risk factorsWithdrawal symptoms must be understood within the context of addiction. Firstly, as Medical News Today discusses, a person may experience withdrawal symptoms whether they are physically dependent on drugs or have a full-blown addiction.

In other words, those who are physically dependent but not addicted to a drug may experience withdrawal. For this reason, it is important to understand that the experience of withdrawal symptoms is not synonymous with addiction, but it is always a sign of this illness.

Physical Dependence vs. Addiction

The National Institute on Drug Abuse explains the difference between physical dependence and addiction. In the case of physical dependence on a drug, the body habituates to the drug intake (i.e., builds a tolerance), and when the familiar dosage is eliminated or substantially reduced, the person will experience withdrawal symptoms. One of the hallmarks of addiction is that a person’s behavior changes; a drug addict makes acquiring and consuming drugs a top priority, to the detriment of work, family, school, and other obligations. Addictive behavior is compulsive in that the person may be aware of how destructive the drug abuse has become and wants to stop using but finds she cannot.

The specific type of withdrawal symptoms a person experiences will depend both on the drug of abuse and the person’s individual biology, including any existing health conditions. While it is difficult to predict exactly what withdrawal symptoms will manifest until a person is in withdrawal, this process is often uncomfortable, sometimes painful, and can feature drug cravings (i.e., the body is signaling that it wants the drugs to which it has grown accustomed). Although it may seem illogical, a person going through withdrawal may have the desire to detox and achieve abstinence, but the body acts at the cross-purpose of wanting the familiar drug. It is important to understand that just as the body habituated to the drug of abuse, the body will eventually adapt to abstinence.

Signs and Symptoms of Withdrawal

It may be difficult for the untrained eye to detect that a person is going through drug withdrawal. The National Council on Alcoholism and Drug Abuse provides insight into some of the most common withdrawal symptoms, ones that cut across many different drug types, including:

·       Jumpiness, anxiety and irritability ·       Sweating, shaking and trembling
·       Headaches ·       Loss of appetite
·       Depression ·       Nausea and vomiting
·       Fatigue ·       Needing to use drugs to steady nerves

In the most severe cases of withdrawal, a person may experience hallucinations, confusion, fever, and seizures. As Psychology Today discusses, withdrawal can also lead to the loss of life.

The drugs most associated with fatality during the withdrawal process are alcohol, benzodiazepines, and opiates. For this reason, it is important to know some of the most common signs of withdrawal from these drugs.



Alcohol
Benzodiapzepines
Opiates and Opioids
Relapse

According to Healthline, after chronic abuse of alcohol, a person who stops or significantly reduces his alcohol intake may trigger withdrawal and experience both physical and psychological distress. Symptoms may appear six hours or a few days after the last drink. Symptoms can be most uncomfortable in the first few days, and they can persist for weeks. Some of the most common alcohol withdrawal symptoms include:

·       Increased heart rate ·       Tremors and anxiety
·       Nightmares ·       Irritability
·       Insomnia ·       Nausea and vomiting
·       Confusion ·       Sweating

Benzodiazepine withdrawal symptoms may occur for as few as one to four days and, in the most extreme cases, last as long as 10 to 14 days. There is no hard and fast rule as to how much benzodiazepine abuse will result in the manifestation of withdrawal symptoms, but research shows that taking high doses of short-acting benzodiazepines may result in more severe symptoms, which can include seizures and psychosis. However, at the mild to moderate end of the withdrawal spectrum, the most documented symptoms include:

·       Sleep disturbances ·       Hand tremors, anxiety and panic attacks
·       Headaches and perceptual changes ·       Sweating
·       Dry retching ·       Weight loss
·       Difficulty concentrating ·       Palpitations

There is a rising need for opiate and opioid withdrawal treatment as these drugs continue to be among the most commonly abused in America. Opiates refer to those drugs that are derived from the opium in a poppy plant. Opioids are synthetic drugs, at least in part, which are designed to replicate the compound structure of opium. Both opiates and opioids have a pain-relieving effect. The opioids in circulation are mainly lawful prescription pain relievers, manufactured in FDA-approved pharmaceutical laboratories, but they can be diverted into the hands of non-prescribed users. In this way, a lawful drug becomes an illicit one.

In general, opiate or opioid withdrawal symptoms begin to occur within 24 hours. In the case of heroin, withdrawal symptoms generally occur within 12 hours of last use, whereas methadone abusers may experience withdrawal after 36 hours. Symptoms generally become milder within 72 hours, and subside within a week. In the first 24 hours, the following opiate withdrawal symptoms may manifest:

·       Restlessness ·       Insomnia
·       Anxiety ·       Excessive sweating
·       Eyes tearing ·       Runny nose
·       Muscle aches ·       Ongoing yawning

After the initial 24 hour withdrawal window, a person recovering from opiate abuse may experience additional symptoms, including:

·       Abdominal cramping ·       Diarrhea
·       Rapid heartbeat ·       Goosebumps
·       Dilated pupils ·       Nausea and vomiting
·       Blurry vision ·       High blood pressure

According to the National Institute on Drug Abuse (NIDA), there is a 40 to 60 percent drug relapse rate among recovering addicts. The drug cravings that can be present during the withdrawal process are a strong factor in the high relapse rate. In the context of cocaine withdrawal, NIDA notes that cravings can be particularly intense and may occur even after weeks or months of abstinence. For this reason, research on those in recovery from cocaine abuse provides helpful insights into withdrawal, recovery and relapse.

NIDA points out that it is important for substance abusers in withdrawal to understand that this experience is common and does not necessarily mean that the person has a true psychological desire to use drugs again. In the case of cocaine cravings, it is critical for persons in withdrawal and recovery to understand that craving are time-limited; cravings generally spike and dissipate within one hour (as long as there is no continued cocaine abuse).

Cravings never have to cause a relapse, but they do need to be the focal point around which relapse prevention strategies are centered. During withdrawal, medical staff members can help to manage these cravings and any uncomfortable or dangerous aspects of the process. Cravings are dangerous to the extent that they do trigger a relapse, in particularly because once a person loses his former level of drug tolerance, if he relapses and takes the familiar dose, he may overdose. Not all overdoses are fatal, but all overdoses are dangerous because there is no way to gauge how much of a drug is too much, especially after a period of sobriety.

In addition to the substance abuser herself, family members and other loved ones are best positioned to see the signs of withdrawal occurring. Observing any of the above symptoms, especially with knowledge that a substance user has discontinued or reduced her drug use, should prompt a visit to an addiction specialist or medical professional. A doctor can diagnose withdrawal by taking a blood or urine drug test and conducting a full intake interview on the user’s current and previous drug use. This diagnostic step can help ensure that the person in withdrawal gets the help needed to go through this process as safely as possible.

Managing Withdrawal

ritalin abuserFrom a treatment perspective, a medical provider will have to determine the best course of action. Some individuals try to withdraw at home or in another non-medically supervised setting, but this may be dangerous and even deadly in some cases. The best option is to seek medical help for managing withdrawal.

Medscape, a site primarily designated for physicians, provides the following examples of how withdrawal symptoms may be managed with supervision and medications:

  • People experiencing mild alcohol withdrawal may be treated on an outpatient basis whereas those with moderate to severe alcohol abuse may require residential treatment or hospitalization.
  • Withdrawal from stimulant drugs is generally treated by observation alone and does not necessitate the use of any specific medications.
  • Opioid withdrawal may be treated with an opioid agonist, such as methadone or buprenorphine, as well as benzodiazepines to control muscle cramps and insomnia.
  • GHB (a central nervous system depressant) withdrawal may at first be treated with high doses of benzodiazepines or other sedatives.

During the withdrawal process, consulting physicians and professional staff members may offer over-the-counter drugs (such as pain relievers) to make the process more comfortable. But in some cases, such as opioid withdrawal, prescription medications may be used to safely taper the body off the opioid dependence. The use of opioid agonists to treat opioid dependence may also help to avoid a relapse. In the case of alcohol withdrawal, prescription sedative drugs, such as benzodiazepines, barbiturates, propofol and ethanol, may be used. Users of sedative drugs may be treated during withdrawal with long-acting benzodiazepine or phenobarbital drugs. It is important to note that at present only a few drugs are FDA-approved to treat addiction and for only specific drugs of abuse, such as the use of Suboxone to treat opiate addiction.

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