Dextromethorphan (DXM) Withdrawal: Symptoms and Finding Help

Dextromethorphan (DXM) is a cough suppressor that is a major active ingredient in more than 120 over-the-counter medications.

Dextromethorphan can cause euphoria and visual and auditory hallucinations when consumed in high doses. Because of this, many users, especially teens and preteens who are not old enough to buy alcohol, often abuse or misuse DXM to feel intoxicated.

Signs that your child could be misusing DXM include changes in behavior, dropping grades, and loss of interest in normal activities, says psychiatric mental health nurse practitioner (PMHNP) Valerie Puffenberger.

If you or a loved one is misusing DXM and would like to stop, it’s important to understand what withdrawal symptoms may appear and how to best manage them for a successful recovery. On this page, we’ll explore DXM withdrawal and resources to help get you through the process.

What Causes DXM Withdrawal?

Dependence on DXM ultimately leads to withdrawal.

Dependence occurs when you consume high quantities of DXM for long enough that your brain and body become accustomed to the drug. In other words, your brain and body begin to require DXM to function “properly.”

As a result, when those dependent on DXM stop taking it or reduce their dose, they experience a collection of unpleasant symptoms known as DXM withdrawal. These symptoms are caused by your brain and body struggling to return to normal function without DXM.

Symptoms of DXM Withdrawal

Every individual is different, as is each case of DXM withdrawal. What symptoms appear during DXM withdrawal, as well as their severity and duration, will vary depending on factors like:

• The user’s genetics, gender, weight, and body chemistry
• The severity of their DXM dependence
• The presence of any co-occurring mental health or substance use disorders

Some of the most common psychological DXM withdrawal symptoms include:

• Depression
• Feelings of sadness or hopelessness
• Anxiety and nervousness
• Irritability
• Mood swings and emotional instability
• Cravings to use DXM again

Common physical DXM withdrawal symptoms include:

• Fatigue
• Lack of energy or motivation
• Muscle aches or discomfort
• Headaches
• Nausea
• Vomiting
• Sweating

“Getting through DXM withdrawal is an extremely tough process but try to stay positive and take it one day at a time,” says Puffenberger. “Each day sober is a step in the right direction toward a healthier life and shows such strength on your part.”

DXM Withdrawal Timeline

How long DXM withdrawal lasts varies from person to person. Some of the most important factors that determine the length of DXM withdrawal include:

• Dosage and duration of use
• Frequency of use
• Polydrug use
• Overall health
• Mental health
• Support and treatment

Although all cases are different, below is a general timeline of DXM withdrawal:

Day 1 – 2

Generally, symptoms of DXM withdrawal will first appear within 24 to 48 hours. Generally, these symptoms will be fewer in number and lesser in severity.

Days 2 – 7

During the first week of DXM withdrawal, additional symptoms may appear, and symptoms generally worsen in severity. This period is the start of what is known as acute withdrawal.

Days 8 – 14

During the second week of DXM withdrawal, symptoms typically lessen in severity, and most will disappear entirely by the end of the second week. This is the last part of acute withdrawal.

Day 15 – Year 2

In some instances, some symptoms of DXM withdrawal, especially psychological symptoms, may persist for up to two years. These are known as post-acute withdrawal symptoms.

Detox and Treatment for DXM Withdrawal

DXM withdrawal can be very uncomfortable, and many users will end up relapsing before withdrawal ends to avoid its symptoms. For the best chance at getting through DXM withdrawal and avoiding relapse, keep the following tips in mind:

Don’t Go “Cold Turkey”

DXM withdrawal symptoms are generally the most severe and difficult to get through when the user quits “cold turkey” or stops taking DXM completely, suddenly, and without detox.

Quitting cold turkey creates a significantly more unpleasant experience for the user and greatly increases their likelihood of relapse.

The best course of action is to taper down your use, ideally with the help or supervision of medical staff.

Medically Supervised Detox

Medically supervised detox can make DXM withdrawal both safer and more comfortable for the user.

When a patient undergoes medically supervised DXM detox, they receive 24/7 monitoring and support from medical professionals. Examples of possible medical treatments used for DXM withdrawal include:

• Taper-down method: The dosage of DXM is gradually reduced over time, giving the body more time to adapt to its absence.
• Medications: Over-the counter medications are sometimes used to reduce or eliminate the symptoms of DXM withdrawal.
• Supervision: Medical professionals supervise and monitor patients undergoing DXM detox to make sure they are safe, comfortable, and committed to the process.

What treatments are provided will depend on the individual patient’s unique needs and circumstances.

Therapy and Counseling

Therapeutic approaches are also used for DXM withdrawal management. Some of the most common and effective therapies include:

• Cognitive behavioral therapy (CBT): CBT helps patients identify and change negative thought and behavior patterns. As a result, CBT helps patients develop healthy coping strategies and resist triggers to use DXM.
• Motivational interviewing (MI): MI aims to improve motivation for change. As a result, it reduces ambivalence about quitting DXM.
• Contingency management (CM): CM provides tangible rewards or incentives for positive behaviors. This approach reinforces continuing abstinence from DXM.
• Dialectical behavior therapy (DBT): DBT combines CBT with mindfulness strategies. DBT is especially useful for managing DXM withdrawal for patients with co-occurring mental health issues and those who need help regulating their emotions.
• Mindfulness-based stress reduction (MBSR): MBSR promotes a non-judgmental awareness of thoughts and feelings. MBSR combines mindfulness, meditation, and other awareness techniques to help patients reduce their stress and manage cravings.

Self-Help Strategies

In addition to getting help from medical and mental health professionals, Puffenberger outlines some self-help strategies to get you through DXM withdrawal:

• Stay hydrated and maintain a healthy, nutritious diet. Drink plenty of water and eat fruits, vegetables, whole grains, lean proteins. Electrolyte replacement drinks can help with the nausea as well. Supplement with vitamins B and C. Avoid processed, sugary foods which may exacerbate your symptoms.
• Rest frequently. Your body and mind need time to heal during withdrawal. Get adequate sleep each night and lay down during the day as needed. Don’t push yourself too far. Have someone with you to monitor your health as needed.
• Take hot, relaxing baths or showers. These may help relieve agitation, anxiety, body aches, nausea.
• Explore gentle exercises. Walk outside to seek distraction and mood-boosting fresh air, or find other gentle forms of exercise to provide some outlet for your agitation. But don’t overexert yourself.
• Stay connected to supportive friends, family, doctors, or recovery support groups. Actively reach out to loved ones when you’re struggling most with the isolation and cravings. Know you don’t have to do this alone.

Supporting a Loved One in DXM Withdrawal

Supporting a loved one in DXM withdrawal in appropriate and healthy ways can help them achieve and maintain sobriety.

Some of the most helpful ways you can support a loved one in DXM withdrawal include:

• Understand the challenges of DXM withdrawal: Educate yourself about DXM withdrawal and its physical and psychological effects so you can respond with patience and empathy when your loved one is hurting most.
• Don’t become an enabler: Even people with the best intentions can accidentally encourage negative behaviors in those with substance use disorders. To avoid enabling your loved one during DXM withdrawal, set boundaries, refrain from using products that have DXM in them, and consider individual or family counseling for yourself.
• Provide effective communication and emotional support: Create a safe, non-judgmental space that allows for open communication. Practice active listening and offer emotional support when possible.
• Encourage professional support: Some form of professional support, whether in the form of detox, rehab, or even a therapist, will dramatically increase the likelihood of your loved one achieving and maintaining sobriety.
• Help with relapse prevention: Work together to identify triggers, develop coping strategies, and make healthy lifestyle changes. Create a supportive environment free of products that contain DXM, and make sure to celebrate any and all successes.

Long-Term Recovery and Relapse Prevention

Long-term DXM recovery is only possible if patients can successfully prevent relapse. Luckily, there are many DXM relapse prevention strategies and tools you can use.

Create a Relapse Prevention Plan

A relapse prevention plan is like an instruction manual. It will help you better understand and anticipate triggers and, more importantly, give you the actions and resources needed to deal with them. You will typically create a relapse prevention plan with your addiction treatment team, whether that’s staff at a rehab center or an individual therapist. However, you can also create one on your own.

A relapse prevention plan should include:

• All your triggers (I.e., the people, places, and situations that make you want to use DXM).
• Healthy coping strategies to calm your emotions, distract from cravings, and ultimately reduce your urges to use DXM.
• An emergency plan for handling high-risk situations.
• A support network of friends, family, professionals, and support groups.

It is important to regularly review and update your relapse prevention plan.

Seek Ongoing Support and Therapy

One of the most important aspects of long-term DXM recovery and relapse prevention is to seek ongoing support and therapy.

Many different types of therapy are useful for DXM relapse prevention, including individual therapy, group therapy, and family therapy. Group therapy or support groups can be especially effective, providing an ongoing source of support, advice, and community.

Develop Healthy Coping Strategies

It is also essential that you practice healthy coping strategies for long-term recovery. Some to consider include:

• Participating in mindfulness and meditation
• Engaging in regular exercise
• Participating in sports (e.g., community sports leagues)
• Using art and music to express yourself
• Reading
• Socializing with sober friends
• Spending time outdoors in nature
• Joining a club centered around a positive interest
• Practicing self-care through getting enough sleep and eating healthy meals
• Continuing your education

Try out different activities with an open mind and the intention of growing into the person you truly want to be. It will take time, commitment, and patience, but it will pay off in the end.

We’re Here to Help

If you or someone you love is going through DXM withdrawal, it may seem as if there is no hope. Luckily, nothing could be further from the truth. The entire staff at Legacy Healing Center is dedicated to helping our patients get through DXM withdrawal so they can achieve a lasting recovery.

We believe the only way to successfully treat DXM addiction is by healing the patient’s mind, body, and spirit. That’s why our addiction rehab programs use a holistic approach, from initial admission through aftercare.

Call 888-534-2295 today to speak with a treatment staff member at Legacy Healing Center.

Dextromethorphan Withdrawal FAQs

What are the common symptoms of DXM withdrawal?

Some of the most common symptoms of DXM withdrawal include:

• Depression and feelings of sadness or hopelessness
• Increased anxiety and nervousness
• Irritability and decreased tolerance of stress
• Mood swings
• Cravings for DXM
• Fatigue
• Muscle aches and discomfort
• Nausea and vomiting
• Profuse sweating

How long does DXM withdrawal last?

How long DXM withdrawal lasts will vary from person to person. However, in general, acute DXM withdrawal generally lasts no more than 14 days. Post-acute withdrawal symptoms are lower in number and severity but may occur periodically for up to two years.

Is it safe to quit DXM cold turkey?

While it is not generally life-threatening to quit DXM cold turkey, it is not always safe and almost never advisable. When deciding whether quitting DXM cold turkey is safe for a specific individual, they must consider a number of factors, including the potential intensity and duration of withdrawal symptoms, safety concerns related to abrupt cessation of use, underlying health issues (especially cardiovascular or mental health issues), and the risk of relapse.

Before attempting to quit DXM cold turkey, it is highly advisable that you consult with a healthcare professional, consider gradual tapering or medically supervised detox, and build a strong support system of friends, family, and professionals.

What are the recommended treatment options for DXM withdrawal?

Some of the most recommended and effective treatment options for DXM withdrawal include:

• Medically supervised detox
• Gradual tapering under medical guidance
• Behavioral therapies, including cognitive behavioral therapy (CBT) and motivational enhancement therapy (MET)
• Group therapy and support groups
• Family therapy
• Medication-assisted treatment (MAT) under medical supervision
• Holistic techniques, including mindfulness, stress-reduction techniques, and routine exercise
• Continued aftercare and support, including ongoing therapy and relapse prevention

How can I support a loved one going through DXM withdrawal?

There are many strategies that you can use to help support a loved one going through DXM withdrawal. Some of the most important include:

• Educate yourself on DXM, DXM withdrawal, and DXM recovery.
• Be non-judgmental.
• Listen actively.
• Encourage and enable professional help.
• Be patient and understanding.
• Offer emotional support.
• Assist with practical needs.
• Attend support groups together.
• Help them prevent relapse.
• Celebrate milestones.

About the Author

Jeffrey Juergens

Jeff Juergens is a leading author in the addiction and recovery field, dedicating the last seven years of his life to helping those struggling with substance use issues find the help that they need. Jeff's work has been used in rehabs across the country as tools to help patients achieve sobriety.

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Dr. Olushola, MSW

Olushola Lawal, MSW, RCSWI Olushola (Shola) Lawal serves as a Primary Therapist at Legacy Healing Detox. Shola was born and raised in South Florida. He is a Florida State University double alumnus graduating with his Bachelor of Social Work in 2013 and his Master of Social Work in 2015. Shola’s...

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