Addiction Withdrawal

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Part of the Complete Guide to Understanding Addiction


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I. What is Addiction Withdrawal?

A human body functions on a principle called homeostasis. The concept was originated by Claude Bernard in the mid-1800s and the term coined by Harvard physiologist Walter Cannon in the 1920’s. It defines the body’s ability to constantly adjust and keep all its interdependent elements in equilibrium. In layman’s terms, this means that the body will fight to keep itself from going out of whack, no matter what foreign substances or unhealthy practices pull to one extreme.

Drug use artificially creates chemical imbalances. For example, alcohol, a depressant, holds down the transmitters in the brain that produce energy and focus. As dependence to alcohol increases, the body adjusts its tolerance level accordingly. This is why as people drink more, and drink more often, it will take much greater amounts to get them drunk. When a person stops using, the body needs some time to compensate for the sudden loss of whatever the drug of choice was providing. Until it does, a person’s natural balance will be shaken, and withdrawal symptoms will present.

In general, a good rule of thumb to consider is that whatever the substance use is providing, withdrawal will create the opposite effects. Cessation of stimulant use will create lethargy and depression, and vice versa. This will affect a person both emotionally and physically as we will illustrate below.

II. What are the Effects of Withdrawal?

As mentioned above, withdrawal takes both an emotional and physical toll. Symptoms and the strength how they present varies on the substance itself, the type of substance, and the length of abuse that has taken place, among other elements.

  1. Central Nervous System (CNS) Depressants

 Depressants slow brain activity. Due to homeostasis, when someone is addicted to this type of addictive substance, the brain will compensate by producing stimulant chemicals in abnormally large amounts. Upon sudden abstinence, these extra chemicals take time to readjust and the brain is massively overstimulated. An apt analogy by a explainer from Harvard Health Publishing draws a parallel between sudden alcohol withdrawal to “an accelerated vehicle that has suddenly lost its brakes.“  This can lead to heart palpitations, seizures, and strokes.

Alcohol withdrawal carries risk of a condition called Delirium Tremens (DT). Its symptoms are hallucinations, high blood pressure, and overall confusion. When left unchecked, it can progress to complete cardiovascular and respiratory collapse. It has a relatively high mortality rate, with over 5% of those diagnosed succumbing to it.

The two leading abused depressant substances are alcohol and benzos. When ceasing use of these substances, medically supervised detoxification is absolutely critical. Quitting cold turkey is simply too dangerous.

  • Opioids

Opioid withdrawal on the physical side is generally contained to intense discomfort and is not usually considered life-threatening. However, it can cause violent illness, dizziness, vomiting and the like, and is best done in a controlled medical environment to ease symptoms as much as possible. Furthermore, the emotional stressors of withdrawal can lead to depression, suicide ideation and other mental stability issues and should be carefully monitored.   

  • Stimulants (Cocaine)

Other drugs, including stimulants like cocaine, while not as physically damaging during withdrawal, can cause emotional and psychological stress. It may provide overwhelming triggers and trigger relapse.

In all cases, the best course of action is to seek treatment in an accredited drug and alcohol detox and rehab facility. Care and supervision in a controlled environment may well be the difference between lasting abstinence or relapse.  

III. How Long Does Withdrawal Last?

In general, addiction withdrawal falls into two distinct phases.

The first stage is the initial period of abstinence, which splits into early withdrawal and acute withdrawal. During that time, there will be a strong physical reaction to the body losing its fix. As mentioned above, the substances most treacherous to navigate while in withdrawal are alcohol and depressants like benzos.

  1. Early Withdrawal and Acute Withdrawal: Stage One

According to the American Academy of Family Physicians (AAFP), symptoms brought on by alcohol abstinence generally begin from six to twelve hours after initial abstinence. It starts with relatively minor symptoms such as insomnia, upset stomach, anxiety, and headaches. It intensifies in day 2 and can cause hallucinations and seizures. Delirium Tremens may begin to manifest after 48 hours. Alcohol withdrawal usually peaks at 72 hours and then starts to gradually taper off.

Physical dependence to benzos can develop in as little as 3 to 6 weeks of use. Dependence is what is chiefly responsible for withdrawal symptoms and varies according to length of abuse, among other factors. Also, different forms of benzos have different half-lives. Drugs like Xanax and Ativan cycle out of the body more quickly, and withdrawal onset can present in 8-12 hours of the last dose. Other forms, such as clonazepam, are longer acting and it can be one or two days and in some cases even longer for withdrawal to start. Acute withdrawal on average lasts 5-7 days but can sometimes persist for weeks.

It is important to note that these are only baseline averages and varies from patient to patient. When detox is performed in a professional setting, the client will be constantly monitored, and great attention will be paid to his or her progress.

  • Post-Acute Withdrawal Syndrome: Stage Two

After acute withdrawal symptoms have resolved themselves, there can be another stage of withdrawal called Post-Acute Withdrawal Syndrome (PAWS). While initial withdrawal manifests physically and is related to the body healing from the ravages of drug and alcohol abuse, the post-acute stage is primarily an emotional and psychological phenomenon. Depending on an individual’s level of past drug abuse, both in intensity and duration, it occurs weeks or months after abstinence. It can be triggered by stress or involvement in situations- people, places, or things- that remind people of the period in life that they were using. People that have experienced PAWS liken it to a roller coaster. There are periods of calm and storm, and many times there is seemingly no rhyme or reason to why episodes begin or subside.

PAWS can last for a while, sometimes for two years or more. There will be mood swings, lethargic behavior, anxiety, and overall irritability.

It is a major cause of relapse and people need to be prepared for it to happen. When a person in recovery experiences post-acute symptoms, it is important for them to know it is normal and usually will last a couple of days. Remember that it is a good sign- your body is healing, and this is part of the process!

IV. What are the Common Symptoms of Addiction Withdrawal?


OPIOIDS

  • Nausea
  • Vomiting
  • Diarrhea
  • Loss of appetite
  • Abdominal aches
  • Muscle aches
  • Sweats
  • Hot /Cold flashes
  • Chills
  • Piloerection
  • Rhinorrhea
  • Lacrimation
  • Tremors
  • Elevated Pulse
  • Agitation/Irritability
  • Pupil Dilation
  • Yawning
  • Sneezing
  • Depression
  • Anxiety
  • Mood swings
  • Low stress tolerance
  • Impaired concentration
  • Impaired memory

           ALCOHOL 

  • Headache
  • Paroxysmal Sweats 
  • Night Sweats  
  • Loss of Appetite
  • Unsteady Gait
  • Tremors
  • Nausea
  • Vomiting
  • Elevated Pulse
  • Elevated Blood Pressure
  • Elevated Temperature
  • Muscle Twitching
  • Anxiety
  • Insomnia
  • Agitation/Irritability
  • Hallucinations (Auditory, Visual, and Tactile)
  • Seizures
  • Depression
  • Impaired concentration
  • Impaired memory
  • Disoriented/confusion
  • Delirium Tremens
  • Mood swings
  • Low stress tolerance

V. What are Addiction Withdrawal Treatment Options?

For a person dependent on alcohol or opioids, an inpatient detox program is almost always critical. Sudden quitting and a lack of supervision from doctors and trained addiction professionals creates significant health risks and possible death.

A good detox program will provide a safe setting for withdrawal to take place.  There should be 24-hour care, constant monitoring, and compassion. In many cases there are medications that will be appropriate to ease withdrawal symptoms, as well as to ease cravings. Such a course of action is delicate and needs to be continually assessed, evaluated, and prescribed by skilled physicians and administered by medical teams, preferably with backgrounds in addiction. 

Dependence on other substances may sometimes only require outpatient therapy. These decisions should be made after a full mental and physical workup.

It is important to stress that detox is only the first phase of addiction rehab treatment. In order to achieve long term sobriety, people struggling with addiction are best served entering residential treatment once detox is satisfactorily completed. They will learn coping methods, trigger identification and avoidance, and many other skills vital to staying clean and becoming productive. Treatment helps people manage the chronic nature of addiction, work through PAWS episodes that later emerge, and staves off relapse.  

VI. What are Medications Commonly Used during Detox?


ALCOHOL

  • Ativan
  • Librium
  • Magnesium
  • Thiamine
  • Phenobarbital
  • Zofran
  • Phenergan
  • Vistaril
  • Immodium
  • Gabapentin

           OPIOIDS 

  • Lucemyra
  • Clonidine
  • Robaxin
  • Vistaril
  • Bentyl
  • Zofran
  • Phenergan

VII. Addiction Withdrawal at Avenues Recovery

Throughout the Avenues Recovery Network,  detox is performed with the utmost care and dedication. A staff outstanding for their skill and warm bedside manner stand at our clients side and guide through the dark and scary moments of withdrawal. Led by topflight physicians and addiction experts, it is a place of compassion and hope. Treatment is evidence-based, personalized, and holistic. Every possible complication is accounted for and monitored closely.

Detox is followed by our renowned residential and outpatient patient addiction treatment programs. The mission at Avenues does not end with detox. We are committed to putting people back on their own two feet, who can look forward to a bright future as members of a strong and supportive community.

Learn more about Avenues Recovery’s drug detox and alcohol detox programs.

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Brooke Abner,

Motivational Coach