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by EBSCO Medical Review Board
(Abstinence Syndrome)

Definition

Drug withdrawal reaction is a set of symptoms that happen after you stop using a long-term drug. The reaction can vary based on the drug and how often it was used. They can include physical and mental changes. Some may be mild while other can have severe reactions that need medical care.

Causes

Drugs change how the body works. The body becomes dependent on the drugs to do basic tasks. When the drug is stopped, the body must learn how to function again without the drug. This is what causes withdrawal symptoms. It can take some time for the body to recover.

Risk Factors

Using drugs outside of medical guidelines can increase the risk of withdrawal. Some drugs can also cause dependence even when used as prescribed.

Symptoms

Withdrawal will start after use is stopped. This can be in a few minutes to a few days. The types of problems will depend on the type of drug and the length of use.

Withdrawal from opioids like heroin may cause:

  • Cravings
  • Flu-like symptoms, such as a runny nose, chills, or sweating
  • Increased sensitivity to pain
  • Muscle pain and spasms
  • Restlessness
  • Nervousness
  • Yawning and problems sleeping
  • Belly cramps
  • Diarrhea
  • Nausea and vomiting

Withdrawal from cocaine may cause:

  • Cravings
  • Irritability and nervousness
  • Tiredness
  • A depressed mood
  • Loss of contact with reality
  • Seeing or hearing things that are not there
  • Thoughts of self harm

Withdrawal from the misuse of medicines like benzodiazepines may cause:

  • Cravings
  • Problems sleeping
  • Irritability and nervousness
  • Tremors
  • Sweating
  • Lack of focus
  • Nausea and vomiting
  • Lack of hunger
  • Weight loss
  • Rapid heartbeat
  • Muscle pain

Diagnosis

The doctor will ask about symptoms, past health, and drug use. A physical exam will be done.

Tests may be done to detect the drug levels and how it has changed how the body works. This can be done with blood and urine tests. Saliva, sweat, or hair may also be tested.

Treatment

The goal of treatment is to manage symptoms. The treatment used will depend on symptoms and the drug that was misused.

Support care in a treatment center may be needed. It may be the first part of a treatment program or simply medical care during withdrawal. Care may include:

  • IV vitamins and fluid
  • Medicine to ease withdrawal symptoms
  • Monitoring and medical support for severe reactions

Medicine can be used to slowly step down the drug. The medicine can stop withdrawal symptoms but do not give user the same “high” as they get with the drug. It is then reduced slowly over time. The body has time to adjust before the medicine is stopped completely.

Counseling or group therapy may be needed for those with substance abuse. It can help to develop healthier coping strategies and support systems.

Exercise and good sleep habits may also help.

Prevention

Some withdrawal may be prevented if medicine can be slowly reduced over time. This may be possible with medicine used as part of medical care.

RESOURCES

Alcoholics Anonymous  https://www.aa.org 

Substance Abuse and Mental Health Services Administration  https://www.samhsa.gov 

CANADIAN RESOURCES

Canadian Centre on Substance Use and Addiction  http://www.ccsa.ca 

Health Canada  http://www.canada.ca 

References

Benzodiazepine withdrawal syndrome. EBSCO DynaMed website. Available at: https://www.dynamed.com/condition/benzodiazepine-withdrawal-syndrome. Accessed March 25, 2021.

Drug withdrawal symptoms, timelines, and treatment. American Addiction Centers website. Available at: https://americanaddictioncenters.org/withdrawal-timelines-treatments. Accessed March 26, 2021.

Drugs, brains, and behavior: The science of addiction National Institute for Drug Abuse website. Available at: https://www.drugabuse.gov/publications/drugs-brains-behavior-science-addiction/preface. Accessed October 22, 2020.

Kosten TR, Baxter LE. Review article: Effective management of opioid withdrawal symptoms: A gateway to opioid dependence treatment.  Am J Addict. 2019 Jan 31 early online.

Opioid withdrawal. EBSCO DynaMed website. Available at: https://www.dynamed.com/condition/opioid-withdrawal. Accessed October 22, 2020.

Principles of drug addiction treatment: a research based guide. National Institute of Drug Abuse website. Available at: http://www.drugabuse.gov/publications/principles-drug-addiction-treatment. Accessed October 22, 2020.

Treatment approaches for drug addiction. National Institute for Drug Abuse website. Available at: https://www.drugabuse.gov/publications/drugfacts/treatment-approaches-drug-addiction. Accessed October 22, 2020.

Revision Information