Withdrawal syndrome or ” mono ” is a cluster of physical and psychological symptoms that arise when a person abruptly stops using a previously abused substance. It can also appear if the addict decreases the amount of substance he used to consume. For example, when a person suddenly stops using cocaine, alcohol or heroin.
This most commonly occurs if there is dependence on alcohol, drugs, certain psychotropic drugs, or tobacco. However, it can also occur with some foods (such as sugar or coffee) or non-substance addictions such as pathological gambling.
The withdrawal syndrome is an important indicator that there is dependence on something. This appears more intensely if the doses consumed are high. As if the individual has been abusing the substance for longer.
Withdrawal symptoms vary widely. They depend on the substance that has been abandoned and generally correspond to the opposite sensations that the substance has contributed. For example, if alcohol is relaxing, then in the withdrawal phase, the alcoholic will be nervous and tense.
This is due to problems in the functioning of our nervous system, as it is used for the drug’s effects to work normally.
Symptoms can get worse if the drug is abused to try to alleviate other illnesses, infections, malnutrition, pain, sleep problems, etc. In this way, withdrawal can be even more unpleasant, which increases the likelihood of using the drug again.
As for the diagnosis, it is not uncommon for this syndrome to be confused with various diseases or mental disorders. That is why it is important to gather information to find out if the patient has taken a substance and then abruptly stopped using it.
There are some medications to treat withdrawal symptoms. However, with most substances, the addict must go through this substance-free phase to overcome their addiction problem.
Causes of withdrawal syndrome
Our organism is always in search of homeostasis. Thus, when you receive the same substance over and over again, a series of mechanisms are triggered that have the objective of returning to the previous state. In other words, keep functioning without the consumption of the drug affecting you.
This is known as “tolerance” and is the phenomenon that explains why addicts increasingly need a higher dose to feel the desired effects. Thus, the nervous system gets used to and adapts to the new substance so that it continues to function properly.
Therefore, if the substance is removed, the achieved homeostasis is disrupted and unpleasant withdrawal symptoms appear.
Brain and addictive substances
Our nervous system has substances called neurotransmitters, chemical compounds that allow our neurons to exchange information. Neurons release neurotransmitters and also capture them through specific receptors.
Addictive substances modify the normal activity of our brain by attaching to these receptors or enhancing (or decreasing) the effects of existing neurotransmitters. This is translated by feelings of reward, well-being, relaxation, euphoria, etc.
However, the body perceives that there is an external substance modifying its normal functioning, and its way of stopping the chaos is to create compensatory mechanisms to adapt to it (tolerance).
Thus, the amount of neurotransmitters released and the number of receptors that capture them are modified. For example, if a substance produces significant increases in serotonin in some region of the brain, natural serotonin production is diminished, as well as the downregulation of serotonergic receptors.
This occurs after a long time consuming the substance in large quantities. So, when the individual interrupts consumption, he feels discomfort, anxiety, changes in appetite, sleep… (Withdrawal syndrome). As your body without the drug becomes out of balance, it takes time to get back to homeostasis.
On the other hand, there are many other habits whose dependency is mainly psychological rather than physiological. Withdrawal symptoms in this case are a little different. The brain interprets that it has lost a valuable reward, which is reflected in emotional distress and behavioral changes.
Withdrawal syndrome symptoms
Each type of medication produces a specific withdrawal syndrome, although there are general withdrawal symptoms that can be observed. These can be divided into emotional and physical.
emotional symptoms
These symptoms can occur with any type of addiction. Some of them can also arise from non-substance addictions such as gambling, shopping, sex or the internet. They are associated with the “down” mood experienced by stopping the pleasurable substance or activity. These symptoms are:
– Anxiety
– Restlessness or nervousness.
– irritability.
– Difficulty concentrating.
– Great sensitivity to stress, “they drown in a glass of water”.
– Intense desire to use the drug again or engage in addictive activities.
– social isolation.
– Headaches.
– Insomnia and / or sleep disorders.
On drugabuse.com, they indicate that something that characterizes these symptoms is their intermittency, which can appear and disappear for days and even weeks. Furthermore, they do not affect the individual to the same extent throughout the course of the withdrawal.
On the other hand, it appears that some of the symptoms mentioned can arise anytime from several weeks to months after coming off the substance. These fluctuate, there are periods when there are no symptoms.
Each substance is associated with a certain time in the onset of withdrawal symptoms. For example, with alcohol, the most intense withdrawal symptoms are reached between 24 and 72 hours. While in benzodiazepines, this peak reaches approximately two weeks.
The explanation given for this phenomenon is that each substance has different long-term effects on our brain.
physical symptoms
They are those usually produced by substances that cause physical dependence, such as alcohol, tranquilizers and opiates. They have a physiological character and consist of:
– Excessive sweating.
– Increased heart rate.
– Palpitations
– muscle stiffness.
Tremors.
– Accelerated breathing.
– Diarrhoea, nausea or vomiting.
Types of withdrawal syndrome
Depending on the substance consumed, the DSM-V distinguishes different types of withdrawal symptoms described below.
alcohol withdrawal syndrome
According to the World Health Organization, alcohol withdrawal symptoms usually appear between 6 and 48 hours after stopping consumption.
They consist of tremors, sweating, nervousness, agitation, low mood, nausea, discomfort … In addition to the desire to consume this substance again, which is known as “craving”. These under normal conditions disappear within 2 to 5 days after withdrawal.
In more severe cases, delirium tremens may occur, characterized by changes in consciousness, sweating, fever, convulsions, hallucinations and even risk of death.
tobacco withdrawal syndrome
In the DSM-V, it is described that the amount of tobacco consumed is eliminated or reduced, which in the following 24 hours produces symptoms such as irritability, frustration, anxiety, concentration problems, increased appetite, nervousness, mood and difficulties. to sleep.
stimulant withdrawal syndrome
Stimulants include substances such as amphetamines, cocaine, speed, caffeine, etc. Its withdrawal produces a depressed mood, as well as fatigue, insomnia or hypersomnia, increased appetite, unpleasant and vivid dreams, psychomotor retardation or agitation.
Sedative, hypnotic, or anxiolytic withdrawal
Sedatives include alcohol, sleeping pills, tranquilizers for anxiety, etc.
If they stop taking it or their dose is reduced, two or more of these symptoms will appear: increased heart rate, sweating, and other symptoms of autonomic nervous system overactivity; tremors, insomnia, nausea or vomiting, hallucinations or perceptual illusions, anxiety, psychomotor agitation and even convulsions.
opioid withdrawal syndrome
Opioids are analgesics (substances that dissipate pain). Some of them are morphine, codeine, methadone and heroin.
Withdrawal syndrome may arise if administration of the addictive substance is stopped or if an opioid antagonist is used in the addict.
Three or more of these symptoms must appear: low mood, nausea or vomiting, diarrhea, muscle aches, watery eyes, runny nose or excess nasal mucus, pupil dilation, sweating, chills, fever, sleeplessness, or yawning.
cannabis withdrawal syndrome
If marijuana is used daily or almost daily for several months and then stopped, withdrawal symptoms may occur, such as: aggression, irritability, anxiety, sleep problems, loss of appetite (and consequently weight loss); restlessness and depressed mood.
In addition, there is at least one physical symptom, such as: abdominal pain, tremors, spasms, sweating, fever, chills, or headaches.
caffeine withdrawal
Although caffeine is a legal and widely consumed substance, it is a stimulant drug (and therefore can cause withdrawal).
In the Diagnostic and Statistical Manual of Mental Disorders (DSM), it is indicated that caffeine withdrawal occurs due to daily and prolonged consumption of this substance, followed by an abrupt interruption or reduction of the dose.
It produces three or more of the following symptoms: headache, drowsiness, discouragement and irritability, concentration problems and flu-like symptoms (nausea, pain, muscle stiffness…). These symptoms must produce clinically significant discomfort or influence the person’s social or professional life.
neonatal abstinence syndrome
Although it does not appear in the DSM-V, this type of withdrawal has been studied extensively. It is the syndrome that is observed in newborns when the mother consumes any kind of addictive substance during pregnancy. Newborns can also experience withdrawal if a medication is stopped with substances such as morphine, used to relieve pain.
Symptoms in babies and adults vary according to the type of medication the mother has used, the dose, how long it has been taken, and how the mother’s body eliminates the medication.
The most common is that these babies at birth have a strong cry, nervousness, tremor, fever, seizures, excessive sucking, vomiting or diarrhea.
Treatment
Although withdrawal is very unpleasant, it is a necessary process that an addict must go through in order to recover from addiction.
First, the addicted person must be aware of the symptoms they will experience if they stop the drug. Just as the important thing is that you resist this process in order to overcome your problem.
Medicines
Currently, most detox clinics do not use any medications. While it is true that medications have been shown to help some people with this phase by reducing the side effects of withdrawal.
For example, buprenorphine and methadone are effective for opioid detoxification and for physical symptoms. They also reduce cravings to use the drug again. Both are opioid agonists. That is, they produce an effect similar to opiates, but milder.
They are also sometimes combined with naloxone, an injectable medication. It is an opioid antagonist, meaning it has the opposite effect to opiates, blocking opioid receptors in the brain.
However, it must be managed and supervised by a medical professional, as its abuse can lead to even worse withdrawal syndrome.
For withdrawal caused by cocaine abuse, a medication called modafinil, a mild stimulant, has proven to be helpful.
As for benzodiazepines, they are sometimes withdrawn gradually using long-acting benzodiazepines. This is because it can be dangerous to abruptly stop using these medications. Its withdrawal can lead to seizures, strokes or heart attacks.
Something similar happens with alcohol. When it is suddenly removed, it causes dangerous consequences such as those mentioned above, as well as hallucinations and delirium tremens.
Antidepressant medications were also used during the medical detox process to prevent anxiety, depression and panic attacks.
medical supervision
It is essential that substance detox is under medical supervision. A professional will ensure the patient’s safety by monitoring their vital signs and emotional symptoms. The goal will be to reach a comfortable and safe state of physical stability so that psychological symptoms can be addressed (American Addiction Centers).
The important thing is that each treatment is appropriate to the case and the drug (or drugs) used, as well as the side effects of abstinence.
In addition to drugs, the work of a team of professionals is essential in the drug detoxification process. It will be very helpful for these patients to set goals and focus on achievement. They must assume that abstinence is a difficult step, but it is only part of the path to combating addiction.
Once stabilized, the patient usually works with group and individual therapies. They strengthen a person’s self-esteem and social skills. Strategies are also developed to avoid situations where the substance could fall.
On the other hand, you can develop your skills and hobbies through healthy activities. Usually, physical exercise is recommended, as it helps to strengthen the immune system and restore brain balance, in addition to reducing stress.
