Withdrawal

What is withdrawal?

Withdrawal refers to the signs and symptoms that appear when a drug that causes physical dependence is regularly used for a long time and then suddenly discontinued or decreased in dosage. The term can also, less formally, refer to symptoms that appear after discontinuing a drug or other substance (unable to cause true physical dependence) that one has become psychologically dependent upon.

The continued use of many kinds of drugs such as Alcohol and Heroin causes reversible changes within the body that lessen the drug’s original effects over time. This is known as tolerance. To have these changes to a drug is to have developed a physical dependency on it, for when the drug is suddenly discontinued or decreased the changes do not disappear straight away. Unmitigated by the drug, the changes appear as withdrawal symptoms that are generally the opposite of the drug’s direct effects. Depending primarily on the speed at which the drug is removed by the body, withdrawal symptoms can appear within a few hours to several days after stopping use.

Withdrawal Symptoms

The withdrawal symptoms associated with many drugs of abuse are well-known. Central to the role of nearly all drugs that are commonly abused to produce a “high” is the brain’s “pleasure centre”. Sustained use of the drug results in less and less stimulation of this area of the brain until eventually it produces no high at all. Discontinuation of the drug then produces a withdrawal syndrome often characterised by an uncomfortable mood, depression, anxiety and irritability, in fact the opposite of the high.

Withdrawal symptoms vary between individuals, but there are some common symptoms. As already identified above the experience of withdrawal can be seen to be the opposite of the high and may be experienced as depression, anxiety and craving. If these feelings are extreme they can help drive the person to continue the drug despite significant harm — the definition of addiction — or even to suicide.

As the symptoms vary, some people are, for example, able to stop using immediately, without any slowly reducing their use while others may never find success despite repeated efforts. However, the length and the degree of an addiction or drug use can be an indicator to the severity of withdrawal.

Withdrawal is a more serious medical issue for some substances than for others. While cannabis withdrawal, for instance, is usually managed without medical intervention, attempting to give up a benzodiazepine or alcohol dependency can result in seizures and worse if not carried out properly. An instantaneous full stop to long, constant alcohol use can lead to delirium tremens, which may be fatal.

Cold Turkey and withdrawal

“Cold turkey” is a slang expression describing the actions of a person who gives up a habit or addiction all at once. That is, rather than gradually easing the process through reduction or by using replacement medication as in the case of Heroin addiction and the use of drugs such as Methadone. The supposed advantage is that by not actively using replacement medication, the person avoids thinking about the habit and its temptation and avoids further feeding the chemical addiction. Clearly identified disadvantages related to the abuse of drugs such as heroin is the unbearable suffering from the total absence, causing tremendous stress on heart and blood vessels and in a worst case scenario possible stroke or heart failure.

As already identified sudden withdrawal from drugs such as benzodiazepines, barbiturates and various opiates can be extremely dangerous, leading to potentially fatal seizures. In long-time alcoholics, going cold turkey can cause life-threatening seizures and fits and thus is not considered an appropriate method for treating an alcohol addiction.

In the case of habits related to mild and legally obtainable drugs, going cold turkey may be unpleasant, but most probably not life-threateningly dangerous.

Dealing with withdrawal

Dependent upon many of the factors identified above the most effective way to deal with withdrawing from the majority of drugs of abuse (including alcohol) and, indeed many prescribed medications is by way of a medically supervised detoxification. This can be by way of replacement medications and/or a supervised reduction of the drug in question.

This detox or detoxification can be in a number of settings and can be by way of:

Home Detox (or Community Detox)
In-patient Detox
Rapid Detox

Dependent upon severity and length of use and the symptoms experienced when making any attempt to reduce or remove the drug by the user in the past a decision should be made about the level of detox based upon a professional assessment.

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