Withdrawal symptoms occur because of the human body’s natural desire to maintain homeostasis, or balance. When something within the body is outside of normal parameters, the body attempts to compensate. Most psychoactive drugs work by affecting the levels of certain neurotransmitters, usually by raising them, and the body reacts in various ways, such as by reducing the amount produced or by making receptors more sensitive.
When people begin consuming drugs like amphetamine, the body quickly begins to adapt and push back against the effects. The adaptation is the basis for drug tolerance, in which larger amounts of the drug must be taken to achieve affects once achieved with a lower dose. As an individual continues to abuse the substances, the body begins to see their presence as normal, and in some ways is only balanced when the drug is in the system.
The drug’s effects and the body’s pushback act as opposing forces. When the drug is not present in the body, the user will feel the body’s reaction intensely, which is experienced as the symptoms of withdrawal. The New Zealand Drug Foundation describes it as two balanced people playing tug of war and one person dropping the rope and sending the other person flying.
The Nature of Withdrawal Symptoms
Because withdrawal symptoms are caused by the body’s adaptations to a drug, they are generally opposite in nature from a drug’s primary effects. This means that for drugs that depress the central nervous system, withdrawal effects are generally stimulatory. For stimulating drugs, withdrawal symptoms generally depress the body. There are also withdrawal effects that are common to many psychoactive substances, such as cold and flu-like symptoms.
The National Council on Alcoholism and Drug Dependence lists the following common withdrawal symptoms: headaches, fatigue, sweating, insomnia, loss of appetite, anxiety, depression, irritability, trembling, nausea and vomiting. They note that in severe cases people may experience seizures, fever, agitation, confusion and hallucinations. Severe symptoms require medical attention.
How quickly people begin experiencing withdrawal symptoms depends on personal metabolism and on the nature of the substance. The Substance Abuse and Mental Health Services Administration (SAMHSA) reports that withdrawal from crack cocaine can begin within hours of the last use. Alcohol withdrawal can begin 24 to 48 hours after the blood alcohol level drops, and heroin withdrawal within 24 hours of last consuming the drug.
Medically Supervised Detox
Detoxification, or detox, is the process of undergoing withdrawal until the body is clear of the addicting substance. It is always wise to do this under medical supervision. Detox can be undertaken in different ways and in different settings. Sometimes, an outpatient detox is possible. At other times, the best choice is for patients to undergo treatment in a hospital, freestanding clinic, or addiction treatment facility.
Sometimes an insurance company will cover residential detox for some substances, but not others. This is due to the fact that withdrawal from certain substances is considered more medically dangerous. Often, withdrawal from sedative substances like alcohol and benzodiazepines is most problematic.
How Withdrawal Symptoms Are Treated
Although it is natural to be leery of undergoing withdrawal, medical personnel work very hard to make detox as safe and comfortable as possible. Symptoms are monitored and addressed as needed. A SAMHSA publication entitled “Detoxification and Substance Abuse Treatment” lists the following possible interventions.
- Alcohol – For alcohol withdrawal, slowly metabolized benzodiazepines may be given. The drugs may be given intravenously or orally. When patients are stabilized, the benzodiazepines are slowly tapered over the next few days. Other medications that can be used include barbiturates, beta-blockers, antipsychotics and anticonvulsants.
- Opiates and opioids – Withdrawal from opiates like heroin and opioids like prescription painkillers is often treated with methadone or buprenorphine. In addition, patients may be given medications to counteract gastrointestinal symptoms like stomach cramps, diarrhea, nausea and vomiting. Clonidine may also be used, along with drugs to treat insomnia, headache, and bone and muscle pain.
- Benzodiazepines and Other Sedative-Hypnotic Drugs – Patients who have abused short-acting benzodiazepines may be switched to longer acting drugs in the same class. Phenobarbital may also be used.
- Stimulants – Withdrawal from stimulants like cocaine and amphetamine is often treated symptomatically. People may be very hungry and in need of large portions of nutritious food. Headaches may be evaluated and treated. Drugs that have been used for stimulant withdrawal include amantadine, modafilinil and mirtazapine.
Although the duration of detox varies, undergoing the process is always a matter of facing short-term discomfort for long-term rewards. The price of continuing in addiction is much higher: physically, emotionally, socially, and financially.
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