What Does Withdrawal Mean? Symptoms, Causes, Treatment & Medication
What is Withdrawal?
Withdrawal from drugs and alcohol is a common medical problem widely prevalent in many countries. The withdrawal response after discontinuation of a particular drug or alcohol can depend on the length and quantity of use. The body aims to maintain homeostasis, and when a chemical that was once overused is removed, counter-regulatory mechanisms may produce unopposed effects, and withdrawal symptoms may ensue. When people consume alcohol for at least 1 to 3 months or even consume large quantities for at least seven to ten days, the withdrawal response can occur within 6 to 24 hours after cessation of alcohol. The alcohol withdrawal symptoms are relieved immediately by consuming additional alcohol.
According to data from the National epidemiologic survey on alcohol and related conditions, the estimated lifetime prevalence of alcohol use disorder was 12.8% and 4.8% annually. About 20% of adults in the emergency room may suffer from alcohol use disorder and about 4-40% of patients admitted to ICU will have alcohol withdrawal symptoms(AWS).
Only 24% of patients with alcohol use disorder were ever treated. Patients who have AWS have an increased length of hospital stay and increased mortality than those who do not have AWS. Chronic alcoholism and withdrawal are more common in men than in women. The mortality rate from alcohol withdrawal and DT is high if untreated. 
As many as 5% of these patients may develop delirium tremens (DT) when they withdraw from chronic alcohol use. The number of people addicted to opioids, sedatives, and stimulants is not known. Though benzodiazepine withdrawal is a medical emergency due to the onset of withdrawal seizures, benzodiazepine intoxication is relatively benign. Opiate withdrawal is uncomfortable, but fatalities are rare. Withdrawal from cocaine and amphetamine results in sedation and a state resembling adrenergic blockade, death is rare.
Symptoms of Withdrawal
The signs and symptoms of alcohol withdrawal may range from a simple tremor to a fully blown delirium tremens characterized by autonomic hyperactivity, tachypnea, hyperthermia, and diaphoresis. About 25% of patients may develop alcohol hallucinations. Some patients with alcohol use disorder may also develop seizures which are brief.
Many patients with alcohol withdrawal have additional medical or traumatic conditions that may increase their associated risk of morbidity and mortality. Risk factors associated with increased mortality include cirrhosis, the presence of DTs at the time of diagnosis, the existence of underlying chronic pathology other than liver disease, and a need for endotracheal intubation.
Barbiturates and Benzodiazepines
The use of sedatives like barbiturates and benzodiazepines can also produce withdrawal responses that resemble alcohol withdrawal syndrome. Autonomic and psychomotor dysfunction often characterize the withdrawal symptoms. The symptoms tend to develop 2 to 10 days after discontinuation of the agent. Gamma Hydroxybutyrate (GHB) is now a common club drug abused at nightclubs and all-night parties. The withdrawal response is mild, resembles a sedative withdrawal syndrome with psychotic symptoms. Severe withdrawal symptoms tend to occur in chronic users and can also present with seizures and rhabdomyolysis.
Opiate withdrawal response is usually mild and not life-threatening. It usually resembles a flu-like illness characterized by yawning, sneezing, rhinorrhea, nausea, diarrhea, vomiting, and dilated pupils. Depending on the half-life of the drug, the symptoms may last for three to ten days. Also, individuals who abuse IV drugs are prone to infections like endocarditis, osteomyelitis, cellulitis, hepatitis, and septic emboli. Patients with Opioid Use disorder may have signs of a cough, hemoptysis, and tachypnea due to opportunistic infections as a result of acquiring HIV and PCP. IV drug users may have scars and needle marks.
Cocaine and Amphetamines
Central nervous system (CNS) stimulants like cocaine and amphetamine can also produce withdrawal symptoms. Like opioids, the withdrawal symptoms are mild and not life-threatening. Often the individual will develop marked depression, excessive sleep, hunger, dysphoria, and severe psychomotor retardation but all vital functions are well preserved. Recovery is usually slow, and depression can last for several weeks.
Causes of Withdrawal
Alcohol intoxication and withdrawal are complex. Most effects can be explained by the interaction of alcohol with neurotransmitters and neuroreceptors including gamma-aminobutyric acid (GABA) and glutamate (NMDA). The changes in the inhibitory and excitation neurotransmitters disrupt the neurochemical balance in the brain, causing symptoms of withdrawal. Ethanol inhibits opioid binding to P-opioid receptors, and long-term use results in the upregulation of opioid receptors. Opioid receptors in the nucleus accumbens and the ventral tegmental area of the brain modulate ethanol-induced dopamine release, this, in turn, produces alcohol craving and the use of opioid antagonists to prevent this craving.
In opioid or benzodiazepine addiction, chronic stimulation of specific receptors for these drugs suppresses the endogenous production of neurotransmitters, endorphins, or GABA. Removal of the exogenous drug allows unopposed counter-regulatory effects. When the exogenous drug is removed, inadequate production of endogenous transmitters and unopposed stimulation by counter-regulatory transmitters results in withdrawal symptoms. The time it takes to restore homeostasis by the synthesis of endogenous transmitters determines the onset of withdrawal symptoms.
Treatment of Withdrawal Symptoms
Patients with alcohol withdrawal may have numerous potentially life-threatening medical problems. Administration of intravenous glucose to patients with seizures is controversial because this is thought to precipitate acute Wernicke encephalopathy in chronic alcoholism unless thiamine is also administered. A benzodiazepine can be administered to control seizures.
If the patient has hypoglycemia, dextrose 50% in water (D50W) 25 mL to 50 mL and Thiamine 100 mg intravenously (IV) is also indicated. Low doses of clonidine can help reverse central adrenergic discharge, relieving tachypnea, tachycardia, hypertension, tremor, and craving for alcohol. In an agitated patient, neuroleptics such as haloperidol 5 mg IV or intramuscularly (IM) may be added to sedative-hypnotic agents as an adjunctive therapy. Caution must be taken because haloperidol may decrease the seizure threshold as well as prolong the QT interval.
Patients with chronic opioid use disorder need a medication taper with buprenorphine, a partial opioid agonist. Withdrawal symptoms should be assessed with the Clinical Opiate Withdrawal Scale (COWS). COWS is an 11-item scale is used to identify withdrawal symptoms and treatment response. Opioid withdrawal is treated with a long-acting opioid agonist, such as methadone or buprenorphine. Clonidine, an alpha agonist may also decrease the severity of symptoms. Long-acting benzodiazepines may be used to control insomnia and muscle cramps.
Sedative-hypnotic withdrawal is treated with substituting drugs that have a long duration of action, benzodiazepine or phenobarbital for a few days followed by a decreasing dose over 2 to 3 weeks.
GHB withdrawal can initially be treated with high doses of benzodiazepines, refractory cases have responded to pentobarbital, chloral hydrate, and baclofen.
Stimulant-withdrawal syndrome is treated with observation.
Coping with Withdrawal
Usually, acute drug or alcohol withdrawal symptoms last about a week, two at the most. But occasionally, withdrawal symptoms go on for months, or go away and then come back.  This is known as post-acute withdrawal syndrome. If it happens to you, talk to your doctor about getting more help.
Facing depression, anxiety, and other emotional symptoms during withdrawal may be very difficult. It is challenging for almost everyone. However, once you are on the other side, you won’t regret it. You have the rest of your life ahead of you that will be free of alcohol or drugs.
Patients with DTs or other severe withdrawal symptoms may require admission to the intensive care unit due to the risk of mortality. 
Patients with chronic alcoholism or intravenous drug use should be evaluated for inpatient programs. Treatment programs are only successful if the patient is motivated. Often individuals dependent on opiates should be started on methadone or buprenorphine.
- Methadone, a long-acting opiate that prevents somatic withdrawal symptoms but does not cause euphoria equivalent to heroin, may be prescribed.
- Buprenorphine is a Mu-opioid agonist/antagonist prescribed similarly to methadone.
Psychiatric evaluation is strongly recommended to rule out mental health concerns such as suicidal ideation, major depression, and poly-substance abuse.
There are two major signs of substance use disorder: tolerance and withdrawal. The body builds up a tolerance to substances of abuse after continued exposure. As the body adapts to continue functioning, the tolerance increases and leads to a person needing to consume even more substances of abuse to achieve the desired effects.
Those suffering from addiction for long periods of time at high rates of use usually experience more severe withdrawal symptoms, making the process more difficult for them. What does withdrawal mean? The symptoms may seem to get worse through the detox process. They need constant care and attention to help manage the symptoms. Delirium Tremens may lead to death if they are not managed well and in time. Addiction treatment is within your reach to ensure your recovery starts on a comfortable and safe step.
If you, your friend, or your family need help with addiction and withdrawal symptoms, contact We Level Up TX today.
A comprehensive team prescribing medications can alleviate your withdrawal pains while monitoring your health 24 hours. Assuring both your safety and comfort. We Level Up TX’s thorough approach to rehabilitation supports several levels of care to ensure the best possible outcome for every client who enters our doors. From an intensive and more supportive atmosphere for those in the early days of recovery to a comfortable residential-style living dynamic upon completion of detox, we are here to help guide you down the safe and results-based path to your sobriety.