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What to Expect From Drug Withdrawal

The symptoms you may experience if you undergo withdrawal from any type of drug are dependent on the drug you take and other personal factors, such as your genetics and metabolism.

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Withdrawal syndromes can begin within a few hours of your last use of the drug, or they may take days to appear, depending on the severity of your substance use disorder.

Withdrawal symptoms typically have several stages. These include:
  • An acute period where the symptoms appear and intensify.
  • A protracted period after the symptoms peak and begin to decrease in intensity.
  • A more prolonged period after most of the physical symptoms have subsided. You may still experience cravings, depression, and sensitivity to stress.

The potential to relapse is high during any stage of withdrawal. Relapse potential decreases if you are involved in a physician-assisted medical detox program.

Physical Dependence

Physical dependence is signified by withdrawal symptoms when you stop using any type of substance. It results from a two-part process that involves the development of tolerance and the later development of withdrawal symptoms.

  • Tolerance represents the development of resistance or decreased responsiveness to the effects of the substance. Tolerance is a relatively common occurrence, even for people who only take drugs for medical reasons.
  • Withdrawal symptoms occur when you cut down the amount of the drug you use, or you abruptly stop using it altogether.
  • Withdrawal symptoms will typically occur in two phases. First, there is an acute phase that begins after you stop using the substance, where the symptoms appear and increase in strength or intensity. Then, there is a longer, more protracted phase that occurs after the symptoms peak in intensity. After the peak, their strength declines.
  • The acute period is usually brief. It typically only lasts a few days or a week at most. The protracted period can last for several days or weeks.
  • You will always develop some level of tolerance to the drug before you experience any withdrawal symptoms.

Tolerance and withdrawal (physical dependence) symptoms occur as a result of your body’s attempt to maintain homeostasis.

Homeostasis, Opponent Processes & Tolerance

Homeostasis refers to how your system attempts to maintain a constant and stable level of functioning in order for your body to work more efficiently.

Your body’s level of balance can change for specific situations, such as when you enter a very cool room, exert yourself, or are injured. But your body attempts to maintain a relatively stable level of functioning over all of its systems given whatever environment you are in.

walking-woods
It is hypothesized that the development of physical dependence occurs as result of several general principles related to your system’s attempt to maintain homeostasis.
  • When you repeatedly use a drug or alcohol, the neural pathways in your brain will change (neuroplasticity). The drug will either activate or inhibit the functioning of certain neurons. It will increase or decrease the levels of hormones and neurotransmitters in your body in order to produce its effects.
  • These results are the consequences of the mechanism of action of the drug. Over time, it disrupts the state of balance that your system has established.
  • As an attempt to maintain homeostasis, your system will increase substances like neurotransmitters and hormones that offset the effects of the drug.
  • The increase in the levels of other neurotransmitters and hormones that offset the effects of the drug will eventually result in you needing more of the drug to get the types of effects you achieved when you first started taking it (tolerance).
  • Continuing to use the drug in increasingly higher amounts results in your system increasing its production of the substances that offset the effects of the drug.
  • Eventually, if you stop using the drug or significantly cut down the dosage, the increased levels of other active neurotransmitters, hormones, and other substances that offset the effects of the drug now produce a different state of imbalance. This state produces sensations and symptoms in opposition to the effects that the drug produced (withdrawal symptoms).
thought-theory

The opponent process theory — a theory originally designed to clarify color vision — has been used to explain how tolerance and withdrawal develop in your system when you chronically use a drug. For instance, if a drug produces euphoria, the opponent process would be dysphoria (negative emotions and negative feelings). If the drug reduces your anxiety level, the opponent process would be an increase in anxiety or uneasiness. If the drug stimulates your system, the opponent process would be lethargy.

Withdrawal Symptoms

Although the opponent process theory can generally explain how tolerance and withdrawal symptoms develop, it does not explain why all the types of withdrawal symptoms that occur with different drugs develop. The types of symptoms that can occur during withdrawal will vary depending on the type of drug you were using.

Symptoms like nausea, vomiting, diarrhea, and cravings appear in most of the withdrawal syndromes associated with drugs of abuse, most likely because of the larger amounts of drugs that chronic recreational users take.

In addition to these, there are other symptoms that typically occur with withdrawal syndromes.
  • Rebound effects are symptoms that the drug was originally designed to control. These symptoms return during withdrawal or discontinuation. These may include significant pain during opioid withdrawal, anxiety or insomnia during benzodiazepine withdrawal, and lethargy during withdrawal from stimulants.
  • Decreased tolerance to the effects of the drug often occurs rapidly during drug withdrawal. This can produce a dangerous situation if you relapse. You may overdose due to your reduced tolerance if you take an amount of the drug that you previously used.
  • Flu-like symptoms are common, such as fever, chills, sweating, and headache.
  • A lack of motivation, an inability to experience pleasure or difficulty experiencing pleasure, and increased sensitivity to perceived stress are common effects that occur during withdrawal. These may represent changes in the brain’s neuropathways as a result of drug abuse.
  • Mood swings, depression, and apathy are common withdrawal symptoms.
  • Alterations in autonomic system functioning, such as irregular heartbeat, irregular breathing, and changes in blood pressure, are common.

Withdrawal from some drugs, like alcohol and benzodiazepines, is associated with the potential to develop seizures, significant confusion, and/or psychosis. Seizures can be potentially fatal.

Withdrawal Timelines

According to the description of withdrawal syndromes in the DSM-5, the diagnostic manual for the American Psychiatric Association (APA), the timeline for withdrawal syndromes will vary depending on the drug used. Other factors, such as how much of the drug you typically took, the manner in which you took it, whether you often combined it with other drugs, how long you abused the drug, and individual factors like your genetic profile, your metabolism, and your weight, can also affect how you experience withdrawal.

Withdrawal timelines are variable, but they are typically broken down into stages.
Acute
An acute stage begins relatively soon after you stop using your drug of choice, peaks in its intensity, and lasts for a relatively short period of time compared to the entire withdrawal syndrome.
Protracted
A more protracted withdrawal syndrome occurs after the symptoms peak and start to decrease in their intensity. This stage will typically last longer than the acute stage, but it will usually not last more than several days to two weeks.
Post-Acute
You’ll bring your loved ones to meetings with a therapist, and you’ll all talk about addiction recovery together.

PAWS most likely represents other factors that are associated with long-term recovery from substance abuse. These may include physical changes to the neural pathways in the brain, difficulty extinguishing conditioned behaviors that occur in many different circumstances, and the types of personality factors or motivational issues that were present before your drug abuse.

Alcohol

The withdrawal syndrome associated with an alcohol use disorder can be quite variable in its severity. Light to moderate drinkers will most likely experience mild to moderate alcohol withdrawal symptoms that may not require medical attention. Because there is always the potential for someone to develop seizures, you should be monitored by a physician who is experienced in treating withdrawal from alcohol.

Heavier drinkers are at increased risk to develop seizures, delirium (confusion and psychosis), and other life-threatening symptoms. Again, there is a risk that these could occur in light drinkers who have abused alcohol for a significant length of time.

Depending on your alcohol use, you could experience withdrawal symptoms within a day or two after stopping use. If you chronically abused alcohol on a heavy basis, withdrawal symptoms may begin only a few hours after stopping use.

Mild to moderate alcohol withdrawal symptoms typically last a week or two. More severe symptoms can last for several weeks or longer, depending on the situation.

Anyone with a diagnosis of an alcohol use disorder who wishes to stop drinking should begin with medical detox. Do not simply stop drinking on your own. Medical supervision is needed.

Benzodiazepines

The withdrawal syndrome from benzodiazepines can appear very similar to the withdrawal syndrome associated with alcohol.

Both can occur rapidly, produce severe confusion, and trigger seizures that can be potentially fatal. Both are typically treated by administering long-acting benzodiazepines in a physician-assisted medical detox program.

Benzodiazepines are administered on a tapering schedule. Eventually, you will be weaned from benzodiazepines once your withdrawal symptoms subside.

Opioid

Although withdrawal from opioid drugs can be very distressing, the symptoms are typically not considered to be potentially fatal. There is a far less risk that you will develop seizures unless there is some other pre-existing condition that increases your risk for seizures.

Your tolerance level to opioid drugs increases rapidly. If you have been chronically abusing opioids, you may have a significant tolerance that allows you to take amounts of opioids that would be potentially fatal to someone who has not developed tolerance to the drugs.

The major risk associated with opioid withdrawal is that you will relapse during the withdrawal process. Since your tolerance will have significantly decreased, relapse could lead to a fatal overdose. Other risks include dehydration and/or self-harm due to emotional distress.

For chronic, heavy users, opioid withdrawal symptoms can begin within several hours after stopping use. For mild to moderate opioid use disorders, it may take a day or two for symptoms to appear.

Medical detox for opioids typically involves the use of an opioid replacement medication like methadone or buprenorphine (Suboxone).

Stimulant

Withdrawal associated with stimulant medications like methylphenidate (Ritalin), methamphetamine, cocaine, and amphetamines will typically produce more emotional symptoms than physical symptoms. You may also experience issues with sweating, nervousness, and lethargy.

For most people, withdrawal from stimulants produces extreme mood swings and cravings that increase the risk of relapse. Medical detox for stimulant withdrawal typically includes medications to control cravings and reduce lethargy, and interventions to address apathy and depression.

Medical Detox

Detox is a natural process the body uses to rid itself of toxins and waste products. The process is primarily performed by the liver.

Medical detox is a medically assisted program to help the process, although it doesn’t really speed up the body’s ability to detoxify itself. Instead, it addresses the symptoms of withdrawal that may spur you to relapse. Thus, many organizations now refer to this process as a withdrawal management program.

detox-cleanse

Medical detox involves the use of medications to control withdrawal symptoms and medical supervision to help you get through withdrawal safely and without relapsing.

Physician-assisted medical detox programs will often last longer than detoxing on your own, but these programs are far safer. They can address other potential health issues you may encounter during the withdrawal process.

Medical detox is highly recommended for anyone with any type of substance use disorder. It is necessary for those who are addicted to alcohol and benzodiazepines since some withdrawal symptoms associated with these substances can be life-threatening.

Medical Detox Is Not Enough

Although a medical detox program can reduce your risk of relapse in the early stages of recovery and help you safely get through the withdrawal syndrome, it is not enough on its own to avoid relapses in the future.

Relapse rates for all types of substance use disorders are relatively high. The potential to relapse is significantly decreased, however, if you participate in treatment following detox. Generally, this means involvement in some type of addiction treatment program where therapy is the backbone of the program. Completion of a structured program should be followed by an aftercare program (sometimes referred to as continuing care).

In therapy, you’ll address the types of issues that spurred your substance abuse in the first place. You’ll learn strategies to deal with these issues, and with your therapist, you’ll develop a plan for long-term abstinence.

If you do not get involved in a treatment program once you complete the medical detox process, it is almost assured that you will relapse. Research consistently demonstrates that the longer you remain in treatment for your substance use disorder, the greater your chances are of remaining abstinent.

Those who have the highest rates of sustained abstinence continue to participate in recovery-related activities, such as support groups, for many years following detox.

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