People who decide to stop taking drugs or drinking alcohol after using or drinking for long periods of time, need to be aware that they might experience withdrawal effects which can be irritating, debilitating and even life-threatening.
Many of these withdrawal signs, which can be psychological and physical in nature, are generally opposite to the effects the person experienced when the drug was being taken. For example, abrupt withdrawal from long-term use of Valium (diazepam) and other benzodiazepines, drugs which are prescribed to alleviate anxiety and insomnia, can lead to pronounced anxiety, insomnia, agitation, intrusive thoughts and panic attacks.
In addition, people withdrawing from benzodiazepines can experience physical withdrawal signs, such as burning sensations, feeling of electric shocks, and full-blown seizures. The duration and strength of these withdrawal signs is in part dependent on the amounts of drug having been used and the duration of time the person has been using the drug.
Long-term administration of drugs and/or drinking alcohol can lead to tolerance, such that over time higher doses of the drug or alcohol are required to exert the same positive effects seen initially with the lower dose. One consequence of this tolerance is that increasing the dose over time is likely to lead to more pronounced withdrawal signs when drug or alcohol use is terminated.
People wishing to terminate use of benzodiazepines after long-term administration should seek medical advice, for example from their GP, before doing so.
‘The detox from Benzos was one of the worst things I have ever been through. I continued being reduced by 1mg a week until I got to 2mg a day of diazepam, and then my GP stopped the script. I have since found out that this wasn’t really the best thing, for my mind or body, to be stopped cold turkey still on 2mg a day. I had some seizures and terrible headaches, and I couldn’t sleep properly for months. The first time I had a seizure I was out in town and knocked myself out on a wall. I was taken to hospital where they gave me some diazepam, as they were sure that the seizures were from the doctor reducing me too quickly.
I ended up in hospital about nine times with seizures, but I would not take more benzos, since I didn’t want to go through the withdrawal again. I was worried that I would feel awful forever, and never escape from my addiction, but after about eight months it seemed that the worst of the withdrawals was over.
Once the seizures were under control, helped along by some non-addictive epilepsy medication, I tried to get back to a normal day-to-day life. However, I was so nervous about literally anything and everything. I found it difficult to learn how to deal with anxiety and stress without having benzos to help. I thought I would never lead a normal life. It took almost a year after the detox before the anxiety and sleeplessness had subsided to a manageable level, so it was difficult to plan anything for the future as my head was all over the place.’ Sapphire
People who have become heavily dependent on alcohol may need to seek medical advice before stopping drinking. Alcohol has some similar actions to benzodiazepines in the brain, and similar withdrawal symptoms, such as increased anxiety, agitation, intrusive thoughts and even seizures.
People who have become addicted to stimulant drugs like amphetamine and cocaine can feel depressed when they stop using. The expression ‘What goes up, must come down’, comes to mind. Heroin withdrawal signs include stomach cramps, vomiting and retching, muscle pains, the shakes, hot and cold spells, and headaches. The strength and impact of these withdrawal signs depends on the length of time using, doses used, and the overall physical condition of the user. Withdrawing from opiate use is rarely life-threatening.
However, a person who has stopped using heroin—from being in prison, for example—and then decides to use again must be very careful. They must inject less drug than they had generally used before terminating use, as their tolerance has been lost due to the period ‘away’ from the drug. Too my people have overdosed, due to respiratory arrest following injection of their ‘usual’ dose, by ignoring this piece of advice.
Craving, an intense or overpowering desire to engage in drug-taking or alcohol consumption, can occur for substances associated with addiction, such as opiates, stimulants, alcohol and nicotine. Craving has been suggested as a prominent feature maintaining drug/alcohol use and precipitating relapse after a period of abstinence.
Craving can be produced by external stimuli and/or internal mood states. Over a long history of drinking or drug-taking, stimuli that have been repeatedly associated with consumption of alcohol or drugs (e.g. sight of the pub, or the syringe) become conditioned stimuli that can elicit craving. For example, watching someone smoke a cigarette and the smell of the tobacco can remind an ex-smoker of the relaxing effect of smoking and trigger an intense desire to experience this effect again.
Craving can also arise from the need to relieve withdrawal or conditioned withdrawal symptoms. Thus, a person returning to an area where they have experienced withdrawal on many occasions in the past may experience conditioned withdrawal symptoms, which in turn can generate craving.
Mood states also elicit craving. Many of us have needed a drink of alcohol to alleviate the stress we have felt on a certain occasion. Imagine what it would be like for a person recovering from a serious alcohol problem who is already experiencing alcohol withdrawal signs and now become stressed because of some external stimulus, such as seriously bad news.
Positive mood states (e.g. excitement) can also generate craving when having previously been associated with the pleasurable effects of drugs and alcohol.
People on a recovery journey need to learn how to deal with the cravings they experience. Fortunately, cravings gradually disappear over time, although the time for this to occur differs from person to person.
The photograph used in this blog post was by Simon Berger and has come from Unsplash, a great resource of free high resolution photographs.
