What is Withdrawal?

Withdrawal is the process of cutting out or cutting back on alcohol or drugs after a period of prolonged or excessive use (ADF 2021).

This can lead to a variety of symptoms. A common example of withdrawal is feeling a headache slowly develop when you forgo your morning coffee.

It’s an unpleasant feeling, but the headache is your body responding and adjusting to the lack of caffeine in your system. Your body is attempting to maintain homeostasis, i.e. stable internal conditions (Kenny 2014).

Dependence and Addiction

It is important to note that DSM-5 has criteria for the diagnosis of Substance-Related and Addictive Disorders (APA 2013).

In the context of withdrawal from drugs and alcohol, it is crucial that the concept of addiction and dependence is first acknowledged. Prolonged or excessive use of a substance can lead to tolerance and physical dependence. This process in itself is complex and depends on various physical, environmental, social and psychological factors (SA Health 2022; Becker 2008).

It’s this dependence that the body has on the substance that then leads to withdrawal if the substance is abruptly stopped or reduced.

If people who are very dependent on alcohol cease drinking, they will likely face a range of physical and cognitive symptoms (Kenny 2014). Note that it is extremely dangerous and even life-threatening for someone who is addicted or dependent on alcohol to cease drinking suddenly without pharmacological/medical intervention and support (Alcohol Rehab Guide 2022).

Types of Dependencies

Physical Dependence

Physical dependence is a pharmacologic effect characteristic of various types of substances. It is defined as the occurrence of an abstinence syndrome (withdrawal reaction) after the sudden discontinuation of a drug, substantial dose reduction or administration of an antagonist (a substance that disrupts the physiological action of another) (Polston & Wallace 2017).

In the case of physical dependence, not only has a person used a substance long enough for their body to rely on it to feel ‘normal’ (ADF 2021), but they will also require more and more of the drug to achieve the initial positive effect and will rely on continued use of the drug to prevent painful and uncomfortable withdrawal symptoms (Selner & Legg 2018).

Psychological Dependence

Generally, the term psychological dependence encompasses both the emotional and mental processes that are associated with the development of, and recovery from, a substance use disorder. It is worth noting, however, that there can be no complete separation of emotion and cognition from physiology (American Addiction Centers 2021).

An example of psychological dependence is if a person expressed uncertainty about being able to stop using the substance of choice; or if they displayed signs of anxiety if someone tried to intervene or prevent them from taking the substance (American Addiction Centers 2021).

Severity of Withdrawal

The severity of withdrawal will depend on the following factors:

• Which substance(s) they’ve been taking
• How long the person has been using the substance for
• Their age
• Their physical health
• Their psychological characteristics and health
• The method of withdrawal
• Physical dependence.

(ADF 2021; Healthdirect 2022)

Withdrawal Symptoms

Symptoms vary between individuals and will depend on which substance the person is withdrawing from.

For information about the typical withdrawal symptoms for specific drugs, see the Alcohol and Drug Foundation’s drug list.

As a person’s body becomes used to functioning without the drug, withdrawal symptoms will range from mild to severe and can be life-threatening.

Generally, the symptoms of withdrawal will be the opposite of what the drug feels like. An example of this is when withdrawing from a drug such as alcohol - a depressant - a person may experience restlessness and agitation (ADF 2021).

Common symptoms related to drug withdrawal include:

• Insomnia
• Irritability
• Changes in mood
• Depression
• Anxiety
• Aches
• Muscle spasms
• Pains
• Craving
• Fatigue
• Hallucinations
• Nausea.

(Healthdirect 2022; Gonzales 2020)

Coping With Cravings

When a person is addicted to a drug, their body knows that the fastest way to feel good will be to take that particular drug.

Cravings will generally fluctuate in their frequency and they may be weak or strong. Managing cravings is important in the long term, as they may come back even years after a person has stopped using the substance (ADF 2021).

Craving management may include mind retraining techniques such as productive distraction or relaxation. This can involve reading, watching a movie, meditating or exercising (ADF 2021).

Remind patients that their brain has acquired a pattern of thought over time, but they are capable of retraining their brain to follow a new thought pattern (ADF 2021).

The length of time that someone will experience withdrawal symptoms for depends on many factors, including the type of drug and how long the person has been using it. Generally, withdrawal symptoms will last between a few days to a few weeks. However, cravings can last for a long time (ADF 2021).

There is also the option of treating withdrawal symptoms with certain medications (pharmacotherapy) (ADF 2021).

Is Withdrawal Safe?

It is vital that a person has medical supervision to carry out a safe withdrawal.

This is particularly important when withdrawing from alcohol, gamma-hydroxybutyrate (GHB), benzodiazepines or ketamine (ADF 2021).

Recovery should take place in a safe environment, such as at home (if appropriate), in a detox facility or in a hospital (Healthdirect 2022).

Steps to Safe Withdrawal

The following steps can support the process of a safe withdrawal:

1. Talking to a doctor or alcohol and other drugs treatment service
2. Writing down a list of reasons for giving up the drug
3. Planning what to do if drugs are used during withdrawal
4. Identifying situations/contexts in which drug-taking may be particularly tempting
5. Learning the risks of overdosing
6. Keeping busy (watching movies, exercising, reading)
7. Practising stress management and distraction techniques
8. Practising self-care.

(ADF 2021; Gonzales 2020)