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Drug withdrawal, drug withdrawal syndrome, or substance withdrawal syndrome, is the group of
symptom Signs and symptoms are the observed or detectable signs, and experienced symptoms of an illness, injury, or condition. A sign for example may be a higher or lower temperature than normal, raised or lowered blood pressure or an abnormality show ...
s that occur upon the abrupt discontinuation or decrease in the intake of medicational or
recreational drugs Recreation is an activity of leisure Leisure has often been defined as a quality of experience or as free time. Free time is time Time is the continued sequence of existence and event (philosophy), events that occurs in an apparent ...
. In order for the symptoms of withdrawal to occur, one must have first developed a form of
drug dependence Substance dependence, also known as drug dependence, is a biopsychological situation where-by an individual's functionality is dependent on the necessitated re-consumption of a psychoactive substance, because of an adaptive state that has develo ...
. This may occur as
physical dependence Physical dependence is a physical condition caused by chronic use of a tolerance-forming drug, in which abrupt or gradual drug withdrawal Drug withdrawal, drug withdrawal syndrome, or substance withdrawal syndrome, is the group of symptoms that ...
,
psychological dependence Psychological dependence is a state that involves emotional–motivational withdrawal symptoms, e.g. anxiety Anxiety is an emotion Emotions are mental state, psychological states brought on by neurophysiology, neurophysiological changes, ...
or both. Drug dependence develops from consuming one or more substances over a period of time. Dependence arises in a dose-dependent manner and produces withdrawal symptoms that vary with the type of drug that is consumed. For example, prolonged use of an
antidepressant Antidepressants are medication A medication (also called medicament, medicine, pharmaceutical drug, medicinal drug or simply drug) is a drug used to medical diagnosis, diagnose, cure, therapy, treat, or preventive medicine, prevent disea ...
medication is likely to cause a rather different reaction when discontinued compared to discontinuation of an
opioid Opioids are substances that act on opioid receptors to produce morphine-like effects. Medically they are primarily used for pain relief, including anesthesia. Other medical uses include suppression of diarrhea, replacement therapy for opioid use ...
, such as
heroin Heroin, also known as diacetylmorphine and diamorphine among other names, is an opioid Opioids are substances that act on opioid receptor Opioid receptors are a group of inhibitory G protein-coupled receptors with opioids as ligands. T ...

heroin
. Withdrawal symptoms from opiates include anxiety, sweating, vomiting, and diarrhea. Alcohol withdrawal symptoms include irritability, fatigue, shaking, sweating, and nausea. Withdrawal from
nicotine Nicotine is a naturally produced alkaloid Alkaloids are a class of basic BASIC (Beginners' All-purpose Symbolic Instruction Code) is a family of general-purpose, high-level programming language In computer science Computer sci ...

nicotine
can cause irritability, fatigue, insomnia, headache, and difficulty concentrating. Many prescription and legal nonprescription substances can also cause withdrawal symptoms when individuals stop consuming them, even if they were taken as directed by a physician. The route of administration, whether
intravenous Intravenous therapy (abbreviated as IV therapy) is a medical technique that delivers fluids, medications and nutrition directly into a person's vein. The intravenous route of administration is commonly used for rehydration or to provide nutrition ...
,
intramuscular Intramuscular injection, often abbreviated IM, is the injection Injection or injected may refer to: Science and technology * Injection (medicine) An injection (often referred to as a "shot" in US English, a "jab" in UK English, or a "jag" ...

intramuscular
,
oral The word oral may refer to: Relating to the mouth * Relating to the mouth, the first portion of the alimentary canal that primarily receives food and liquid **Oral administration of medicines ** Oral examination (also known as an oral exam or oral ...
or otherwise, can also play a role in determining the severity of withdrawal symptoms. There are different stages of withdrawal as well; generally, a person will start to feel bad (crash or come down), progress to feeling worse, hit a plateau, and then the symptoms begin to dissipate. However, withdrawal from certain drugs (
barbiturates A barbiturate is a drug Uncoated tablets, consisting of about 90% acetylsalicylic acid, along with a minor amount of inert fillers and binders. Aspirin is a pharmaceutical drug A medication (also referred to as medicine, pharmaceutica ...
,
benzodiazepines Benzodiazepines (BZD, BDZ, BZs), sometimes called "benzos", are a class of psychoactive drug A psychoactive drug, psychopharmaceutical, psychoactive agent, or psychotropic drug, is a chemical substance that changes nervous system function and r ...
,
alcohol In chemistry, alcohol is an organic compound that carries at least one hydroxyl functional group (−OH) bound to a Saturated and unsaturated compounds, saturated carbon atom. The term alcohol originally referred to the primary alcohol ethan ...
,
glucocorticoids Glucocorticoids (or, less commonly, glucocorticosteroids) are a class of corticosteroids, which are a class of steroid hormones. Glucocorticoids are corticosteroids that bind to the glucocorticoid receptor that is present in almost every vertebra ...
) can be fatal. While it is seldom fatal to the user, withdrawal from opiates (and some other drugs) can cause miscarriage, due to fetal withdrawal. The term "
cold turkey "Cold Turkey" is a song written by English singer-songwriter John Lennon, released as a single (music), single in 1969 by the Plastic Ono Band on Apple Records, catalogue Apples 1001 in the United Kingdom, Apple 1813 in the United States. It is ...
" is used to describe the sudden cessation use of a substance and the ensuing physiologic manifestations. The symptoms from withdrawal may be even more dramatic when the drug has masked prolonged malnutrition, disease, chronic pain, infections (common in intravenous drug use), or sleep deprivation, conditions that drug abusers often suffer as a secondary consequence of the drug. When the drug is removed, these conditions may resurface and be confused with withdrawal symptoms. Genes that encode for the Alpha5 Nicotinic Acetylcholine Receptor affect nicotine and alcohol withdrawal symptoms.


Effect on homeostasis

Homeostasis is the body's ability to maintain a certain chemical equilibrium in the brain and throughout the body. For example, the function of shivering in response to cold is to produce heat maintaining internal temperature at around . Homeostasis is impacted in many ways by drug usage and withdrawal. The internal systems perpetuate homeostasis by using different counter-regulatory methods in order to create a new state of balance based on the presence of the drug in the system. These methods include adapting the body's levels of neurotransmitters, hormones, and other substances present to adjust for the addition of the drug to the body.


Substances

Examples (and ICD-10 code) of withdrawal syndrome include: * F10.3 alcohol withdrawal syndrome (which can lead to delirium tremens) * F11.3 Opioid use disorder#Withdrawal, opioid withdrawal, including Methadone#Withdrawal symptoms, methadone withdrawal * F12.3 cannabis withdrawal * F13.3 benzodiazepine withdrawal syndrome, benzodiazepine withdrawal * F14.3 Cocaine dependence#Withdrawal symptoms, cocaine withdrawal * F15.3 Caffeine#Dependence and withdrawal, caffeine withdrawal * F17.3 nicotine withdrawal


Symptoms

Symptoms of withdrawal vary widely based on what drug a person is withdrawing from.


Cravings

When going through a Drug withdrawal, withdrawal period, craving is a psychological urge for the substance that is being withheld. This substance can be alcohol or a form of drug but is not limited to these. The duration that cravings last after discontinuation varies substantially between different addictive drugs. For instance, in smoking cessation, a substantial relief is achieved after approximately 6–12 months, but feelings of craving may temporarily appear even after many years following cessation. Cravings may be triggered by seeing objects or experiencing moments that are associated with the drug or usage of it, and this phenomenon, termed post acute withdrawal syndrome, may linger the rest of the life for some drugs. For the alcohol withdrawal syndrome, the condition gradually improves over a period of months or in severe cases years.


Prescription medicine

As noted above, many drugs should not be stopped abruptly without the advice and supervision of a physician, especially if the medication induces dependence or if the condition they are being used to treat is potentially dangerous and likely to return once medication is stopped, such as diabetes, asthma, cardiovascular disease, heart conditions and many psychological or neurological conditions, like epilepsy, depression (mood), depression, hypertension, schizophrenia and psychosis. The stopping of antipsychotics in schizophrenia and psychoses needs Antipsychotic#Discontinuation, monitoring. The stopping of
antidepressant Antidepressants are medication A medication (also called medicament, medicine, pharmaceutical drug, medicinal drug or simply drug) is a drug used to medical diagnosis, diagnose, cure, therapy, treat, or preventive medicine, prevent disea ...
s for example, can lead to antidepressant discontinuation syndrome. With careful physician attention, however, medication prioritization and discontinuation can decrease costs, simplify prescription regimens, decrease risks of adverse drug events and poly-pharmacy, focus therapies where they are most effective, and prevent cost-related under-use of medications. Medication Appropriateness Tool for Comorbid Health Conditions in Dementia (MATCH-D) warns that people with dementia are more likely to experience adverse effects, and to monitor carefully for withdrawal symptoms when ceasing medications for these people as they are both more likely to experience symptoms and less likely to be able to reliably report symptoms.


Anti-hypertensive drugs

The latest evidence does not have evidence of an effect due to discontinuing vs continuing medications used for treating elevated blood pressure or prevention of heart disease in older adults on all-case mortality and incidence of heart attack. The findings are based on low quality evidence suggesting it may be safe to stop anti-hypertensive medications. However, older adults should not stop any of their medications without talking to a healthcare professional.


See also

* Chemical dependency * Craving (withdrawal), Craving, a psychological withdrawal symptom * Drug detoxification * Drug tolerance * Hangover * Neonatal withdrawal * Rebound effect * Post-acute withdrawal syndrome (PAWS)


References


External links

{{Authority control Drug rehabilitation Withdrawal syndromes Substance-related disorders