Withdrawal often referred to as withdrawal syndrome, is a situation where a person presents with predictable signs and symptoms following a sudden removal of a drug’s regular dosage, according to the National Institute of Drug Abuse (NIDA). The signs and symptoms associated with withdrawal syndrome may vary depending on the drug, however, there is a tendency to have the physical functions and processes that were initially being suppressed by taking the drug to be exaggerated. A person who has been dependent on depressants like sedatives, opiates, and alcohol may begin to rebound with excessively stimulated symptoms as they go through the symptoms of withdrawal. On the other hand, an individual who has been irresponsibly using excitatory stimulants such as crystal meth and cocaine may have a rebounding depression within their physiologic function after an abrupt removal of the drug, this happens just before withdrawal symptoms begin.
Drug Withdrawal Timelines
The withdrawal symptoms, as well as the length of the withdrawal, is greatly based on the kind of drug being abused and the time it has taken an individual to live under influence of that drug (addiction). The timelines for the drug withdrawal syndromes based on different drugs may be as follows:
- Cocaine: An individual may experience depression and restlessness that last for about 7 to 10 days
- Prescription painkillers and heroin: A person may have flu-like symptoms that go on for about 24 to 48 hours
- Alcohol: An individual may experience tremors or seizures that may last from three days to about a couple of weeks
- Benzodiazepines: A person may have anxiety and seizures that tend to last for weeks, sometimes for months.
According to the National Center for Health Statistics, the number of people aged 12 and above who said they have used an illicit drug at least in the past month is about 10.1 percent (estimated 27.1 million) as of 2015. In the same year, the number of individuals at the age of 12 and above who said they have used a psychotherapeutic drug for nonmedical use in the past month was 2.4 percent. Taking alcohol and an addictive drug changes the way the brain is able to process emotions and regulate mood. In a majority of the cases, they create an increased number of neurotransmitters such as dopamine and serotonin that induce an artificial feeling of a “high” or a feeling of pleasure.
If a person continues to abuse alcohol or drugs, it alters the reward and motivation pathways thus causing drug dependence and cravings. Once an individual becomes dependent on a drug when they stop taking that drug, withdrawal symptoms set in. Depending on an individual’s bodily and brain functions, the withdrawal symptoms, as well as timelines, may vary. You will find that when drugs are taken and absorbed into the body, they remain active for some time. The time it takes for the substances and their metabolites to be completely eliminated from the body will vary greatly. The “half-life” of a drug is the time it takes for half amounts of the substance to be excreted from the body and it relates to the withdrawal timelines.
Again, the duration and severity of withdrawal symptoms may be influenced by many factors including the level of dependency. The length of time an individual has been abusing a substance and the type of drug or substance being abused will have an effect on the time it takes for the withdrawal symptoms to go away and their severity. Other factors include:
- The dosage (amount) an individual takes each time
- The method of administration, for example, smoking, swallowing, snorting, or injecting
- Genetic makeup and family history
- Mental and medical health factors
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Heroin and Opiates
Opiates, also referred to as opioids are drugs meant to treat pain. When an individual stops using the drug after they have been on heavy use for some time, they experience opioid or heroin withdrawal symptoms. About 435,000 people in the US used heroin in 2014 and in the same year, roughly 4.3 million individuals were said to be nonmedical users of pain-relieving medications or narcotics such as heroin, codeine, morphine, oxycodone, and methadone. People who abuse narcotic pain relievers for an extended period tend to develop drug tolerance and physical dependence. Prescription opioids like OxyContin and Vicodin tend to have similar effects to heroin and about 80 percent of people who use heroin (for medical and recreational purposes) report having misused prescription opioids first.
Opiates Withdrawal Symptoms
Withdrawing from long-term use of opioid drugs causes physical and psychological effects. The physical symptoms may at times mimic those of flu. The withdrawal symptoms occur in two distinct phases namely: early and late withdrawal. With the former (early withdrawal) an individual experiences:
- Muscle aches
- A runny nose
During late withdrawal phase, an individual may experience symptoms such as:
- Dilated pupils
- Abdominal cramps
During dependency phase when a person is addicted to narcotic painkillers, usually the brain has to release more noradrenaline so that an individual maintains their wakefulness. However, when the opioids are suddenly removed, the body pumps the excessive amounts of noradrenaline, something that happens for about a week. This causes many of the withdrawal symptoms. A person may have an intense fear, sometimes, they may be preoccupied with thoughts of drying.
The Drug Enforcement Administration says that heroin takes effect pretty quickly, but it tends to leave the body quickly. Heroin has a very short half-life, just a few minutes. An opioid like OxyContin is said to have a half-life of about 3 to 4 hours, that’s for the immediate-release version while the extended-release version has a half-life of about 12 hours. Morphine, another narcotic painkiller has a half-life of about 6 to 10 hours. So, withdrawal tends to start after the half-life (the time when the drug is active in the body) expires.
Among the highly prescribed medications for treating psychological and physical maladies in the US are benzodiazepines. These medications are used in conditions like panic disorders, anxiety, and seizures. Sometimes, they may be used as muscle relaxants or sleep aids. It is estimated that more than 15 kinds of benzodiazepines exist for treating different health problems. To be characterized as a benzodiazepine, the medications should show some of the following drug actions:
- Muscle relaxant
- Anxiety relief
- Mild memory-loss inducer (an amnesiatic)
Benzodiazepines have sedative properties that make them the most likely to be abused, especially if an individual uses them along with other depressants like opiates and alcohol. With the Controlled Substances Act, benzodiazepines are classed as Schedule IV drugs. Among the most prescribed benzodiazepines are such as Xanax, Ativan, Librium, and Valium. A benzodiazepine drug known as Rohypnol has received a lot of attention in the recent years because it’s association with sexual assault cases often being referred to as the “date-rape drug.”
Benzodiazepines interfere with a brain neurotransmitter known as gamma-aminobutyric acid (GABA). The neurotransmitter inhibits motor neurons meaning the presence of GABA stops or slows down neuronal activity. These drugs work by enhancing the activity of GABA, something that slows nerve impulses in an individual’s body.
Benzodiazepines Withdrawal Symptoms
When a person has been living under the influence of benzos, and they suddenly stop taking them, they may experience a rebound. As the body begins to restore the balance of GABA levels that have dropped, early withdrawal symptoms begin to manifest in the form of anxiety and insomnia. A majority of the withdrawal symptoms arise in the phase of acute withdrawal and they include:
- Irregular heart rate
- Short-term memory loss
- Panic attacks
- A headache
- Stiffness and pain of muscles
- Disturbed sleep
- Difficulty concentrating
- Heart palpitations
According to a report by the National Library of Medicine, if a person stops taking benzos abruptly, it can result in life-threatening withdrawal symptoms because of the associated grand mal seizures that may lead to coma or death. More serious side effects associated with benzos withdrawal include extreme confusion, hallucinations, delirium, and fever.
Benzos have different half-lives, some may be short-acting and others are long-acting. These are also those that are intermediate-acting, so the withdrawal timelines may differ depending on how the active ingredient of the medications stays in the body. A short-acting benzo like triazolam (Halcion) will have a shorter half-life, which also means that the withdrawal will set in fast compared to intermediate or long-acting benzos.
Cocaine has a short half-life, it will clear from the body in less than an hour. Being a stimulant drug, cocaine increases the heart rate, blood pressure, and temperature. In people who use cocaine, they find that it brings about extreme euphoria and higher energy levels. It also enhances self-confidence. That said, these feelings don’t usually last for long. Because a dose doesn’t cause lasting feelings, individuals tend to abuse cocaine by repeated binge patterns. The powder form of cocaine is mostly smoked, injected, or snorted while the rock form, also known as “crack”, is administered by smoking. People who inject and smoke cocaine have it delivered pretty fast into the brain resulting in a great “high” and faster “crashes.”
In a 1986 study conducted by Gawain and Kleber, it indicated that cocaine withdrawal takes place in three phases. The study involved 30 cocaine-dependent outpatients and the research team identified the phases as crash, withdrawal, and extinction.
In phase one, which is the “crash” withdrawal stage, cocaine users had acute dysphoria, anxiety, irritability, exhaustion, increases in the desire for sleep, decreased craving, and increased appetite. The “crash” stage developed rapidly after ending a heavy cocaine use.
The second phase or phase two, also referred to as the “withdrawal” stage, manifested with the symptoms such as poor concentration, increased craving, some lethargy, and some irritability. These symptoms went on for about 10 weeks.
In phase three, which is also known as extinction, it was mostly characterized by intermittent craving. The users also experience suicidal thoughts that may present for a couple of months after the last consumption of cocaine.
While this phasal model has persisted in the clinical application, other studies haven’t supported it, they have found a different trend where users of cocaine gradually return to their normative function with time. Cocaine withdrawal, unlike other substances, may not have many physical symptoms. It is also not life-threatening.
While moderate use of alcohol may not be harmful, it is estimated that 18 million American adults suffer from AUD or alcohol use disorder. Their drinking contributes to harm and distress. With alcohol dependence and alcoholism, they cause:
- Tolerance, where an individual seeks to drink more so that they get the same effect
- Craving or a strong need to drink
- Loss of control, once you start drinking, you cannot stop
- Physical dependence that manifests with withdrawal symptoms every time you suddenly end drinking
Alcohol abuse may not necessarily mean that a person is physically dependent, but they may have problems. For example, a person abusing alcohol may put themselves in dangerous situations or even lead to social and legal problems. Some people may have binge drinking where they consume about five or more drinks in a span of two hours, that’s for men. With women, binge drinking may indicate that one consumes four or more drinks within the same span of two hours. Heavy drinking increases your risk of having certain cancers and can damage your brain, liver, and other organs. Women who drink while pregnant may risk harming their baby. Other effects caused by alcohol abuse include increased risk of deaths arising from car accidents, suicides, homicides, and injuries.
How Do You Know You Have AUD?
If two of the situations below apply to your alcohol drinking case, then you may be said to have AUD:
- Have a strong desire to consume alcohol
- Want to stop or cut down on drinking but you can’t
- You spend a lot of time drinking alcohol or recovering from its use
- You keep on drinking even when it is causing problems with your friends and family
- Every time you go drinking, you drink more than you had planned or you drink longer
- You keep on drinking even when you feel like it’s making you anxious or depressed
- You need more alcohol so that you can get the effects
- Have been having withdrawal symptoms after you have been drinking (when the alcohol is wearing off). These symptoms include anxiety, irritability, nausea, restlessness, sweating, shakiness, and depression.
Alcohol Withdrawal Symptoms
With 1 in every 12 American adults battling with alcohol abuse and dependence, it may be said that alcohol is a highly abused substance. The New England Journal of Medicine notes that about 50 percent of individuals having AUD develop withdrawal symptoms whenever they discontinue or reduce their alcohol consumption. Also, about 3 to 5 percent of individuals with AUD tend to suffer a very serious alcohol symptom known as delirium tremens along with other grand mal convulsions. Other side effects that are associated with alcohol withdrawal include:
- Loss of appetite
- Mood swings
- Nausea and vomiting
- Diminished color in the face
- Elevated heart rate
- Clammy skin
- Muscle aches
- Difficulty concentrating
- A headache
- Shallow breathing
Alcohol withdrawal may set in just a few hours after your last drink, however, serious symptoms of delirium (severe confusion) may not start until a couple of days later. Delirium tends to be sudden and an individual needs to be monitored day and night by a medical specialist. The cravings and emotional effects associated with alcohol abuse may continue to occur for a long time.
Why and When a Patient Needs Detox?
People addicted to alcohol, benzos, and opioids need a medical detox to help get rid of the substance from their body without any significant adverse consequences. It may take time, but under the supervision of a medical professional, an individual may eventually be free from the substances. The medical professional will safely monitor any vital signs or emotional issues that a patient may develop during the detox process.
Sometimes, medications like methadone and buprenorphine may be administered to help ensure effective treatment of dependency on opioids. These substances are considered partial opioid agonist meaning they partially activate the brain’s opioid receptors. Because the drugs are long-lasting, it means they are reliable in reducing drug craving and withdrawal symptoms.
In people with benzos addiction, they may be prescribed a longer-acting benzodiazepine to help with the detox. The extended-release benzo helps to taper down the drugs abused and control withdrawal. Patients receiving medical detox may also be prescribed medications like mood stabilizers or antidepressants to address certain psychological symptoms including anxiety, depression, and panic. An individual may be considered for inpatient or outpatient medical detox depending on their level of addiction or dependency.
Different drugs tend to have varying withdrawal timelines (the time it takes for withdrawal symptoms to set in following an end to the drug consumption), hence treatment for the patients needs to be tailored depending on the side effects and the drug in question. A medical professional should assess the emotional and physical symptoms to find out the kind and level of care that would yield the best results. The withdrawal may be complicated by the medical and mental health of the patient or abuse of multiple drugs at a time.
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