Recognizing Withdrawal

Using drugs or drinking alcohol once won’t trigger withdrawal symptoms afterward. You may feel the negative effects of your body dealing with the substance, like a hangover after drinking too much, but that’s still not withdrawal.

Withdrawal is a specific set of symptoms that come about as a result of a missing chemical stimulus in the body. It is important to recognize how these relationships develop over time and can lead to serious medical conditions like withdrawal symptoms without proper care.

Regarding substance use, people are generally placed into one of two categories: casual (non-pattern-based) or pathological (pattern-based). Those in the casual category tend to use a substance infrequently, such as only having an alcoholic beverage on holidays or smoking a cigar on special occasions. Additionally, people with a casual relationship with substances use them in a limited capacity and have no issue not using them again for long periods with no real consequences.

Pathological relationships, conversely, are marked by frequent, repetitive patterns, daily smoking, daily (or frequent) alcohol use above recommended standards, or even use of other substances such as opiates, stimulants, and sedatives that are used outside of medical guidance. Pathological relationships usually result in substance use disorders along with other behavioral health conditions that, without help, can lead to serious medical conditions. One of these conditions is directly related to when frequent substance use is suddenly stopped, which is referred to as substance withdrawal.

What Is Withdrawal?

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Dr. Ashish Bhatt, MD explains the dangers of alcohol and Opioid withdrawal, and why it’s important to seek professional help when coming off substances.

What Is Withdrawal?

Drug and alcohol withdrawal is also referred to as detox or detoxification. Withdrawal symptoms occur when a substance like alcohol, opiates, stimulants, benzodiazepines, or other drugs are used frequently and then removed suddenly from the body.

The body strives to feel “normal” throughout the day, also known as homeostasis, which means it makes changes within itself to accommodate for continuous changes to its normal routine. This is important to understand, as most substances that are used are broken down into chemicals that are already produced within the body naturally. By bringing in more of these artificial chemicals repetitively, the body is forced to adjust so it can feel “normal.” The body will begin to stop making its own chemicals in large numbers as the outside substances have effectively taken that job. The medical community calls this phenomenon becoming “physically dependent” on a substance.

Because of these changes, when a user decides to slow down, stop using, or is forced into a situation where they no longer have access to the substance, the body quickly begins to experience uncomfortable symptoms that we call withdrawal symptoms. The severity of the withdrawal symptoms will differ among individuals based on a variety of factors that include:

  • Substance(s) used
  • How substances are used
  • Amount of substance used

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Different Kinds Of Withdrawal

While the premise of withdrawal is the same regardless of the substance being used, different substances have different effects on the body which, in turn, leads to different withdrawal symptoms. These symptoms can range from mild flu-like symptoms in the case of opiate withdrawal, to serious, life-threatening symptoms during alcohol withdrawal.

Alcohol (Beer, Wine, Liquor)

Alcohol is often considered a “normal” substance to most people, as it’s not only legal but socially acceptable (sometimes even expected) to drink alcohol in public settings. Almost everyone knows someone who drinks or has had alcohol at some point in their life. There is even a decent chance that some have experienced uncomfortable symptoms the day after drinking too much alcohol, referred to as a hangover. To be clear, those uncomfortable symptoms do not represent true withdrawal symptoms and should not be considered the same experience. When alcohol becomes a “tool” to manage stress and emotions, the relationship becomes pathological in nature.

Sadly, while alcohol is one of the most socially accepted drugs, it is also the substance with the most associated deaths. Alcohol withdrawal is very serious and is often considered the deadliest of all substance withdrawals due to the high risk of seizures and other conditions that can develop without proper medical care. Depending on the severity of the withdrawal, a condition called delirium tremens (DT) can develop, which, while rare, can be fatal even under medical supervision.

Alcohol withdrawal symptoms can last days to weeks if left untreated, and when appropriately treated, they can generally be managed within 5-10 days.

Symptoms Of Alcohol Withdrawal

  • Nausea
  • Vomiting
  • Tremors
  • Profuse sweating
  • Agitation
  • Headaches
  • Hallucinations
  • Anxiety/depression
  • Confusion
  • Fatigue

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Nicotine (Cigarettes, Chewing Tobacco, Vaping)

Nicotine products rival the popularity of alcohol from a legal and social standpoint, though certain forms, such as cigarettes and chewing tobacco, have decreased in recent years. It is a substance that is used both socially and alone, making it a prime example of a substance that can be easily abused, leading to physical dependence. Because nicotine use can be used in so many different environments, the behavior of its use can become ingrained in people’s daily behaviors and result in psychological dependence to “get through the day” with its mood-boosting properties.

Smoking is the leading cause of preventable death—cancer, lung disease, heart disease, and chronic obstructive pulmonary disease (COPD)—in the United States. It’s also a very difficult habit to break, with success rates among current smokers of only 7.5%.

Withdrawal symptoms of nicotine are quite uncomfortable and, combined with the psychological dependence, can feel too difficult to overcome. Thankfully, there are many strategies that include medication management and nicotine replacement therapies that can assist with ending nicotine use.

Symptoms Of Nicotine Withdrawal Include

  • Increased hunger
  • Constipation
  • Increased sweating
  • Agitation
  • Headaches
  • Difficulty sleeping
  • Anxiety
  • Itchiness
  • Fatigue
  • Short temper

Opioids (Heroin, Oxycodone, Fentanyl)

Opioid use disorders have become one of the most common substance use disorders in the US for several reasons. One primary reason for the rise in opioid abuse is related to its history as a pain management medication. When used in short periods, opioids can be an extremely beneficial tool for managing short-term pain after surgeries and for conditions where pain can be resolved quickly.

Unfortunately, opioids have also been used in conditions where pain does not resolve, such as long-term chronic pain conditions like fibromyalgia or arthritis, resulting in use that lasted long enough to create a physical dependence in the body. This dependence can, and has, occurred even when following medical guidance for the medication dosages. This phenomenon has evolved into what is the “opioid epidemic,” which has seen a sharp increase in the use of non-prescription opiates like heroin and fentanyl, resulting in more than 100,000 overdoses across the country in 2022.

The risk of life-threatening conditions occurs with the actual use of opioids, most often in the form of overdose and contracted medical conditions associated with using opiates intravenously (IV). The withdrawal process from opiates is not usually life-threatening; however, it’s still extremely dangerous and should always be done under medical supervision.

Many describe opioid withdrawal as going through a very difficult flu, while others describe it as a sensation of being unable to feel comfortable in their skin.

Symptoms Of Opiate Withdrawal

  • Nausea/vomiting
  • Diarrhea
  • Sleep difficulties
  • Profuse sweating
  • Agitation
  • Chills
  • Body aches
  • Anxiety/restlessness
  • Stomach cramps
  • Blood pressure changes

Benzodiazepines (Xanax, Valium, Klonopin)

Benzodiazepines are a class of prescription medications that are used to treat and manage short-term anxiety and sleep-related disorders. They work by sedating the nervous system of the user, which has similar effects to alcohol. Benzodiazepines, sometimes referred to as “benzos,” enhance the levels of a chemical in the brain called GABA, which is responsible for slowing down processes in the brain. This slowed process typically results in feelings of relaxation, reduced stress, and drowsiness.

Benzodiazepines are so effective at increasing GABA levels that the body can very quickly result in physical and psychological dependence in just a few weeks. Benzodiazepines are highly addictive, and healthcare providers are recommended to only prescribe them for short periods of time to ensure dependence does not form. Benzodiazepine use is especially concerning when alcohol is used in combination due to the high risk of overdose since both substances interact in the body very similarly.

Withdrawal symptoms from benzodiazepines are described as physically and mentally taxing, as the physical and psychological dependence are both being addressed at the same time. There are risks associated with withdrawal from benzodiazepines, and in some instances can be life-threatening. There are multiple types of medical treatment options for a safe Benzodiazepine detox that are highly encouraged, as trying to detox without medical supervision is never advised.

Symptoms Of Benzodiazepine Withdrawal

  • Nausea
  • Vomiting
  • Tremors
  • Profuse sweating
  • Agitation
  • Headaches
  • Heart palpitations
  • Anxiety/panic attacks
  • Confusion
  • Fatigue

Stimulants (Methamphetamine, Cocaine, Adderall)

Stimulants make up a large category of substances and prescription medications that increase nervous system activity. They tend to form more psychological dependence rather than a physical dependence; however, the energy boost they provide can lead to a dependence on them physically to get through the day.

Stimulants all function in different ways and have different impacts on the brain; however, the withdrawal effects all have similar patterns. While withdrawal symptoms are typically the same from stimulant to stimulant, they have different lengths of time that they last in the body, which can lead to withdrawal effects occurring from 6-24 hours, depending on the stimulant.

Stimulant withdrawal is generally not considered life-threatening, although detoxing under the supervision of an experienced medical team is always advised. The process of withdrawal from stimulants usually leads to a state of fatigue and feeling unable to engage in activities, often referred to as “crashing.”

Symptoms Of Stimulant Withdrawal

  • Appetite fluctuation
  • Excessive sleep
  • Insomnia
  • Profuse sweating
  • Agitation
  • Paranoia
  • Difficulty concentrating
  • Anxiety/depression
  • Chills
  • Fatigue

Find Detox Support Today

Regardless of whether withdrawal has life-threatening risks, it can be extremely difficult to manage alone. The risk of medical conditions occurring makes finding help all the more worth it. Contact a treatment provider today to learn about available treatment options.