Withdrawal Syndrome
How long does withdrawal syndrome last? All the information on the causes, symptoms, and treatment of this mental disorder.
Symptoms and Causes
Withdrawal syndrome refers to the set of physical and psychological reactions experienced when the consumption of a substance that has been abused and to which the body has become dependent is reduced or discontinued. Generally, the term applies to harmful substances like alcohol, drugs, or tobacco, but it can also refer to addictive habits such as gambling, sex, exercise, or compulsive eating.
Withdrawal syndrome typically manifests within the first 24 to 48 hours after the last dose consumed, peaks at 48 to 72 hours, and can last for several days or even weeks. Depending on when the symptoms appear, withdrawal syndrome is classified into:
- Acute withdrawal syndrome: Symptoms appear within hours of ceasing consumption.
- Late withdrawal syndrome: Symptoms persist even after the withdrawal phase is over.
- Conditioned withdrawal syndrome: An acute withdrawal syndrome is triggered when exposed to addiction-inducing stimuli again.
Withdrawal syndrome is a critical phase of the detoxification process and requires extremely careful treatment to prevent relapse in patients, especially with substances like alcohol or benzodiazepines, as it can be particularly dangerous and even fatal.
Symptoms
The symptoms of withdrawal syndrome can vary depending on the substance, the duration of use, the usual dosage, and individual factors such as overall physical and mental health. However, a common symptom is the intense urge to consume the substance again or repeat the addictive behavior. Some of the most common addictions and their corresponding withdrawal symptoms include:
- Alcohol withdrawal syndrome:
- Tremors
- Sweating or chills
- Insomnia
- Nausea
- Dehydration
- Headaches
- Anxiety and agitation
- Tachycardia
- Seizures
- Withdrawal syndrome from narcotics such as morphine, opioids, heroin, oxycodone, or codeine:
- Muscle pain
- Abdominal pain
- Diarrhea
- Vomiting
- Sweating
- Fever
- Nasal discharge
- Dilated pupils
- Insomnia
- Rapid breathing
- Anxiety or hyperactivity
- Alertness
- Withdrawal syndrome from stimulants such as cocaine, amphetamines, methamphetamine, or MDMA (ecstasy):
- Fatigue and drowsiness
- Nausea, vomiting
- Restlessness and nervousness
- Depression
- Delirium and hallucinations
- Negative or even suicidal thoughts
- Irritable or violent behavior
- Cannabis withdrawal syndrome:
- Nausea
- Sweating
- Diarrhea
- Loss of appetite
- Weight loss
- Irritability
- Sleep disturbances
- Withdrawal syndrome from anxiolytics and hypnotics such as benzodiazepines, barbiturates, chloral hydrate, or meprobamate:
- Tremors
- Anxiety
- Insomnia
- Irritability
- Delirium
- Tachycardia
- Seizures
- Nicotine withdrawal syndrome:
- Irritability
- Anxiety
- Headaches
- Difficulty concentrating
- Insomnia
- Increased appetite
- Weight gain
- Caffeine withdrawal syndrome:
- Drowsiness
- Headaches
- Restlessness
- Irritability
- Neonatal withdrawal syndrome: This occurs in newborns when the mother is addicted during pregnancy, and the substances consumed cross the placenta to the fetus. Consequently, the baby is born dependent and shows consequences from both consumption and withdrawal.
- Poor growth
- Premature birth
- Seizures
- Birth defects
- Excessive crying
- Poor feeding
- Occasionally, premature death
Causes
Withdrawal syndrome is a direct consequence of addiction. Addiction occurs because substances or addictive behaviors affect the body similarly to neurotransmitters responsible for activity in the brain's pleasure, satisfaction, or reward centers, which are translated into feelings of joy, enthusiasm, or serenity. However, the body gradually adapts to the substance or habit and develops tolerance, meaning that increasing amounts are needed to produce the same effect. Addictive substances eventually replace neurotransmitters and become necessary for normal bodily function. Therefore, the sudden withdrawal of the substance creates an imbalance in the body, resulting in the symptoms described above.
Risk Factors
The main risk factor for withdrawal syndrome is the consumption of addictive substances or the development of addictive behaviors, and the risk increases the longer the addiction is maintained. Additionally, individual factors increase the likelihood of experiencing withdrawal syndrome, such as the presence of mental health disorders or a family history of addiction.
Complications
The most common complication of withdrawal syndrome is relapse into addiction: if the symptoms are too intense, the individual may resume consumption to avoid them, especially if they lack medical or psychological support. Although relapse is a normal part of recovery, it can be extremely dangerous because, after a period of abstinence, an overdose may occur due to consuming a quantity that the body is no longer accustomed to, which can be potentially fatal.
Withdrawal from substances like alcohol or benzodiazepines may also lead to delirium tremens, an acute state of delirium characterized by visual hallucinations, delusions, confusion, agitation, and seizures. Additional symptoms include hypovolemia, hyperthermia, hypertension, tachycardia, or arrhythmia, which can cause cardiovascular collapse and result in death if immediate treatment is not administered.
Prevention
The most effective way to prevent withdrawal syndrome is to avoid addiction, meaning avoiding or limiting the substance or habit that triggers it. For individuals already addicted, it is necessary to gradually abandon the addiction with professional guidance and treatment.
Which doctor treats withdrawal syndrome?
Withdrawal syndrome is evaluated and treated in psychiatry and psychology departments.
Diagnosis
The diagnosis of withdrawal syndrome is based on the presence of characteristic symptoms alongside the history of substance use or addictive habits. It is crucial to obtain not only the patient’s testimony but also that of family members and close acquaintances.
A toxicological examination can also be performed to detect the presence of harmful substances in blood or urine samples.
Treatment
To overcome withdrawal syndrome and, consequently, addiction, the patient must undergo a detoxification treatment. This may require hospitalization or admission to a specialized center and usually involves two complementary approaches:
- Pharmacological treatment: Available options depend on the specific addiction and withdrawal symptoms. They may include:
- Analgesics for headaches and muscle pain
- Benzodiazepines such as lorazepam or diazepam to calm agitation and anxiety
- Antipsychotics if hallucinations or delusions occur
- Anticonvulsants if seizures manifest
- Nicotine supplements in the form of gums or patches for mild nicotine addiction
- Antidepressants such as fluoxetine and buspirone in cases of severe nicotine addiction
- Methadone as a substitute for narcotics
- Naltrexone for alcohol or opioid dehabituation, blocking the reinforcing effects of these substances at the neuronal level
- For withdrawal from anxiolytics or hypnotics, the original drug is often re-administered in smaller doses with gradual reductions
- Psychological treatment: Support therapies to prevent relapse and overcome addiction.
- Cognitive-behavioral therapy: Various techniques are used to identify the root of the addiction, and tools are provided to modify addictive behaviors and methods to satisfy the needs previously met by the addictive substance or habit.
- Support groups: Interaction with individuals facing similar addictions and sharing experiences can facilitate recovery.
In cases of delirium tremens, treatment includes:
- Intravenous fluids to prevent dehydration
- Cooling blankets to reduce hyperthermia
- Benzodiazepines or barbiturates
- Antipsychotics if hallucinations persist despite benzodiazepines
- Thiamine (Vitamin B₁) to prevent Wernicke-Korsakoff syndrome, as chronic alcoholism causes a deficiency in this vitamin, leading to encephalopathy and permanent neurological damage. Magnesium sulfate is also often administered to aid in thiamine synthesis
- Assisted breathing in severe cases
