episode; longer follow-up if a disorder sets in.
Solvents and inhalants
- Withdrawal signs
- Glues, thinners, petrol, gas: headaches, tremor, irritability, trouble concentrating. Mostly in adolescents, and often hidden by the family for a long time.
- Treatment
- Neurological, liver and kidney assessment — these products do damage fast — then care that is as much about family and school as it is medical.
- Duration
- Brief physical withdrawal; cognitive recovery takes months.
Several substances at once?
This is the most common case, and the one you must not handle alone: withdrawals add up and mask one another. Describe the situation on the phone; the order of priorities is a medical decision.
+216 00 000 000The protocol, from the first day to the last.
A successful withdrawal does not end when the shaking stops. Detoxification is the short part; what decides the rest is what gets built during and after it.
Speak to a doctor-
Admission assessment
Clinical examination, blood work, liver and cardiac assessment, grading of dependence severity, and a search for associated disorders — anxiety, depression, sleep, suicide risk. Nothing begins before the ground has been measured.
Day 1
-
Medically supervised withdrawal
Withdrawal is treated, not endured: a protocol specific to the substance, tapering doses, vital signs checked several times a day, hydration, vitamins, prevention of seizures and delirium.
Days 1 to 7, roughly
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Stabilisation
Sleep re-establishes itself, appetite returns, mood lifts — or reveals what it had been hiding. This is where the psychiatric disorder the substance was masking gets treated, and where the day gets its fixed hours back.
Weeks 1 to 3
-
Working on craving
Motivational interviewing, cognitive behavioural therapy, peer group work, identifying high-risk situations, a written plan for the tipping moments, and work with the family where that is possible.
Throughout the stay
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After discharge
Close follow-up appointments, continued treatment, a family session, referral to a peer support group and to the family doctor. The first month outside is the most fragile: it is followed closely.
3 to 12 months
What six weeks change.
The first sign of recovery is neither mood nor motivation: it is the night. Here, week by week, is what actually happens — the same room, the same bed, the same person, six weeks apart.
03 h 00 time of waking
-
The last night before admission
Three hours of sleep, cut into pieces. The 3 a.m. waking is the hardest: it is the hour when withdrawal wakes before you do, and when people often use again just to get back to sleep.
- Sleep
- 3 h, in pieces
- Dread on waking
- at its worst
-
The body settles
The medical withdrawal is behind you. The tremor has stopped, blood pressure and pulse are coming down. Sleep returns in pieces: still short, still fragile, but it returns without the substance.
- Sleep
- 4 h
- Dread on waking
- strong
-
The nights knit back together
Sleep gathers into one block instead of three. It is the first reliable sign that the nervous system is resettling — well before mood follows.
- Sleep
- 5 h, in one block
- Dread on waking
- present
-
What the substance was hiding
The substance masks nothing now. What is left shows plainly: a depression, an anxiety, a long-standing sleep disorder. This is where psychiatric treatment takes over from withdrawal.
- Sleep
- 6 h
- Dread on waking
- variable
-
The morning becomes ordinary again
Getting up no longer takes courage. Appetite returns, weight stabilises, and the day has fixed hours again — meals, workshop, session, bedtime.
- Sleep
- 7 h
- Dread on waking
- mild
-
The urge has a name
The urges are still there — they will be for a long time. The difference is that they now have a name, identified triggers, a response written in advance and someone to call.
- Sleep
- 7 h 30
- Dread on waking
- rare
-
Fourteen nights in a row
Two weeks of full nights. That is the marker we aim for before discharge: not the absence of urges, which cannot be commanded, but sleep that holds on its own.
- Sleep
- 8 h
- Dread on waking
- rare
An illustration, not a photograph of a patient. It shows a common course after supervised withdrawal; real outcomes vary from person to person.
Underneath the addiction, almost always something else.
People rarely drink for no reason. Alcohol puts an anxiety to sleep, cocaine restarts a depression, cannabis switches off thoughts that keep circling, sleeping pills repair nights that bipolar disorder destroyed. Treating the use without treating what it compensates for is simply organising the relapse.
That is why withdrawal here is a psychiatric act: the same doctor runs the detoxification and treats the disorder that appears behind it, once the substance is gone.
- Alcoholanxiety, depression, post-traumatic stress
- Benzodiazepineschronic insomnia, anxiety disorder
- Cannabis, zatlapsychotic disorders, social phobia
- Cocaine, stimulantsbipolar disorder, depression
- Opioidschronic pain, depression
- Pregabalin, Artaneanxiety, chronic pain, insomnia
- Gambling, screensimpulsivity, personality disorder
The disorders we treat.
With or without an associated addiction. These descriptions are here to help you recognise, not to diagnose: only a medical consultation can make a diagnosis.
Depression
Sadness or loss of interest lasting more than two weeks, most of the day, nearly every day. Often joined by broken sleep — waking at 4 a.m. — a changed appetite, tiredness on waking, slowness, guilt, and sometimes the thought that everyone would be better off.
Treatment: psychotherapy, an antidepressant where indicated, restarting rhythm and activity. Admission is warranted when there is suicide risk, refusal to eat, or when nothing moves in outpatient care.
Bipolar disorder
An alternation between depressive episodes and phases of elation: a collapsed need for sleep without tiredness, accelerated speech, spending, outsized plans, irritability, disinhibition. Between episodes a person can be perfectly well, which often delays diagnosis by years.
Treatment: mood stabilisers, protection of sleep, psychoeducation of patient and family so early signs of a new episode get recognised. Alcohol and stimulant use markedly worsens the course.
Anxiety disorders
Generalised anxiety running continuously, panic attacks with a sense of imminent death, phobias, obsessive-compulsive disorder, post-traumatic stress. Anxiety drives use: it is the leading reason people self-medicate with alcohol and sleeping pills.
Treatment: cognitive behavioural therapy and graded exposure, relaxation, maintenance medication if needed — while specifically avoiding long-term benzodiazepines.
Psychotic disorders
Hallucinations, delusional convictions of persecution, disorganised speech, withdrawal, suspicion of those closest. Often the person does not experience themselves as ill, which makes the step impossible without the family.
Treatment: antipsychotic treatment, a safe place for the acute phase, rehabilitation afterwards. How early care starts weighs heavily on the long-term course.
Sleep disorders
Insomnia at onset or in the middle of the night, hypersomnia, an inverted rhythm, repeated nightmares. Rarely isolated: sleep is the first thing to go wrong in almost every psychiatric condition, and the last to repair after a withdrawal.
Treatment: treating the cause, restructuring hours, insomnia therapy, a gradual taper off sleeping pills already in place.
Personality disorders
A stable, lasting way of functioning that causes difficulty: emotional instability and fear of abandonment in borderline states, avoidance of relationships, dependence, rigidity. Addictive behaviour and acting out are frequent.
Treatment: structured psychotherapy over time, work on emotion regulation, a clear and constant frame. Inpatient stays are for crisis periods, not for the underlying treatment.
Burnout and exhaustion
Exhaustion that rest no longer repairs, cynical distance from work, a sense of ineffectiveness, then often a sudden collapse. Frequently accompanied by a quiet increase in alcohol or sleeping-pill use.
Treatment: stopping and stepping back, treating any depressive episode, work on the return — going back to work is prepared, not improvised.
What the days are made of.
Medication has a place, not the whole place. The rest happens in sessions, in groups, and in the rhythm of the day.
Motivational interviewing
Drawing out the patient's own reasons rather than opposing them with ours. It is the approach that earns the most engagement in addiction medicine.
Cognitive behavioural therapy
Identifying the thoughts and situations that come before use or crisis, and building a different response, in advance and in writing.
Group therapy
Hearing someone describe exactly what you thought you alone were living. It is often the moment shame drops enough for the work to begin.
Family session
Families are exhausted, angry, or over-protective. We explain the illness, what helps and what makes it worse, and what they are allowed to stop carrying.
Psychoeducation
Knowing your disorder, its early signs, what your treatment actually does. An informed patient relapses less and comes back sooner.
Art therapy
Painting, writing, music, for the moments when words do not come yet — common in the first days of a withdrawal.
Relaxation and physical activity
Breathing, relaxation, walking, getting moving again. It acts on anxiety, sleep and craving, with no drug interactions.
Nutritional follow-up
Renutrition and correction of deficiencies after alcohol withdrawal, management of weight changes caused by medication.
A day here, hour by hour.
Rhythm does part of the work. After months in which nothing had a fixed time, the body resettles because meals, workshops and bedtime come back at the same hour every day.
- Open 24/7, all year round, public holidays included.
- Emergencies are seen at any hour, without an appointment.
- Consultations by appointment: Mon–Fri 8 a.m.–6 p.m., Sat 8 a.m.–1 p.m..
An example day for a full inpatient stay. The programme is adapted to each patient and reviewed with them every week.
- 07 h 00Waking, vital signs taken
- 07 h 30Breakfast together
- 09 h 00Psychiatrist's round, one-to-one session
- 10 h 30Workshop: art therapy, group session or relaxation
- 12 h 30Lunch
- 14 h 00Free time: patio, reading, an accompanied walk
- 15 h 30Individual psychotherapy or a family session
- 17 h 00Adapted physical activity
- 18 h 30Dinner
- 20 h 00Quiet evening, nursing round, evening medication
- NightA team stays awake until morning
When to make the call.
People almost always wait too long — out of shame, or because they tell themselves they have it under control. One of these signs is enough to justify a call, and the call commits you to nothing.
- You need a drink or a dose in the morning for the day to start.
- Tremor, sweating or dread as soon as you stop.
- Attempts to stop alone have already failed, more than once.
- The doses are climbing, or the sleeping pills no longer work.
- Work, money or family are starting to pay the price.
- Sadness or dread that has lasted more than two weeks.
- Repeated sleepless nights, or sleep that has flipped around.
- Strange talk, unusual suspicion, an abrupt withdrawal from everyone.
- Thoughts of death, a plan, or an attempt narrowly avoided.
Where this care is given.
At Clinique Espoir, El Menzah 9 in Tunis — as a full inpatient stay, in day hospital, or as an outpatient, according to what the situation calls for. The clinic is open 24 hours a day, 7 days a week: single or double rooms, nursing presence day and night, medical transport on request.
The photographs of the entrance and the reception are of the clinic itself. The other images illustrate how the spaces are arranged.
The questions people don't dare ask.
Can withdrawal be done at home?
For tobacco or cannabis, often yes, with follow-up. For alcohol and benzodiazepines, stopping without medical supervision exposes you to seizures and delirium tremens: the decision is made after examination, never in advance and never alone.
How long is an inpatient stay for withdrawal?
The acute phase generally lasts a week. A stay of two to four weeks additionally allows sleep to stabilise, the underlying disorder to be treated, and the work on craving to begin. The duration is reviewed every week with the patient.
What if the person refuses to come?
That is the most common situation. Call for yourself first: we help you prepare the conversation, choose the moment, and know what to do if things get worse. Admission is in principle with the patient's consent; where their state does not allow it, the law provides for admission at a relative's request, and the procedure is explained to you.
Is relapse a failure of the treatment?
No. Relapse is part of the story of most dependencies; what matters is how long before you come back. Coming back after three days of using is not the same as coming back after six months — and nobody here reproaches either one.
Will this stay confidential?
Medical confidentiality covers the whole stay. No information is passed to an employer, an administration or a third party without the patient's written consent.
What does it cost?
It depends on the type of care and the room. Prices are given on the phone, in detail and without obligation, before any admission.
The information on this page is general and does not replace a medical consultation. No treatment, no cessation and no dose change should be decided on the basis of this site.
Describe the situation. We'll tell you what to do.
- +216 00 000 000 24/7
- contact@sevrage-tunisie.com Reply within 24 hours · referral letters from colleagues
- Clinique Espoir — El Menzah 9, Tunis Consultations: Mon–Fri 8 a.m.–6 p.m. · Sat 8 a.m.–1 p.m.