Drug withdrawal syndrome

It is a set of symptoms that are grouped according to different types and levels of severity and occur when there is absolute or relative abstinence from a certain substance after repeated consumption, usually high in doses or time. The onset and course of the withdrawal state are limited in time and related to the type of substance and the dose consumed immediately prior to withdrawal. Withdrawal syndrome may be worsened by seizures.

Diagnostic Guidelines

1. Withdrawal syndrome is one of the indicators of the presence of a dependence syndrome, which is why this diagnosis must also be taken into consideration.

2. The diagnosis of withdrawal syndrome should have priority if it is the chief complaint and if it is serious enough to require medical attention on its own.

3. Somatic symptoms vary according to the substance consumed. Psychological disorders (for example, anxiety, depression, or sleep disturbances) are also common features of withdrawal. Patients typically report that withdrawal symptoms disappear when they go back to substance use.

4. It is important to remember that symptoms of withdrawal syndrome can be induced by conditioned or learned stimuli, even in the absence use of substance use immediately prior. In these cases, the diagnosis of withdrawal syndrome will only be made if its severe enough.

Non-consumption of certain substances and the manifestations associated with their suppression qualify as withdrawal.

• Initial or short-term: immediately upon withdrawal from consumption.

• Intermediate or medium-term (up to three months), approximately up to 30 days after the last consumption.

• Late or long-term up to one year: from 30 days onwards, manifesting frequent cravings and dreams of consumption.

There can be distinguished:

Psychosocial withdrawal: Without notable somatic manifestations in THC and Cocaine users.

Physical withdrawal: In alcoholics and heroin addicts (people addicted to opiates such as morphine and methadone).

Manifestations of withdrawal syndrome

• Wants, cravings or compelling desire to consume: They manifest consciously or subconsciously through emotional states, symptoms and behaviors associated with consumption, or through the subjective sensation of "emptiness or absence of something for oneself to be complete".

• Dreams of Consumption: Vivid dreams that the addict experiences as if they were real, in which he relapses into consumption or rejects the drug.

• Physical Withdrawal Symptoms: Muscle aches, chills, dizziness, vomiting, diarrhea, sweating, and headache. Physical withdrawal in alcoholics and heroin addicts (people addicted to opiates such as morphine and methadone).

• Psychological Symptoms of Withdrawal and emotional disorders: Irritability, aggressiveness, anxiety, sadness, depression, suicidal ideation (which can lead to a suicide attempt).

• Pink Cloud: "Rose-colored glasses." Subjective perception of pseudo-well-being “everything will be fine, this is wonderful", which masks or denies the reality of the person’s addiction.

• Healing Crisis: Subjective perception of healing "I'm fine now, I’m not struggling" the patient masks or denies the reality of their addiction.

a) They arise during recovery and continue long after the use of the mood-altering agent has been stopped.

b) You are not responsible for having cravings, as these are symptoms of the addiction, but you are responsible for the way you react to them.

c) They are temporary, they will pass on their own if you cope with them without relapsing.

d) They tend to reach their maximum intensity within the first hour after their appearance.

e) They do not necessarily have to lead to the use of the mood altering substance.

f) Willpower is an unsatisfactory means of defense against desires.

g) Relapse triggers can consume your strength even after several years of abstinence, so don’t disregard the possibility of cravings and don't get overconfident.

h) Each time the craving is followed by the use of the mood-altering agent, the possibility of having future and even more intense cravings increases. If you can safely react to your urges, without relapsing, they will decrease.

Cravings: Definition, characteristics and action plan

Definition: Wants, cravings or compelling desire to consume are a manifestation of withdrawal syndrome, which manifest themselves consciously or subconsciously through emotional states (usually they produce anxiety), symptoms and behaviors associated with consumption, or through the subjective sensation of "emptiness or absence of something for oneself to be complete".

In short:

• Explicit, conscious, and clear desire to consume (taste, smell, among others).

• Emotional unwellness

• Internal feeling that “something is missing”.

Characteristics of cravings

1. They continue for a long time.

2. You are not responsible for them, since they symptoms of the addiction, but you are responsible for the way you react to them.

3. They are always temporary.

4. They tend to reach maximum intensity during the first hour after their appearance.

5. Don’t always follow the use of a mood-altering substance.

6. Stay away from the situations that cause them.

7. Stay alert and don't get too confident.

8. Each time the craving is followed by the use of the mood-altering agent, the possibility of having future and even more intense cravings increases.

Most frequent triggers in the first stage of withdrawal

• Being in the presence of the drug.
• Seeing people or things you associate with it.
• Places where you took drugs.
• Negative mood states (rejection, anxiety, guilt, anger, depression, boredom).
• Positive mood states.
• Vulnerable physical states (exhaustion, illness and pain).
• Memories such as songs.
• Certain times after work.
• Sounds or smells (opening a can of beer for an alcoholic).
• Seeing other people consume drugs.
• Suddenly acquiring a lot of money.

Conditioning

Stimulus or incentive and triggering states: People, places or objects in the environment, internal feelings.

Rejection, anxiety, guilt, anger, depression, boredom, joy (security), exhaustion, illness, and pain.

Action plan 

1. Seek support from family, friends and specialized health personnel.

2. Get away from situations in which you’ve experienced cravings (places of consumption).

3. Immediately contact a member of your support network.

4. Mentally detach from the impulse and try to observe it as if you were an impartial observer. How interesting! Instead of: It's going to catch me.

5. Anticipate what you will do in the next few hours.

6. Attend a self-help meeting.

Additional successful tools:

• Think beyond the effect of the drug.
• Put it in writing.
• Do relaxation exercises.
• Visualize yourself successfully overcoming your cravings.

Physical exercise and proper nutrition seem to reduce withdrawal symptoms, a daily regimen of certain vitamins (B complex and C in particular) and amino acids (thyroxine, phenylalanine and tryptophan) have been shown to facilitate the replacement of dopamine and other neurotransmitters that are depleted as the effect of certain addictions such as cocaine addiction.

Do your part and draw strength. Between you, your doctor, and family support, you will beat the addiction. Start now!!! You can do it!!