Drug withdrawal is the compilation of symptoms that occur from physical drug dependence after the drug has been decreased in dosage or completely stopped. Withdrawal happens through the buildup in the body of a tolerance to the specific drug, as the brain and other organs adjust to the chemical over time. Symptoms of withdrawal vary, depending upon the level of abuse and the type of substance, and rapidly appear within a few hours or days after last use.
Most drugs of abuse affect the nucleus accumbens, or the “pleasure center” of the brain, and directly manipulate the stimulation of dopamine activity. Over time, throughout the abuse, the neurotransmitter becomes less active, and with the discontinuation of the drug, results in abnormally low levels of dopamine, creating the withdrawal syndrome dysphoria.
Drug abuse generally begins with the search of the user for positive reinforcement, such as euphoria, or “rush” of an “initial” high. Dysphoria is a syndrome of drug withdrawal that produces the opposite symptoms of use, such as depression, anxiety, and overwhelming craving. These symptoms are often much worse than the initial problems that led to use in the first place, and addicts often continue to use indefinitely, despite harmful consequences, in the pursuit of avoiding them.
Extended use of drugs that affect neurotransmitters could result in desensitized or reduced levels of receptors in the synapses of the brain. The negative symptoms created by this occurrence are often relentless until the brain readjusts and the activities of dopamine and other neurotransmitters are restored. Withdrawal symptoms vary with the individual and depend upon many factors, such as type of drug, length, amount, and frequency of use.
The terms “crash” and “rebound” are two words that are important when considering the concept of drug withdrawal. Part of any addiction is the pursuit of pleasurable feelings or “high” and the object of maintaining it. As tolerance develops, the addict is forced to consume larger amounts of the drug to be able to feel the rush of initial use. It is a vicious cycle. As the amount increases in the avoidance of a “crash” or the beginning of withdrawal symptoms, the more the underlying condition worsens. As these negative symptoms recur, they are often compounded and drastically multiplied, creating the compulsive nature that leads to continued use.
Drug withdrawal is often the most difficult when associated with drugs that affect the central nervous system, such as tranquilizers, nicotine, stimulants, painkillers, narcotics, and antidepressants. Symptoms can range in severity from mild depression to life-threatening situations such as delirium tremens, or chronic seizures. It is advised, that in circumstances of severe addictions, drug withdrawal should be monitored in a safe setting by a medically licensed doctor or staff. It is sometimes necessary to wean a person off of a chemical dependency slowly as opposed to “cold turkey”, or all at once. In cases of chronically acute addiction, where the individual’s body has grown to depend upon the drug to function, it could be extremely dangerous to abruptly cease the intake of the particular substance.
Heroin injection continues to be the predominant method of heroin use among addicted users seeking treatment; however, researchers have observed a shift in heroin use patterns, from injection to sniffing and smoking.