The use of alcohol and other drugs is prevalent in the UK and worldwide. Addiction is a severe illness that impacts hundreds of thousands of people every year. According to The National Drug Treatment Monitoring System, there were almost 270,000 UK adults in contact with addiction treatment services between 2017 and 2018.1 This number does not reflect the number of people affected by addiction, as not everybody has access to treatment.
Recovery from drug or alcohol addiction is a complex process, but it can be managed, and many people fortunately recover. Recovery success depends on several factors, including the quality of treatment sought, the level of compliance with a treatment program, and a range of personal factors, such as how long a person has been abusing their substance of choice, their level of access to support, and the presence of other, co-occurring mental health conditions.
Withdrawal happens on a physical and neurological level, which, in combination, can make the experience overwhelming. The body undergoes high levels of stress and discomfort as the body restores itself to homeostasis.2
Withdrawal can be better understood when we understand the impact the drug and alcohol abuse has on the brain. Our brains are made up of billions of nerve cells that intercommunicate – allowing us to function normally in our everyday lives. Foreign substances such as alcohol, cocaine, marijuana, or heroin change how our brain cells communicate with each other.3
When we misuse substances for a long time, our brains get used to those chemicals in the system and adapt around them. As a result, the brain and body expect the substance and struggle to function normally without it. This is known as dependence and is a precursor for addiction.4
Note that dependence does not equal addiction. For example, if you receive a prescription of antidepressants from your doctor, and you adhere to the recommended prescription, the brain still becomes dependent on the antidepressant to function.
It is highly recommended that you do not quit taking your antidepressants all of a sudden. This is because these drugs alter your brain chemistry, and can cause more problems later if they are quit suddenly. Instead, coming off antidepressants calls for a ‘tapering’ approach, where the dose is gradually reduced over time.5 This gives the brain time to adjust without the presence of antidepressants in the system.
Withdrawal should take place under the supervision of addiction treatment professionals. The symptoms, outlined below, can be so distressing and uncomfortable that the person suffering may be tempted to use substances again to escape. In some cases, withdrawal can lead to suicidal ideation, and even attempts at suicide, which emphasises the importance of professional supervision.
Symptoms vary depending on the substance of abuse. Common withdrawal symptoms for different substances include:
- Autonomic arousal6
- Disrupted sleep
- Excessive sweating
- Nausea and vomiting
- High blood pressure
- Aches and pains
- Hypersensitivity to sensory stimuli
- Poor concentration and memory
- Muscle spasms
There are known dangers associated with sudden cessation of alcohol and other drug use. Trying to stop on your own can lead to a range of health complications, some of which include severe issues such as seizures, hallucinations, and delirium tremens.7
The severity of withdrawal depends on several factors, such as8:
- The type of drug used
- How long you have been using the specific drug
- History of mental and physical health
- Physical make-up
Alcohol withdrawal, in particular, can be dangerous. Symptoms can come on slowly but worsen over time. The length of withdrawal also varies between individuals. The withdrawal symptoms can cause so much physical and psychological distress that medical supervision is essential.
Like alcohol, benzodiazepine withdrawal requires medical supervision. Sudden cessation of use can lead to cardiac issues and even seizures.9 Benzodiazepine withdrawal must be managed by a medical professional who can oversee a tapering process.
While benzodiazepines and alcohol pose a serious, even fatal risk, other drugs such as codeine and heroin do not pose the same type of danger regarding withdrawal. Still, the psychological impact of withdrawal can have serious consequences, meaning that withdrawal management from these substances should be taken no less seriously than that for alcohol and benzodiazepines.
Further, one of the biggest risks of withdrawal is that a person will experience intense cravings for the drug.10 When we use these drugs regularly, our bodies build up a tolerance. This means that more of the drug is needed to achieve its desired effects.
This is dangerous because tolerance decreases the longer we go without the drug. If a person experiences withdrawal after abstaining from the drug, they might take a higher dose than their body can handle. This poses a serious of overdose and death.
Withdrawal management does not equal recovery from substance addiction. A person can receive withdrawal management and then relapse post-care. Withdrawal management is not addiction treatment; it is an effort to detoxify the body and support the person before beginning comprehensive, psychosocial treatment in the form of an inpatient or outpatient rehabilitation program.
Clients in addiction recovery programs should always be provided with the appropriate care and support during the detox and withdrawal stages. If a person has been abusing substances for a long time, their withdrawal symptoms will generally be more intense and longer-lasting than those who have been abusing substances for a shorter time, and the level of care they receive should reflect this. Similarly, clients with co-occurring disorders must receive care appropriate to their circumstances.
As mentioned earlier, some substance detoxification programs require medical intervention. For example, alcohol addiction usually requires that clients receive medication for withdrawal management, such as naltrexone and benzodiazepines.11
Naltrexone is suggested to help those in recovery from alcohol addiction remain abstinent by reducing the desire to drink, thus reducing the risk of relapse. Benzodiazepines are used in alcohol addiction recovery to reduce the severity of certain withdrawal symptoms, such as anxiety, panic, and to manage some types of seizures.
Opioids are a class of drugs that slow down activity in the central nervous system.12 Tolerance to opioids builds quickly, and dependence is likely. Withdrawal management for opioid addiction usually involves a tapered detox program, where methadone or buprenorphine is used as a substitute for the drug of addiction. The dose is gradually decreased until it is safe for the body to come off these medications completely.13
Similarly to stimulants, there are no medications specific to benzodiazepine detox. Instead, withdrawal is managed through antidepressants and anti-convulsant medications.14 Typically, detoxification from benzodiazepines involves a tapering process. The dose is reduced at a safe pace until the person can function without the substance.
Comprehensive rehabilitation programs are available and help clients maintain their recovery. In rehab, whether it’s inpatient (residential) or outpatient, clients are not only medically and psychologically supported during the detox and withdrawal phases, but further into therapy, counselling, and aftercare.