What is Withdrawal?
Withdrawal is the combination of physical and mental effects that a person experiences after they stop using or reduce their intake of a substance such as alcohol and recreation or prescription drugs .
Drug or alcohol withdrawal involves the physical, mental, and behavioral changes that can occur after suddenly cutting back on or stopping prolonged use of substances.
The character and severity of withdrawal can vary in association with different substances, but symptoms may be quite pronounced when attempting to quit alcohol and other substances such as opioids, benzodiazepines, and sedatives.
These substances can carry significant risks when going through withdrawal. These withdrawal symptoms can range from mild to potentially dangerous. If not medically managed, withdrawal from certain substances, such as alcohol, opiate, and benzodiazepines, can be quite severe and, in some cases, lethal. Medical detox can be a safe way to help manage withdrawal under the care of treatment professionals.
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Symptoms of Withdrawal
These eight are only a few of the many possible withdrawal symptoms. They represent the most common and most severe symptoms that people experience.
When someone sees, hears, or feels things that aren’t there, they are experiencing something medical experts call alcohol or alcohol hallucinosis. This symptom can be the most challenging and frightening to overcome. Hallucinations start around 6-24 hours after consuming alcohol or drugs (particularly opioids and benzodiazepines). It can persist for a few days.
Opiate withdrawal-induced severe exacerbation of psychosis after the sudden withdrawal of an opiate is a known clinical manifestation . The patient presented with psychotic symptoms such as irritability, delusions of parasitosis, and auditory and visual hallucinations.
In most cases, the hallucinations from alcohol withdrawals are similar to DTs, or delirium tremens. This is when the body struggles in the earliest stages of stopping drinking so much to correct itself from the adverse effects of alcohol that it experiences hallucinations.
Seizures are terrifying and can be risky. Not everyone experiences seizures, but if you do they will occur within the first 48 hours of alcohol withdrawal. Seizures are a common toxic complication of numerous drugs and poisons and drug withdrawal syndromes. .
Several case series have identified various drugs and other substances associated with seizures. Antidepressants, diphenhydramine, stimulants (including cocaine and methamphetamine), tramadol, and isoniazid account for most cases. However, substances implicated in drug‐induced seizures have evolved as new drugs enter the market.
The risk for seizures due to alcohol withdrawal peaks at 24 hours after the last drink and then tapers down. Some people experience single, more intense seizures once in a while. Others experience multiple, “smaller” seizures in groups. Although uncomfortable and scary, the seizures will let up by your third day.
Repeated or prolonged seizure activity may lead to irreversible neurological injury, as well as other life‐threatening complications such as hypoxia, hypotension, pulmonary aspiration, hyperthermia, rhabdomyolysis, and metabolic acidosis.
A tremor is an involuntary shaking movement that can occur anywhere in the body, affecting parts individually. Within only 5 hours of the last alcoholic drink, most people going through alcohol withdrawal will get the shakes. Tremors are most obvious in the hands, but the whole body is shaking.
The shakes are usually accompanied by anxiety, a racing heart, and restlessness. The reason for alcohol withdrawal tremors or shakes is that alcohol affects areas of the brain that control muscle movement. If someone is experiencing anxiety as they go through alcohol withdrawal, they’re more likely also to experience tremors or shaking.
Drug-induced tremors are caused by your brain’s response to the chemicals in certain medications. Drug-induced tremors can also occur as the result of withdrawal from drugs. For example, one of the worst sets of withdrawal symptoms comes from using or abusing long-term benzodiazepines. Benzodiazepines are legal when they are prescribed, and however, you can purchase them on the street.
During alcohol withdrawal, the brain struggles to regain the balance of its neurotransmitters. These chemicals are what allow our brain cells to communicate and function. When they are severely disturbed, in the case of alcohol withdrawal, we can get confused. Our brains are overwhelmed, stressed, and not working as quickly and efficiently as normal.
Confusion is a common withdrawal symptom among meth abusers. They also may display a number of psychotic features, including paranoia, visual and auditory hallucinations, and delusions (for example, the sensation of insects creeping under the skin). Psychotic symptoms can sometimes last for months or years after quitting using methamphetamine. In addition, stress has been shown to precipitate spontaneous recurrence of methamphetamine psychosis in people who use methamphetamine and have previously experienced psychosis.
Nausea and vomiting are typical symptoms of alcohol and drug withdrawal. Unfortunately, this symptom can last for a whole week after quitting the substance.
Prepare for stomach problems by drinking fluids and electrolytes. Some sports beverages might help you get through withdrawal without getting too dehydrated.
Heart palpitations can feel like a heart attack or worse and trigger a panic attack. The cardiovascular system, stressed by chronic substance abuse, has a hard time adjusting to sobriety. During withdrawal, expect your heart to race and beat irregularly from time to time.
The term cardiac arrhythmia describes a disruption to the heart’s natural rhythm. Individuals with cardiac arrhythmia may experience heart palpitations or the feeling of an irregular heartbeat. Heart palpitations and cardiac arrhythmia can lead to stroke, heart failure, and death. In fact, these heartbeat irregularities are one of the leading causes of death related to opioid use. Heart palpitations and cardiac arrhythmia are also risk factors during opioid withdrawal.
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Delirium Tremens (DT)
In only 5%-20% of alcohol detox cases, delirium tremens can take place. This is the most severe form of alcohol withdrawal and it is an emergency situation that requires medical attention. Delirium tremens refer to a hyper-adrenergic state where the brain is overcome with those excitatory neurotransmitters. For those who develop delirium tremens, most will require treatment in the ICU, Intensive Care Unit.
Delirium Tremens is characterized by much more severe versions of the typical withdrawal symptoms. The most recognizable are confusion and hallucinations. Although confusion and hallucinations are to be expected, in delirium tremens, the person is not as clear. They lose sight of reality and can fall into a sleepy or confused state that lasts for days. This condition begins around 24-48 hours after the last drink and can persist for up to two weeks.
Withdrawal from benzodiazepines  has a lot of common features (of alcohol withdrawal) like tremor, agitation, perceptual disturbances, seizure, and even delirium. Moreover, it might also influence the dose of benzodiazepine to be used to treat DT. Delirium tremens (DT) is diagnosed when patients demonstrate: (1) an acute change in mental status or fluctuating changes in mental status; (2) inattention measured using either an auditory or visual test; and either (3) disorganized thinking; or (4) an altered level of consciousness.
For most people, alcohol withdrawal symptoms will pass within 5 days without any major complications. However, in a small minority of cases, some people don’t make it through detox. The mortality rate for people who experience delirium tremens is between 15% and 20%. For this reason, we recommend that anyone considering alcohol detoxification seek out medical assistance ahead of time.
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Causes of Withdrawal
The brain and body work to maintain a state of balance known as homeostasis. Taking a substance changes that balance, so your body has to take steps to adjust, including changing the levels of certain neurotransmitters. These substances act on your brain’s reward system, triggering the release of chemicals.
When you regularly take a substance for a period of time, your body may build a tolerance and dependence on that substance. Tolerance means that it takes larger doses of the substance to achieve the same effects that you initially experienced, while dependence means that your body requires the substance in order to avoid experiencing withdrawal effects.
If you abruptly stop or decrease your substance intake, your body is again thrown off balance and symptoms of withdrawal may result. Such symptoms are often both physical and mental, and can potentially be dangerous depending on the type of drug.
Withdrawal symptoms are often the opposite of the effects of the substance. For example, alcohol is a depressant, so if you suddenly stop consuming alcohol, you might experience symptoms of overstimulation such as anxiety or restlessness.
Types of Withdrawal
The following are some examples of substances that may lead to withdrawal and the expected duration of those symptoms:
Barbiturates are sometimes referred to as central nervous system (brain and spinal column) depressants, or tranquilizers. These drugs produce an anesthetic and sedative effect. Drug intervention is often required when barbiturate addiction is indicated. This drug’s withdrawal can be uncomfortable without medical assistance.
Hallucinogens cause changes in thought patterns, emotions, consciousness, and perception. These drugs can make a person hear, smell, taste, and feel things that are not real or are not happening. A hallucinogen is normally known to intensify a person’s mood, according to the mood that he or she is in when the drug is taken. Withdrawal is not normally dangerous for a hallucinogen, but the potential for injury is high while the drug is in effect. This drug is best used under medical care.
Commonly Abused Hallucinogens
Narcotics are analgesics, also known as pain-relieving drugs. Narcotics are central nervous system depressants with the added psychoactive compound that can increase sleep, reduce pain, and induce euphoria. Narcotics are used for a number of pain-reliving situations, from surgeries and major pain to temporary pain relief. Narcotics can also be used as cough suppressants. Narcotics can cause withdrawal as soon as 12 hours after the last dose, with symptoms lasting up to five days. Psychological withdrawal can last a number of months.
Commonly Abused Narcotics & Opioids
Inhalants ( such as Poppers, and Whippets) are volatile substances used to produce mild-altering effects by producing chemical vapors that are inhaled by the user. Inhalants are normally psychologically addictive, but not physically.
Depressants are psychoactive drugs. These drugs are used to temporarily reduce the function of the brain and central nervous system. These drugs can include opiates, barbiturates, tranquilizers, and others. Alcohol is one form of depressant. Depressants can cause dependency, which causes a user to need more of the drug to achieve the same effects. Withdrawal can occur when a depressant is reduced or stopped. These withdrawal symptoms can be potentially dangerous, so medical withdrawal is often required.
Prescription depressants are grouped into three drug classes: Benzodiazepines, like Xanax, Valium, Klonopin, and Ativan; Barbiturates, like Nembutal; and Sedative-Hypnotics like Ambien, Lunesta and Sonata.
Antidepressants include drugs that are used to treat depression in people. These drugs called selective serotonin reuptake inhibitors, or SSRIs, as well as other forms of antidepressants such as NDRIs, MAOIs, Tricyclic antidepressants, and SNRIs, can cause tolerance and dependency in some individuals. These drugs can cause psychological and physical addiction. Withdrawal can occur if the drug is not tapered correctly.
Stimulants increase the normal activity of the central nervous system. There are a number of legal stimulants, as well as illegal. Legal stimulants include caffeine, nicotine, energy drinks, and prescription amphetamines. Illegal drugs include methamphetamine (meth), cocaine, and ecstasy. These drugs are highly addictive. Often, these drugs cause a mild withdrawal at the onset of use. Over time, if the drug is increased in the body, withdrawal symptoms may worsen.
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Treatment of Withdrawal
Drug and alcohol withdrawal can pose risks for relapse, overdose, medical and psychological complications, and even death. Attempting to withdraw on your own can increase the risk for dangerous outcomes, especially when withdrawing from alcohol and other central nervous system depressants.
Medical detox programs offer the opportunity to go through withdrawal in a safe environment with careful monitoring by professionals. Medical staff will carefully monitor withdrawal symptoms and provide medical treatment to reduce discomfort and prevent complications like delirium and seizures. This type of detox from drugs and alcohol can be accomplished in an inpatient setting. Inpatient medical detox programs offer the opportunity to detox in a highly structured environment with 24-hour monitoring.
Treatment after withdrawal involves learning how to cope with triggers and urges to use alcohol and other drugs and investigating what contributed to the addiction. Continuing treatment options can include inpatient rehab, where a person stays at a facility for an extended period of time. During an inpatient stay, you will have the opportunity to focus exclusively on your recovery without the stressors of everyday life.
The medications your doctor may prescribe to help alleviate symptoms of withdrawal will vary depending on the type of substance you were taking. Some medications that are used to treat various types of withdrawal include:
- Catapres (clonidine)
- Librium (chlordiazepoxide)
- Buprenex (buprenorphine)
- Valium (diazepam)
- Ativan (lorazepam)
Other medications may also be used to manage specific withdrawal symptoms. These may include anti-anxiety medications, anticonvulsants, antipsychotics, or other drugs designed to treat nausea or sleep problems.
Coping with Withdrawal
In addition to seeking medical support, there are also things that you can do that may help you feel better as you go through the withdrawal process:
- Ask for help. Whether you are handling withdrawal on your own or under the supervision of a doctor, it is important to have social support. Tell a trusted friend or family member so that they can check-in and support you during the process.
- Eat well. Focus on eating nutritious, well-balanced meals. Eating fried, fatty, or sugary foods may make you feel worse.
- Exercise. Try to get some physical activity each day. Stretching, walking, swimming, or other activities may help boost your mood.
- Drink plenty of water. It is important to stay hydrated as you are going through withdrawal, especially if you are experiencing flu-like symptoms such as nausea and vomiting.
- Relieve symptoms with over the counter (OTC) medications. Use appropriate OTC medications at the recommended dosages if you are experiencing symptoms such as headache, upset stomach, or diarrhea.
- Sleep. While withdrawal can sometimes lead to sleeping difficulties, try to get an adequate amount of rest. Work to establish a regular sleep schedule and practice good sleep habits.
Stress management activities such as yoga and meditation may also help you cope with your withdrawal experience. Be sure to reach out to your doctor, however, if you are struggling to cope or if you experience any worrisome symptoms.
If someone is struggling with drug or alcohol addiction and its intense and often dangerous alcohol withdrawal symptoms, they should consider inpatient rehab. We Level Up NJ addiction specialists are standing by to help. Asking the question “What does withdrawal mean” and learning about its risks could be a good start in helping your loved one.
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 NIAAA – https://pubs.niaaa.nih.gov/publications/arh314/348-361.htm
 NCBI – https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7872486/
 NCBI – https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4767205/#:~:text=Seizures%20are%20a%20common%20toxic%20complication%20of%20numerous,cases%20are%20due%20to%20drug%20toxicity%201%2C%202.
 NCBI – https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6286444/