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    Alcohol and Drug Withdrawal: Causes, Symptoms and Treatment

    Symptoms of withdrawal may occur when you abruptly stop using alcohol or a drug that you’ve developed a physical and mental dependence on over time. The intensity of withdrawal symptoms and how long they last vary depending on the type of drug or how heavy a drinker you are as well as biological make-up. Typical symptoms range from sweating, goosebumps and trembling to vomiting, insomnia, muscle pain and seizures.

    What is withdrawal?

    Withdrawal is the term used for the physical and psychological symptoms that occur after stopping or reducing your intake of alcohol or a drug. The severity of withdrawal symptoms depend on what substance you stop using, how long you have been drinking or using a drug and your body type.

    Drinking alcohol and using a drug regularly and over a long period of time can develop first into a tolerance, then a dependency and eventually an addiction. Withdrawal symptoms are your body and brain’s reaction to the sudden loss of the substance and reacting to the new chemical imbalance.

    Withdrawal symptoms can be unpleasant and scary. Withdrawal is also potentially dangerous and life-threatening in some cases, which is why you should seek help for the management of drug and alcohol withdrawals from your doctor or a rehab centre like White River Manor in South Africa to undergo a medically-supervised detox. This is always the safer option than going ‘cold turkey’.

    Did you know?

    The phrase “going cold turkey” – when a person abruptly stops drinking alcohol or taking drugs – relates to the goosebumps you sometimes get in the days after you quit, which look like the skin of a cold turkey in the fridge.

    Physical and mental symptoms of substance withdrawal

    It’s important to remember that psychological dependence is as serious as physical dependence if you’re living with an addiction. In fact, psychological and physical characteristics of withdrawal are interchangeable. Symptoms of withdrawal such as depression, anxiety and loss of interest will likely manifest in physical symptoms such as shaking, sweating, headaches, racing heartbeat, shortness of breath and nausea.

    Whole bodyMuscle pain, fatigue, lethargy, excessive hunger, loss of appetite, night sweats, trembling, clammy hands and skin, goosebumps, hot flushes, gagging, nausea, vomiting, stomach cramps, flatulence, runny nose, dilated pupils, watery eyes, seizures, slurred speech, chattering teeth and muscle weakness 
    BehaviourCrying, agitated, irritated, restless pacing and excitable; possibly self-harm, panic attacks or risky behaviour 
    PsychologicalDepression, anxiety, paranoia or delirium 
    CognitiveFeel detached, lose concentration, poor memory, loss of interest, agitated or nervous

    What causes alcohol withdrawal syndromes?

    Alcohol has a depressive effect on your nervous system in which it suppresses certain neurotransmitters, much like a sedative. It affects multiple bodily functions, specifically your brain function which it slows down and changes the way your nerves send messages back and forth.

    Your central nervous system eventually adjusts to having alcohol in your bloodstream all the time and it works hard to keep your brain ‘awake’ and talking to your nerves. It does this by releasing massive amounts of dopamine and GABA (gamma-aminobutyric acid) which act as a chemical messenger. Your body makes excess dopamine and your nervous system uses it to send messages between nerve cells.

    If your brain is continually exposed to the yo-yo effect of the depressant effects of alcohol and a massive flood of dopamine, you will eventually develop a dependence on alcohol. This is because, with heavy, long-term drinking, your central nervous system requires more and more alcohol to produce the same sedative effect and dopamine release.

    If you have an alcohol use disorder and suddenly stop drinking, your neurotransmitters are no longer inhibited by alcohol and your brain struggles to adjust to the new chemical imbalance which is now lacking in dopamine. This imbalance causes the debilitating side effects of alcohol withdrawal.

    You may experience mild to moderately severe symptoms within the first 48 hours after your last drink, such as confusion, severe shaking and nausea. You can also experience severe symptoms such as delirium tremens, hallucinations and seizures which are life-threatening.

    What is alcohol withdrawal syndromes (AWS)?

    Alcohol withdrawal syndrome (AWS) is the name for the collective symptoms that occur when a heavy drinker – someone with alcohol use disorder – suddenly stops or significantly reduces their alcohol consumption. Alcohol withdrawal syndromes can be mild to moderate or severe, including hallucinations, delirium and seizures. In some cases, alcohol withdrawal syndromes can be life-threatening.

    Is alcohol withdrawal dangerous?

    Yes, sudden alcohol withdrawals can be dangerous, even life-threatening. It’s possible to die from alcohol withdrawal but it’s not common. Regardless, abruptly stopping alcohol if you are a heavy drinker is not recommended without professional medical assistance.

    If you suddenly quit drinking alcohol, your system stops releasing the massive amounts of dopamine and other neurotransmitters which it did when you had alcohol in your system. This can cause your brain literally to go into shock because it doesn’t know what to do without this chemical messenger.

    Basically, alcohol itself is a sedative. When you suddenly stop drinking alcohol after developing a dependence on it, you can enter a state of hyperarousal. This can cause heart arrhythmias and kidney and liver dysfunction which can be fatal. These withdrawal symptoms need to be managed by a professional doctor in a supervised detox process to remove the risk of danger to yourself.

    What causes drug withdrawal symptoms

    What causes drug withdrawal symptoms?

    If you are exposed to any type of substance for a regular period of time, the substance throws off your body’s sense of balance. This is known as homeostasis. Homeostasis is the state of stable internal, physical and chemical conditions maintained by a living organism. If homeostasis is successful, life continues. If it is unsuccessful, it results in decay or the death of the organism.

    Your central nervous system works very hard to maintain homeostasis and it does this by introducing counter-regulatory processes. This involves modifying the levels of certain neurotransmitters, hormones and other natural chemicals in your body.

    Over time, as you develop a tolerance for a substance, your body needs more and more of the drug to produce the same effects that were once achieved with less of the substance. Your body keeps adjusting to the levels of drug in your system which leads to increased tolerance and eventually dependence and addiction.

    If you suddenly stop using a drug, homeostasis that your body has worked so hard to maintain is suddenly thrown out whack. Your body maintains homeostasis with a certain level of the drug in its tissues. When this level drops, your system becomes unbalanced and drug withdrawal syndrome occurs. Symptoms range from mild to severe, where you could develop life-threatening symptoms such as seizures.

    Is drug withdrawal dangerous?

    Yes, sudden drug withdrawal is dangerous. It can even be life-threatening in some cases. That’s why it’s recommended that drug withdrawal is managed by professionals in a medical detox programme. You will be provided with medical help to eliminate withdrawal symptoms that can be debilitating and scary.

    Acute drug withdrawal symptoms can cause a variety of physical and psychological health issues. These range from mild flu-like symptoms to severe delirium and seizures. If you experience these withdrawal symptoms for a long time without medical supervision, it can lead to chronic mental issues such as depression and anxiety.

    What is the difference between dependence and addiction?

    When talking about substance withdrawal, it’s important to understand the difference between dependence and addiction. The words are often used interchangeably but there are some ground rules that will help you understand the two terms.

    Drug and alcohol dependence

    Dependence refers to the physical dependence on alcohol or a drug. It is characterised by the symptoms of tolerance and withdrawal. You can have a physical or emotional dependence without being addicted.

    Dependence occurs when your body as a whole becomes used to the effects of alcohol or a drug and goes into withdrawal if you stop using the substance.

    Drug and alcohol addiction

    Drug and alcohol addiction involves both a mental and physical reliance on the substance. It is marked by a change in behaviour which is caused by the biochemical changes in the brain after continued substance use and abuse.

    This change in behaviour can cause people to act irrationally, engage in self-destructive behaviour when they don’t have the substance in their system.

    Addiction is rooted in your brain and is classified as a disease. You develop strong cravings for a drug you’re using due to physical changes in your brain. Uncontrolled cravings and drug use can lead to self-disruptive behaviour and take a serious toll on your health.

    Withdrawal symptoms and treatment by drug type

    As mentioned, withdrawal symptoms differ for each person depending on how long they have been using the substance, the type of substance and their body makeup. Management of alcohol and drug withdrawal should be handled by a professional team at a reputable rehabilitation centre because the process is complex and generally requires medical supervision.

    Source: American Addiction Centres

    Alcohol withdrawal syndrome

    DescriptionAlcohol is a depressant because it has a depressive effect on your system. It slows down brain function and changes the way your nerves send messages back and forth. 
    Withdrawal risksSymptoms of alcohol withdrawals for heavy alcohol drinkers can be severe, even fatal. It’s recommended the management of alcohol and drug withdrawal is done medical supervision in a detox programme. Severe symptoms of alcohol withdrawals is called delirium tremens or the DTS. Individuals may experience dangerously high fevers, grand mal seizures, hyperthermia, cardiac arrhythmias and complications related to co-occurring medical or mental health disorders. DTs can be fatal if swift medical care and attention aren’t provided. 
    Withdrawal symptomsAnxiety, shaky hands, headache, nausea, vomiting, insomnia, sweating, confusion, racing heart, high blood pressure, fever, heavy sweating and seizures. 
    Recommended treatmentA medically-supervised detox programme is recommended to observe the individual and monitor their vital signs, maintain a safe setting that limits self-harm and negative interaction with the outside environment and prescribe medications to manage the acute alcohol withdrawal syndrome.

    Barbiturate withdrawal syndrome

    Also known asTranquilisers or central nervous system depressants 
    DescriptionBarbiturates are sedative medications that were once commonly prescribed for a variety of conditions, including anxiety and insomnia. They have largely been replaced by benzodiazepines due to the risk of dependence and overdose, but they are still used as anesthetic agents and for the treatment of seizures. 
    Withdrawal riskBarbiturate withdrawal symptoms can be life-threatening. Seek medical treatment from a rehab centre or detox facility for barbiturate dependence and withdrawal. 
    Withdrawal symptomsAbdominal cramps, nausea, vomiting, restlessness, insomnia, fatigue, anxiety, tremors, seizures, delirium and hallucinations 
    Recommended treatmentA medically-supervised detox programme is recommended to observe the individual and monitor their vital signs, maintain a safe setting that limits self-harm and negative interaction with the outside environment and prescribe medications to manage the acute barbiturate withdrawal syndrome.

    Cannabis withdrawal syndrome

    Also known asMarijuana or weed 
    DescriptionCannabis is used for medical, religious, and recreational purposes around the world. It’s a Schedule 1 drug and one of the most widely-used illicit drugs in the world. Cannabis is a depressant drug and has a combination of hallucinogenic, depressant and stimulant properties. 
    Withdrawal riskSymptoms range from mild to severe. They may not be dangerous but they are unpleasant. The most common withdrawal symptom of cannabis is a low-grade form of anxiety which is best treated with medical care. 
    Withdrawal symptomsLoss of appetite, mood changes, irritability, insomnia, headaches, loss of focus, cravings for marijuana, sweating, chills, depression and stomachache. 
    Recommended treatmentA medically-supervised detox programme is recommended to observe the individual and monitor their vital signs, maintain a safe setting that limits self-harm and negative interaction with the outside environment and prescribe medications to manage the acute cannabis/marijuana withdrawal syndrome.

    CNS depressant withdrawal syndrome (central nervous system)

    Examples of depressantsAlcohol, benzodiazepines, non-benzodiazepine sleep medications and barbiturates 
    DescriptionCentral nervous system (CNS) depressants are psychoactive drugs that decrease brain activity. These are used to temporarily reduce the function of the brain and central nervous system. They are known as sedatives and tranquilizers. They are typically available by prescription and often used to treat anxiety or sleep disorders. The most common types of drugs in this class are benzodiazepines, non-benzodiazepine sleep medications, and barbiturates. 
    Withdrawal riskDepressant withdrawal symptoms can be extremely uncomfortable and potentially dangerous and fatal. Withdrawal from heavy use should be done with medical supervision. 
    Withdrawal symptomsAnxiety, restlessness, insomnia, tremors, dizziness, nausea, vomiting, headaches, seizures and psychosis. 
    Recommended treatmentA medically-supervised detox programme is recommended to observe the individual and monitor their vital signs, maintain a safe setting that limits self-harm and negative interaction with the outside environment and prescribe medications to manage the acute depressant withdrawal syndrome.

    Hallocinogen withdrawal syndrome

    Examples of hallucinogensLSD (d-lysergic acid diethylamide), Psilocybin (Magic mushrooms), Peyote (Mescaline), DMT (Dimethyltryptamine) and Ayahuasc. 
    DescriptionHallucinogens 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 riskHallucinogens 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. 
    Signs of a bad tripUnpleasant/intense hallucinations, intense fear, paranoia, anxiety, panic, drug-induced psychosis and life-threatening behaviour. 
    Withdrawal symptomsStiff muscles, depressed breathing, convulsions, rapid heart rate, extreme changes in body temperature, cravings, headaches, sweating, seizures and flashbacks. 
    Recommended treatmentA medically-supervised detox programme is recommended to observe the individual and monitor their vital signs, maintain a safe setting that limits self-harm and negative interaction with the outside environment and prescribe medications to manage the acute hallucinogen withdrawal syndrome.

    Inhalant withdrawal

    Examples of inhalantsSolvents: paint thinners, dry-cleaning fluids, gasoline, lighter fluid, correction fluids, felt-tip marker fluid, electronic contact cleaners, glue, nail polish and nail polish remover Aerosols: spray paint, hair spray, deodorant spray, aerosol computer cleaning products and vegetable oil sprays Gases: butane lighters, propane tanks, whipped cream dispenses, ether, chloroform, nitrous oxide (“laughing gas”) and freon Nitrites: room odouriser, leather cleaner and liquid aroma spray 
    DescriptionInhalants are volatile, often flammable substances that vaporise at room temperature. Inhalants produce short-lived, mind-altering effects that can be similar to alcohol’s effects. These substances are often referred to as whippets, laughing gas, huff or hippie crack. 
    Unwanted side effectsPhysical: Drowsiness, lightheadedness, headache, lack of coordination, slurred speech, loss of self-control, numbness and loss of consciousness. Mental: Anger, agitation, hallucinations and delusions
    Withdrawal risksInhalants are normally more psychologically addictive than physically addictive.With continued use of inhalants, the risk of the following issues increases: organ injury (including the liver and kidneys), hearing and vision loss, damage to the bone marrow, nerve damage resulting in long-term loss of coordination and muscle spasticity, developmental delays in children or adolescents secondary to brain injury and anoxic brain damage (from lack of oxygen delivery to the brain). 
    Withdrawal symptomsBody pain, cravings, depression, hallucinations, headaches, insomnia, nervousness, panic attacks, psychosis, sweating and tremors. 
    Recommended treatmentA medically-supervised detox programme is recommended to observe the individual and monitor their vital signs, maintain a safe setting that limits self-harm and negative interaction with the outside environment and prescribe medications to manage the acute inhalant withdrawal syndrome.

    Narcotic withdrawal

    Examples of narcoticsFentanyl (Duragesic), heroin, hydrocodone with acetaminophen (Lorcet, Lortab, Vicodin), hydrocodone (Hysingla ER, Zohydro ER), hydromorphone (Dilaudid, Exalgo), methadone, meperidine (Demerol), Oxycodone OxyContin), Oxycodone with acetaminophen (Percocet) and Oxycodone with aspirin (Percodan). 
    DescriptionNarcotics 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. 
    Withdrawal riskWithdrawal from heavy narcotic use is not medically dangerous but the symptoms can be painful and hard to live with. The unpleasantness often leads to continued drug abuse. In general, the length and harshness of narcotic drug withdrawal depends on the drug you are using and the amount you have been taking. 
    Withdrawal symptomsRestlessness, muscle and bone pain, anxiety, irritability, rapid breathing, runny nose, salivation, insomnia, enlarged pupils, tremors, loss of appetite, diarrhea, vomiting, sweating, cold flashes with goose bumps and restless leg movement. 
    Recommended treatmentA medically-supervised detox programme is recommended to observe the individual and monitor their vital signs, maintain a safe setting that limits self-harm and negative interaction with the outside environment and prescribe medications to manage the acute narcotic withdrawal syndrome.

    Stimulant withdrawal

    Examples of stimulantsLegal: caffeine, nicotine, energy drinks, and prescription amphetaminesIllegal: methamphetamine (meth), cocaine, and ecstasy 
    DescriptionStimulants increase the normal activity of the central nervous system. There are a number of legal stimulants, as well as illegal. 
    Withdrawal riskThese 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. 
    Withdrawal symptomsAnxiety, fatigue, insomnia, hyperactive, depression, psychosis, hallucinations, delusions, cravings, increased appetite or lack of appetite. 
    Recommended treatment A medically-supervised detox programme is recommended to observe the individual and monitor their vital signs, maintain a safe setting that limits self-harm and negative interaction with the outside environment and prescribe medications to manage the acute stimulant withdrawal syndrome.

    8 ways to manage alcohol and drug withdrawal symptoms

    Withdrawal symptoms vary person to person depending of a variety of factors. It’s highly recommended you speak to your doctor or a counsellor at a alcohol and drug treatment centre for advise and help coping with withdrawal symptoms which can range from mild to severe, even fatal.

    1. Medical detox programme under professional supervision

    Depending on the severity of your alcohol and drug usage, the best way to manage physical and psychological withdrawal symptoms is attending a medical detoxification (detox) programme. Cravings and life-threatening symptoms can be managed with medication and emotional support in a 24/7 securing and caring environment.

    2. Eating balanced and nutritious meals

    Diet plays a big role in healing your wellbeing by enriching your body with proteins and essential vitamins. This helps to restore brain and body functioning. Alcohol and drugs can deplete your body of what it needs to run efficiently so it’s vital to replace these proteins and nutrients while experiencing withdrawal symptoms.

    3. Regular exercise

    Regular exercise helps your brain to release endorphins which help to restore chemical balance. It can also reduce stress and tension and help you sleep better. Studies published by the journal Frontiers in Psychology show that exercise can help to minimize relapse and decrease compulsive drug use and cravings, therefore aiding in recovery.

    4. Drink water

    It’s important that you stay hydrated while experiencing withdrawal symptoms. Dehydration is common when you stop or reduce using harmful substances and can be dangerous and potentially fatal. Dehydration also brings on thirst and hunger which can be mistaken as cravings.

    5. Get enough quality sleep

    Quality sleep with help with the healing process. Adopt a structured sleep routine and stick to it, particularly in the early stages of withdrawal. Go to bed at the same time every night and wake up at the same time. Avoid using electronic devices at least a half hour before falling asleep as they over stimulate your brain.

    6. Complement traditional detox medicine with holistic treatment

    You’ll find holistic methods such as yoga, acupuncture and massage therapy very beneficial while detoxing. Massage therapy can reduce muscle tension and acupuncture can relieve pressure at sore points. These holistic treatments help to restore your mind and body balance as well as circulation and blood flow.

    7. Attend group sessions

    A caring peer support group goes a long way to helping you recover and maintain your sobriety. You can attend group sessions as part of an inpatient programme at a alcohol and drug rehabilitation centre, as an outpatient or a support group in your area.

    8. Practice mindful meditation

    Mindfulness meditation is one of the most popular methods of meditation and focuses on increasing focus, concentration and awareness. Other benefits of mindfulness therapy include the ability to alter brainwaves which contribute to improved psychological function and cortisol reduction. It enhances the performance of the frontal cortex, the area of the brain that regulates planning and thinking, reduces fear and increases motivation and motor control.

    Do you need help to cope with alcohol or drug withdrawal symptoms?

    Drug and alcohol withdrawal can lead to various symptoms that can be extremely uncomfortable and potentially dangerous. Withdrawal can also be confusing and overwhelming. Don’t let the fear of withdrawal prevent you for seeking the help you need for a full recovery from an addiction.

    Speak to a counsellor at White River Manor regarding various treatment options for withdrawal from alcohol or drug usage as well as an individualised detox and treatment plan.

    Garden at White River Manor

    White River Manor Disclaimer

    The information in this article is only meant to be used as a tool to help you understand the severity of alcohol and drug withdrawal symptoms and encourage you to seek professional help for a medically-supervised detox programme. It does not substitute medical intervention for the treatment of withdrawal symptoms and recovery from addiction.

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