One out of 12 Americans struggled with addiction in 2014, according to the National Survey on Drug Use and Health (NSDUH), and one of the common side effects of drug addiction is drug dependence. When someone uses drugs regularly, some of the brain’s chemistry is altered. Chemical messengers, called neurotransmitters, that send signals around the central nervous system to tell the body how to react to stress, when to feel pleasure, and work to control emotions are disrupted. This causes both physical and emotional fallout. The body can get used to the drugs being in its system with chronic and repeated use, and parts of the brain may even be rewired from regular drug abuse.
Per the American Society of Addiction Medicine (ASAM), addiction is a brain disease wherein regions of the brain and its circuitry are impacted. When drugs are processed out of the body, levels of some of these neurotransmitters are impacted, and the brain may struggle to rebalance them, resulting in withdrawal symptoms and drug cravings.
Drug withdrawal symptoms can vary depending on the type of drug abused. Some drugs, like stimulants (cocaine, methamphetamine, and prescription ADHD medications) for example, may have more intense emotional withdrawal symptoms. For others, such as with opioids (heroin and prescription painkillers), drug withdrawal can be extremely uncomfortable physically, mirroring a bad case of the flu. Withdrawal from benzodiazepines (prescription tranquilizers and sedatives) and alcohol can be so intense, it can include potentially life-threatening symptoms, Psychology Today warns, and detox should not be attempted without professional help. These drugs should not be stopped “cold turkey” after dependence has formed; they are usually tapered off slowly under the supervision of a trained professional. Drug withdrawal symptoms are optimally managed through a medical detox program as part of a comprehensive addiction treatment plan.
Common Physical and Psychological Symptoms of Drug Withdrawal
Drug withdrawal symptoms can range from potentially fatal seizures to mild nausea and gastrointestinal upset. They often cause opposite reactions than those associated with the drug. For example, benzodiazepine drugs like Xanax and Valium are intended to reduce nerve firings and calm the body’s stress response by enhancing levels of the naturally occurring sedative gamma-aminobutyric acid, or GABA. Functions of the central nervous system, like body temperature, blood pressure, respiration, and heart rate, are depressed under the influence of these drugs. When benzos are then processed out of the body, a rebound effect can occur as levels of GABA dip and central nervous system functions speed up as a result. Grand mal seizures are potential side effects of benzodiazepine drug withdrawal, which The Journal of the Oklahoma State Medical Association warns can lead to coma or even death.
In general, common physical withdrawal symptoms include:
- Abdominal cramps
- Irregular heart rate
- Problems with breathing
- Nausea and stomach upset
- Changes in body temperature
- Heightened or lowered blood pressure
- Changes in appetite and potential weight fluctuations
- Chest pain
- Alterations in pupil dilation
- Back, joint, bone, and muscle pain
- Muscle tension
- Muscle weakness
- Decreased sex drive
- Decreased motor coordination
- Runny nose and/or congestion
- Muscle spasms
- Sluggish movements
- Teeth chattering or grinding
- Involuntary eye movements
- Increased sensitivity to pain
- Rashes or skin irritations
- Bloating and increased flatulence
- Numbness or tingling in hands, feet, fingers, & toes
Drug withdrawal encompasses both physical and emotional symptoms. Levels of serotonin and dopamine, some of the neurotransmitters that help to regulate moods and induce feelings of happiness, are impacted by drug abuse and dependence. During drug withdrawal, the body may be depleted of dopamine and/or serotonin, leaving individuals feeling irritable, moody, depressed, anxious, paranoid, disoriented, apathetic, tense and on edge, excitable, restless, and jumpy. People may have difficulties feeling pleasure from normal things. They may also feel detached from themselves or suffer from psychotic side effects like hallucinations (seeing or hearing things that are not actually there) or delirium. Nightmares, vivid dreams, and sleep disturbances are also common.
Aggression, hostility, and violent outbursts may also accompany drug withdrawal. During drug withdrawal, individuals often have trouble thinking straight and concentrating, and short-term memory functions may be impaired. Emotional lows, crying for no reason, drug cravings, and mood swings are common, as the brain struggles to restore healthy levels of its mood-regulating chemicals.
Individuals may be at a higher risk for suicidal thoughts, ideations, or actions during drug withdrawal, making medical detox and professional help all the more necessary.
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Variables in Drug Withdrawal
Drug withdrawal symptoms vary from person to person, and their severity largely relies on the level of dependence on the drug. The longer a person has used the drug in question, the more severe the dependency. The method in which it was abused, the amount used at a time, and polydrug (using more than one drug at time) abuse can all influence drug dependency. Biological factors, such as metabolism, age, gender, and any medical or mental health conditions, also play a role in the intensity of drug withdrawal. Genetics and personal or family history of addiction also factors in. Environmental aspects, like home life and exposure to trauma and stress, can be involved in the level of drug dependence and therefore the significance and duration of the withdrawal side effects. The more dependent on a drug a person is, the more intense and longer withdrawal is likely to be.
Drug withdrawal begins as soon as the drug stops being active in a person’s body. This can be different depending on the drug involved. Typically, opioid withdrawal begins about 12 hours after the last dose (closer to 30 hours for longer-acting opioids like methadone), the National Library of Medicine (NLM) reports. Stimulant drugs like cocaine are usually fast-acting and wear off quickly, so withdrawal symptoms may start sooner.
For most drugs, withdrawal symptoms typically peak within the first few days of stopping use and then start to gradually lessen over time. Acute withdrawal usually refers to the bulk of a person’s withdrawal symptoms and tends to follow this general timeline, the Substance Abuse and Mental Health Services Administration (SAMHSA) publishes:
- Marijuana: 5 days
- Alcohol: 5-7 days
- Opioids: 4-10 days
- Stimulants: 1-2 weeks
- Benzodiazepines: 1-4 weeks
After acute withdrawal, symptoms usually start to taper off, although sometimes people may suffer from protracted withdrawal. Protracted withdrawal syndrome can include ongoing drug cravings, sleep and mood disturbances, irritability, physical pain, decreased energy levels, and difficulties with memory and the ability to think clearly. Protracted withdrawal may continue for several weeks or even months without professional help.
The presence of co-occurring mental health disorders simultaneously with drug dependence and addiction can complicate and exacerbate withdrawal symptoms. When co-occurring disorders are present, integrated and comprehensive care models work to manage the side effects of both disorders at the same time, as each disorder may contribute to the other. Drug withdrawal symptoms can be successfully managed with the help of medications and a high level of supportive care that is provided through a medical detox program.
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