Alcohol and Drug Withdrawal

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What Is Withdrawal?

Withdrawal is the various physiological symptoms someone could experience if they stop using or decrease the heavy or extended use of alcohol or drugs.1 The onset, duration, and intensity of withdrawal symptoms will differ depending on various factors: the abused substances, how long the substance was abused, and the amount of the substance that was used.1,2

Withdrawal symptoms may be uncomfortable, distressing, or even life-threatening. Depending on the withdrawal symptoms and the substance that was abused, it might be necessary to use medication to help make withdrawal more comfortable and safer.1 Withdrawal symptoms are often uncomfortable enough to lead a person to return to drug use.

Substance Withdrawal Symptoms

Although each drug has specific physical and mental withdrawal symptoms associated with discontinuation, there are a number of general physiological symptoms that typically occur during withdrawal from alcohol or drugs.

Physical Symptoms

Woman with fever from substance withdrawal
Some general symptoms often associated with withdrawal from drugs or alcohol include:3-6

  • Flulike symptoms, such as fever, chills, nausea, vomiting, diarrhea, stomach cramps, muscle cramps, headaches, or perspiration.
  • Difficulty breathing.
  • Irregular heart rate, decreased heart rate, or increased heart rate.
  • Pressure or tightness in the chest.
  • Shakiness or tremors.
  • Difficulty sleeping, including trouble staying asleep or staying awake.

Psychological Symptoms

A person may experience a number of mental, emotional, and cognitive symptoms as a result of withdrawal from drugs or alcohol, including:3-6

  • Extreme cravings.
  • Nervousness, anxiety, and/or panic attacks.
  • Mood instability and/or severe depression.
  • Restlessness and/or irritability.
  • Isolating from other people.
  • Difficulties with concentration, memory, and problem-solving.
  • Drug craving

Drugs that belong to the same class will have similar withdrawal profiles. In general, a drug’s withdrawal symptoms are typically the opposite of its pharmacologic effects.6

Withdrawal Factors

In addition to the symptoms associated with discontinuing a specific drug, other important factors that may influence the severity, onset, and length of the withdrawal syndrome include:3,6

  • The length of time the person took the drug and how much he or she typically used. People who have used drugs for longer periods of time and/or taken them in larger amounts may experience more severe and lengthier withdrawal symptoms.
  • How the drug was used. Injecting, smoking, or snorting the drug may result in more acute and complicated withdrawal syndromes than oral consumption of pills or liquids.
  • The use of other drugs. Combining drugs with alcohol or with other drugs such as narcotic pain medications, benzodiazepines, and stimulants, may lead to additional symptoms or more severe and complicated withdrawal symptoms.
  • Individual differences in metabolism and psychological makeup. People may detoxify at different rates and be more or less sensitive to the various physiological effects of withdrawal.
  • The form of withdrawal. Enrolling in a medically supervised withdrawal management program, which may include prescription medication, can result in a lengthier period of withdrawal. But despite a lengthier withdrawal course, the unpleasant symptoms of withdrawal may be significantly reduced or even eliminated.

Tolerance and Dependence

Drug and alcohol withdrawal is a series of physiological symptoms brought on by a decline of drugs and/or alcohol in the blood and tissues. It may be preceded by the development of tolerance to and dependence on a drug.

Tolerance

Tolerance describes an individual’s state when the dose of a particular drug (or alcohol) becomes less effective with continued use of the substance, the person needs a higher dose to achieve the effects that were once achieved at lower doses.7 Tolerance causes a person with a substance use disorder (SUD) to continue increasing their drug or alcohol dosage to reach their desired high.8

Dependence

Dependence describes the physical state when  a person’s body has adapted to the presence of a substance. When a person stops using or significantly decreases the amount of a drug or alcohol, their body begins to go through withdrawal.8,9

Withdrawal symptoms may indicate physical dependence.

Withdrawal symptoms indicate that a person may have developed physical dependence on a substance.9 This is not the same thing as addiction or an SUD, which is where a person compulsively takes drugs or drinks alcohol despite harmful consequences.13 Physical dependence does not necessarily mean the person has an SUD, or addiction, although dependence does often accompany an SUD.9


Treatment for Withdrawal

Quitting a drug and going through withdrawal “cold turkey” can be uncomfortable and potentially lead to adverse medical complications.

Medically assisted withdrawal management programs offer safe, effective, and comfortable  approaches to detoxification and negotiating the withdrawal process.

Nurse monitoring patient in drug withdrawal

Detoxification and Medically Managed Withdrawal

Detoxification (detox) is the process through which the body clear itself of alcohol or drugs.10 Detox is meant to help individuals manage the uncomfortable and potentially dangerous effects that can occur when drug or alcohol uses stops.10

Detox may include the use medications that are prescribed and provided by a doctor, and this is called “medically managed withdrawal.”10 There are medications that can help patients with withdrawal from opioids, alcohol, benzodiazepines, barbiturates, and other sedatives.10 Some of these medications also help to prevent drug cravings not only during detoxification but also during treatment—and even beyond treatment. This helps to guard against relapse and also makes it easier for people to stay in treatment.14

It’s important to note that detox and medically managed withdrawal do not address the social, behavioral, and psychological issues connected to addiction, so it should only be viewed as the important first step of treatment.10

Medications

The withdrawal management process may include the administration of medications that can significantly reduce withdrawal symptoms or, in some cases, eliminate them.

Some of the medications used in the withdrawal management process include:11,12

  • Benzodiazepines for withdrawal from alcohol and other benzodiazepines.
  • Opioid replacement medications, such as buprenorphine (Suboxone) and methadone, to lessen withdrawal symptoms and suppress cravings from opioid drugs such as heroin, morphine, Vicodin, and OxyContin.
  • Medications to block the effects of and reduce cravings for opioids, such as naltrexone.
  • Supportive medications that address specific withdrawal symptoms and other symptoms associated with co-occurring psychological disorders or medical issues.

Medical management of withdrawal may be necessary in the case of long term abuse for certain classes of drugs, including alcohol, benzodiazepines, and barbiturates. Withdrawal from regular use of these substances can result in severe confusion, hallucinations, and the development of life-threatening seizures that may need to be medically addressed. 4,6

People attempting to stop their abuse of these drugs should first consult a physician and/or a licensed mental health care professional before significantly reducing their use or discontinuing the drug.


 

Withdrawal from Specific Drugs

Learn more about the withdrawal symptoms, timeline, and treatment process for:


Sources

  1. National Institute on Drug Abuse. (2019). Frequently Asked Questions.
  2. Gupta, M., Gokarakonda, S.B., Attia, F.N. (Updated 2020 Jul 2). Withdrawal Syndromes. StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2020 Jan-.
  3. Doweiko, H. (2011). Concepts of chemical dependency. Stanford, CT: Nelson Education.
  4. American Psychiatric Association. (2013). Diagnostic and statistical manual of mental disorders (5th ed.). Arlington, VA: American Psychiatric Publishing.
  5. Heit, H. A. (2003). Addiction, physical dependence, and tolerance: Precise definitions to help clinicians evaluate and treat chronic pain patients. Journal of Pain & Palliative Care Pharmacotherapy 17(1), 15-29.
  6. Ries, R. K., Fiellin, D. A., Miller, S. C., & Saitz, R. (2014). The ASAM principles of addiction medicine. New York: Lippincott Williams & Wilkins.
  7. National Institute on Drug Abuse. (2018). The Science of Drug Use and Addiction: The Basics.
  8. National Institute on Drug Abuse. (2017). Tolerance, Dependence, Addiction: What’s the Difference?
  9. National Institute on Drug Abuse. (2018). Principles of Drug Addiction Treatment: A Research-Based Guide (Third Edition): Is there a difference between physical dependence and addiction?
  10. National Institute on Drug Abuse. (2018). Principles of Drug Addiction Treatment: A Research-Based Guide (Third Edition): Types of Treatment Programs.
  11. World Health Organization: Geneva. (2009). Clinical Guidelines for Withdrawal Management and Treatment of Drug Dependence in Closed Settings.
  12. Substance Abuse and Mental Health Services Administration. (2020). Naltrexone.
  13. American Society of Addiction Medicine. (2019). Definition of Addiction.
  14. National Institute on Drug Abuse. (2020). Drugs, Brains, and Behavior: The Science of Addiction: Treatment and Recovery.

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