Drug and Alcohol Withdrawal: An Insight

Withdrawal from alcohol and other drugs is the set of clinical features that occur when a person cuts out or cuts back the addictive substance after a period of prolonged or excessive use.

What is Withdrawal?

A common example of withdrawal is feeling a headache slowly develop when you forgo your morning coffee.

It’s an unpleasant feeling, but the headache is your body responding and adjusting to the lack of caffeine in your system. Your body is attempting to maintain stable internal conditions; this stability is called homeostasis (Kenny 2014).

Dependence and Addiction

It is important to note that DSM 5 has criteria for the diagnosis of Alcohol Use Disorder and Drug Use Disorders (APA 2013).

In the context of withdrawal from drugs and alcohol, it is crucial that the concept of addiction and dependence is first acknowledged. Prolonged or excessive use of a substance can lead to tolerance and physical dependence. This process in itself is complex and depends on various physical, environmental, social and psychological factors (SA Health n.d.; Becker 2008).

It is this dependence that the body has on the substance that then leads to withdrawal if the substance is abruptly stopped or reduced.

If people who are very dependent on alcohol cease drinking, they will likely face a range of physical and cognitive symptoms (Kenny 2014). Note it is extremely dangerous and even life-threatening for someone who is addicted or dependent on alcohol to cease drinking suddenly without pharmacological/medical intervention and support.

Types of Dependencies

Physical Dependence

Physical dependence is not addiction, these are not interchangeable terms.

Physical dependence is a pharmacologic effect characteristic of various types of substances. It is defined as the occurrence of an abstinence syndrome (withdrawal reaction) after the sudden discontinuation of a drug, substantial dose reduction, or administration of an antagonist (a substance that disrupts the physiological action of another) (Polston, GR & Wallace, MS 2017).

In the case of physical dependence, not only has a person used a substance long enough for their body to rely on it to feel ‘normal’ (ADF n.d.) but an individual will require more and more of the drug to achieve the initial positive effect and will rely on continued use of the drug to prevent painful and uncomfortable withdrawal symptoms (Oster 2017).

Psychological Dependence

Generally, the term psychological dependence encompasses both the emotional and mental processes that are associated with the development of, and recovery from, a substance use disorder or process addiction. It is worth noting, there can be no complete separation of emotion and cognition from physiology (American Addiction Centers 2019).

An example of psychological dependence is if a person expressed uncertainty about being able to stop using the substance of choice; or if they displayed signs of anxiety if someone tried to intervene or prevent them from taking the substance (American Addiction Centers 2019).

Severity of Withdrawal

The severity of withdrawal will depend on the following factors:

• How long the person has been using for;
• Which drug(s) they’ve been taking;
• Their age;
• Their physical health;
• Their psychological characteristics;
• The method of withdrawal;
• Physical dependence.

(ADF n.d.; Healthdirect 2018)

Symptoms

Symptoms will vary between people and depending on which substance the person is withdrawing from. See typical withdrawal symptoms for specific drugs.

As a person’s body becomes used to functioning without the drug, withdrawal symptoms will range from mild to severe and can be life-threatening.

Generally, the symptoms of withdrawal will be the opposite of what the drug feels like. An example of this is when withdrawing from a drug such as alcohol - a depressant - a person may experience restlessness and agitation (ADF n.d.).

Common symptoms related to drug withdrawal include:

• Insomnia;
• Irritability;
• Changes in mood;
• Depression;
• Anxiety;
• Aches;
• Muscle spasms;
• Pains;
• Craving;
• Fatigue;
• Hallucinations; and
• Nausea.

(Healthdirect 2018; Gonzales 2018)

Coping With Cravings

When a person is addicted to a drug, their body knows that the fastest way to feel good will be to take that particular drug.

Cravings will generally fluctuate in their frequency and they may be weak or strong. Managing cravings is important in the long term, as they may come back even years after a person has stopped using the substance (ADF n.d.).

Craving management may include mind retraining techniques such as productive distraction or relaxation. This can involve, reading, watching a movie, meditating or exercising.

Remind patients that their brain has acquired a pattern of thought over time, but they are capable of retraining their brain to follow a new thought pattern (ADF n.d.).

The length of time that someone will experience withdrawal symptoms depends on many factors, including the type of drug and how long the person has been using it. Generally, withdrawal symptoms will last between a few days to a few weeks. However, cravings can last a long time (ADF n.d.).

There is also the options of treating withdrawal symptoms with certain medications, this is called pharmacotherapy (ADF n.d.).

Is Withdrawal Safe?

It is vital that a person has medical supervision to carry out a safe withdrawal.

This is particularly important when withdrawing from alcohol, gamma-hydroxybutyrate (GHB), benzodiazepines or ketamine (ADF n.d.).

It is crucial that recovery takes place in a safe environment, such as at home if appropriate, in a detox facility, or a hospital (Healthdirect 2018).

Steps to Safe Withdrawal

The following can support the process of a safe withdrawal:

1. Talking to a doctor or alcohol and other drugs treatment service;
2. Writing down a list of reasons for giving up the drug;
3. Planning what to do if drugs are used during withdrawal;
4. Identify situations/contexts in which drug-taking may be particularly tempting;
5. Learn the risks of overdosing;
6. Keeping busy (watching movies, exercising, reading);
7. Practising stress management and distraction techniques;
8. Practising self-care.

(ADF n.d.; Gonzales 2018)

Additional Resources

• Drug Facts, Alcohol and Drug Foundation, https://adf.org.au/drug-facts/
• Withdrawal Management of Alcohol and Other Drugs - Part 1 https://www.ausmed.com.au/cpd/lecture/withdrawal-management
• Withdrawal Management of Alcohol and Other Drugs - Part 2 https://www.ausmed.com.au/cpd/lecture/withdrawal-management-of-alcohol-and-other-drugs

References

• Alavi SS, Ferdosi M, Jannatifard F, Eslami M, Alaghemandan H, Setare M 2012, ‘Behavioral Addiction Versus Substance Addiction: Correspondence of Psychiatric and Psychological Views’, Int J Prev Med, 3(4):290-4
• Alcohol and Drug Foundation (ADF) n.d., Withdrawal, ADF, viewed 16 December 2019, https://adf.org.au/reducing-risk/withdrawal/
• American Addiction Centers Editorial Staff 2019, What is Psychological Dependence? American Addiction Centers, viewed 17 December 2019, https://americanaddictioncenters.org/the-addiction-cycle/psychological-dependence
• Becker, HC 2008, ‘Alcohol Dependence, Withdrawal, and Relapse’, Alcohol Res Health, 31(4):348-61
• Diagnostic and Statistical Manual of Mental Disorders 2013: DSM-5, Arlington, VA, American Psychiatric Association
• Gonzales, M 2019, Withdrawal Symptoms of Symptoms of Alcohol and Drugs, Drug Rehab, viewed 17 December 2019, https://www.drugrehab.com/addiction/withdrawal-symptoms/
• Healthdirect 2018, Addiction Withdrawal Symptoms, Healthdirect, viewed 16 December 2019, https://www.healthdirect.gov.au/addiction-withdrawal-symptoms
• Kenny, P 2014, ‘What Causes Drug Withdrawal?’ Brain Facts, viewed 16 December 2019, https://www.brainfacts.org/ask-an-expert/what-causes-drug-withdrawal
• Oster, R 2017, ‘Understanding the Difference Between Physical Dependence and Addiction’, The Buzz, viewed 17 December 2019, https://www.centeronaddiction.org/the-buzz-blog/understanding-difference-between-physical-dependence-and-addiction
• Polston, GR and Wallace, MS 2017, Analgesic Agents in Rheumatic Disease, in Kelley and Firestein's Textbook of Rheumatology (Tenth Edition).
• SA Health n.d., Alcohol Withdrawal Management, SA Health, viewed 17 December 2019, https://www.sahealth.sa.gov.au/wps/