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Substance Withdrawal Syndrome
Substance Withdrawal Syndromes

Presentation

Nicotine Intoxication presentation restlessness, insomnia, anxiety, arrhythmias treatment no specific treatment symptomatic treatment only Withdrawal presentation irritability, headache, anxiety, weight gain, craving treatment for cessation pharmacologic [medbullets.com]

Unfortunately, no specific time periods associated with the symptoms were presented, although only 12 patients (8% of the sample) left the 28-day treatment program prior to completion. [health.gov.au]

This article will discuss some features of withdrawal from drugs that are highly emotional or psychological in their presentation. [lagunatreatment.com]

The body changes how it functions so that “normal” occurs when the drug is present. When a person first tries to get sober, the clean state no longer feels right. [blackbearrehab.com]

The material discussed in the Materials is not intended to present the only or necessarily the best pediatric method or procedure, but rather presents the approach or opinion of the discussant. [pediatriccare.solutions.aap.org]

Entire Body System

  • Fatigue

    These consisted of anorexia, rhinitis, and fatigue, followed by irritability and insomnia. Vomiting developed by the end of 48 hr of abstinence. Propoxyphene was then reinstituted, and within 24 hr the patient was asymptomatic. [annals.org]

    Extreme fatigue and severe depression may present. Days 11-17 While most symptoms have begun to lessen, depression and insomnia may continue. For some, insomnia can lead to hypersomnia or excessive sleeping. [addictioncenter.com]

    With AWS, you may experience a combination of physical and emotional symptoms, from mild anxiety and fatigue to nausea. Some symptoms of AWS are as severe as hallucinations and seizures. At its most extreme, AWS can be life-threatening. [healthline.com]

    Alcohol withdrawal symptoms include irritability, fatigue, shaking, sweating, and nausea. Withdrawal from nicotine can cause irritability, fatigue, insomnia, headache, and difficulty concentrating. [en.wikipedia.org]

    Individuals may experience fatigue and changes in sleep or mood for months. Severe effects, such as high fevers, confusion and seizures, also are known to develop. In extreme cases, withdrawal can be fatal. [drugrehab.com]

Gastrointestinal

  • Nausea

    Symptoms Symptoms of alcohol withdrawal include nausea, anxiety, and a fast heart rate. [medicalnewstoday.com]

    Symptoms are flu-like, and include gastrointestinal distress, anxiety, nausea, insomnia, muscle pain, fevers, sweating, and runny nose and eyes. [medical-dictionary.thefreedictionary.com]

    With AWS, you may experience a combination of physical and emotional symptoms, from mild anxiety and fatigue to nausea. Some symptoms of AWS are as severe as hallucinations and seizures. At its most extreme, AWS can be life-threatening. [healthline.com]

    The nausea and vomiting would be considered physical symptoms of withdrawal; however, experiencing nausea and vomiting is also associated with a number of other psychological/emotional and cognitive effects that can include things like anxiety, depression [lagunatreatment.com]

    […] dependence on benzodiazepines is accompanied by a withdrawal syndrome which is typically characterized by sleep disturbance, irritability, increased tension and anxiety, panic attacks, hand tremor, sweating, difficulty in concentration, dry wretching and nausea [ncbi.nlm.nih.gov]

  • Diarrhea

    Diarrhea is another very uncomfortable and potentially dangerous withdrawal symptom. Loss of fluids and electrolytes from diarrhea can cause the heart to beat in an abnormal manner, which can lead to circulatory problems and even heart attack. [healthline.com]

    Other medicines can: Treat vomiting and diarrhea Help with sleep Naltrexone can help prevent relapse. It is available in pill form or as an injection. [medlineplus.gov]

    […] friends, family members, or colleagues) Physical symptoms: Impaired motor coordination Shallow breathing and slowed heart rate Dilated pupils Itchiness Excessive yawning Delayed reflexes or response times Apparent numbness to physical pain Nausea and diarrhea [sierratucson.com]

    Uncoordinated sucking and swallowing, difficulty feeding, poor weight gain and diarrhea are common digestive system symptoms. Other symptoms include nasal stuffiness, sweating, mottled skin color and difficulty maintaining a normal temperature. [livestrong.com]

    Babies with NAS can get dehydrated from having diarrhea or throwing up a lot. Drinking higher-calorie baby formula. Some babies with NAS need extra calories to help them grow because they have trouble feeding or slow growth. [marchofdimes.org]

  • Abdominal Cramps

    Opioid withdrawal is accompanied by rhinorrhoea (running nose), lacrimation (excessive tear formation), aching muscles, chills, gooseflesh, and, after 24-48 hours, muscle and abdominal cramps. [who.int]

    Early symptoms of withdrawal include: Agitation Anxiety Muscle aches Increased tearing Insomnia Runny nose Sweating Yawning Late symptoms of withdrawal include: Abdominal cramping Diarrhea Dilated pupils Goose bumps Nausea Vomiting These symptoms are [medlineplus.gov]

    Opioid Withdrawal Symptoms Include: Early symptoms Late symptoms Agitation Abdominal cramping Anxiety Diarrhea Watery eyes Dilated pupils Muscle aches Nausea Sweating Vomiting Vomiting and diarrhea could lead to dehydration and other body disturbances [drugrehab.com]

    Late phase: In this phase individuals are likely to experience nausea, vomiting, chills, diarrhea, abdominal cramps, and also likely to have dilated pupils. Withdrawal from opiates can last as little as weeks long. [blog.cognifit.com]

    They include: diarrhea abdominal cramping goose bumps on the skin nausea and vomiting dilated pupils and possibly blurry vision rapid heartbeat high blood pressure Although very unpleasant and painful, symptoms usually begin to improve within 72 hours [healthline.com]

  • Abdominal Pain

    Opioids Patients who experience drug withdrawal symptoms after stopping opioid use will often experience flu-like symptoms, such as sneezing, fatigue, abdominal pain, diarrhea, nausea, vomiting, leg cramps, and chills. [withdrawal.net]

    Physical symptoms may include headaches, muscle spasms, bone pain, diarrhea, heart palpitations, numbness and tingling in the extremities. [luxury.rehabs.com]

    Withdrawal syndrome: Common symptoms: increased anxiety, tremor, irritability, restlessness, depression, dizziness, sweating, insomnia, nightmares, abdominal pain, tachycardia and hypertension (usually mild). [patient.info]

    Z in the morning, he complains of severe abdominal pain in his RLQ, severe back pain from the hospital bed, nausea, and constipation. The team decides to increase the dose and frequency of his hydromorphone and docusate is added. [medbullets.com]

    I have abdominal pain, I am sweating, have the chills, as if I had a fever, or I have a headache 81% 0.44 8. I feel tired 93% 9. I have vivid unpleasant dreams 82% 10. I sleep a lot 81% 11. My appetite has increased a lot 88% 12. [bmcpsychiatry.biomedcentral.com]

Cardiovascular

  • Hypertension

    Rebound hypertension after sudden discontinuation of methyldopa therapy. Med J Aust. 1977 Apr 30; 1 (18):659–659. [ PubMed ] [ Google Scholar ] Scott JN, McDevitt DG. Letter: Rebound hypertension after acute methyldopa withdrawal. [ncbi.nlm.nih.gov]

    On exam, the alcoholic withdrawal response signs may include hyperventilation, tachycardia, tremor, hypertension, diaphoresis or hypothermia. [statpearls.com]

    Vital sign changes such as tachycardia and hypertension may occur concomitantly with acute drug withdrawal. [unboundmedicine.com]

    This drug is used for hypertension and to treat withdrawal from opiate narcotics. [encyclopedia.com]

    […] induces dependence or if the condition they are being used to treat is potentially dangerous and likely to return once medication is stopped, such as diabetes, asthma, heart conditions and many psychological or neurological conditions, like epilepsy, hypertension [en.wikipedia.org]

  • Tachycardia

    On exam, the alcoholic withdrawal response signs may include hyperventilation, tachycardia, tremor, hypertension, diaphoresis or hypothermia. [statpearls.com]

    Vital sign changes such as tachycardia and hypertension may occur concomitantly with acute drug withdrawal. [unboundmedicine.com]

    Withdrawal syndrome: Common symptoms: increased anxiety, tremor, irritability, restlessness, depression, dizziness, sweating, insomnia, nightmares, abdominal pain, tachycardia and hypertension (usually mild). [patient.info]

    […] that increase serotonin concentration by different mechanisms are prescribed. 35 In adults, serotonin syndrome is characterized by the following triad of clinical signs: changes in mental status (agitation, confusion); autonomic hyperactivity (fever, tachycardia [pediatrics.aappublications.org]

Musculoskeletal

  • Myalgia

    The syndrome is characterized by rhinorrhea, sneezing, yawning, lacrimation, abdominal cramping, leg cramping, piloerection (gooseflesh), nausea, vomiting, diarrhea, mydriasis, myalgias and arthalgias. [emedicine.medscape.com]

Psychiatrical

  • Anxiety Disorder

    Examples of various disorders that have been cited as co-occurring alongside substance use disorders, including opioid addiction, include: Panic and anxiety disorder Depression Abuse of and addiction to other drugs Bipolar disorder Oppositional defiant [sierratucson.com]

    See the separate articles Insomnia and Generalised Anxiety Disorder for options. Advise patients of the risk of dependence and impaired reaction times. Advise that this may affect ability to drive or operate machinery. [patient.info]

    These mental illnesses that co-occur with heroin addiction include: Depressive disorders Anxiety disorders Bipolar disorder Schizophrenia Eating disorders Post-traumatic stress disorder Personality disorders Other substance addictions Alcoholism [optionsbehavioralhealthsystem.com]

    Other symptoms in this phase are insomnia, agitation, anxiety ( generalized anxiety disorder ), and excessive sweating. [blog.cognifit.com]

  • Distractibility

    Their presence can provide distraction, while their support can help individuals to stay motivated to make it through the withdrawal process. [deserthopetreatment.com]

    Paulo Graziano explains why fidget spinners cause more distraction than concentration for some children. [brainfacts.org]

Neurologic

  • Insomnia

    Insomnia has also been found to influence relapse rate. Studies have found that magnesium or trazodone can help treat the persisting withdrawal symptom of insomnia in recovering alcoholics. [en.wikipedia.org]

    Symptoms are flu-like, and include gastrointestinal distress, anxiety, nausea, insomnia, muscle pain, fevers, sweating, and runny nose and eyes. [medical-dictionary.thefreedictionary.com]

    Melatonin occasionally has a role for those with insomnia. [patient.info]

    For opiates/narcotics: anxiety, insomnia, dilated pupils, increased heart rate, elevated blood pressure, nausea, and vomiting. For stimulants, such as cocaine: excessive tiredness and depression. [everydayhealth.com]

    These consisted of anorexia, rhinitis, and fatigue, followed by irritability and insomnia. Vomiting developed by the end of 48 hr of abstinence. Propoxyphene was then reinstituted, and within 24 hr the patient was asymptomatic. [annals.org]

  • Seizure

    Withdrawal seizures: seizures occur within 48 hours of alcohol cessations and occur either as a single generalized tonic-clonic seizure or as a brief episode of multiple seizures. [en.wikipedia.org]

    As a consequence, patients in alcohol withdrawal develop anxiety, agitation, tremor, seizures, and diaphoresis, all of which can occur with hypoglycemia. [statpearls.com]

    Diets high in fat and low in carbohydrates can reduce the frequency of epileptic seizures. Not all seizures are as dramatic as the ones you see on TV. [brainfacts.org]

  • Headache

    […] by a withdrawal syndrome which is typically characterized by sleep disturbance, irritability, increased tension and anxiety, panic attacks, hand tremor, sweating, difficulty in concentration, dry wretching and nausea, some weight loss, palpitations, headache [ncbi.nlm.nih.gov]

    As the alcohol wears off, these effects lead to common hangover symptoms, such as headache, nausea, and fatigue. Alcohol withdrawal syndrome is different. [medicalnewstoday.com]

    These usually include at least two of the following: tremors anxiety nausea vomiting headache an increased heart rate sweating irritability confusion insomnia nightmares high blood pressure The symptoms may worsen over two to three days, and some milder [healthline.com]

    If you typically drink a little coffee, and maybe a soda with lunch, then you might feel tired, a little irritated by others, and have a headache. If you are a pot-of-coffee and a 44-oz. [study.com]

    Withdrawal symptoms can include severe anxiety, headaches, sadness, anger, sweating, shaking, disorientation and depression. They can last anywhere from days to weeks or even months after quitting. [foodaddictionresearch.org]

  • Agitation

    Nicotine Dysphoria, agitation, behavioral changes, and increased appetite may all occur. [unboundmedicine.com]

    Twelve to 24 hours after cessation, the condition may progress to such major symptoms as confusion, hallucinations (with awareness of reality), tremor, agitation, and similar ailments. [en.wikipedia.org]

    Management of severe agitation A minority of patients withdrawing from stimulants may become significantly distressed or agitated, presenting a danger to themselves or others. [ncbi.nlm.nih.gov]

    The condition is a state of confusion that produces hallucinations, delusions and severe agitation. [drugrehab.com]

    Its signs and symptoms include: extreme confusion extreme agitation a fever seizures tactile hallucinations, such as having a sense of itching, burning, or numbness that isn’t actually occurring auditory hallucinations, or hearing sounds that don’t exist [healthline.com]

  • Tremor

    Some signs your doctor will look for include: hand tremors an irregular heart rate dehydration a fever Your doctor may also perform a toxicology screen. This tests how much alcohol is in your body. [healthline.com]

    On exam, the alcoholic withdrawal response signs may include hyperventilation, tachycardia, tremor, hypertension, diaphoresis or hypothermia. [statpearls.com]

    The following symptoms may result: For alcohol: sweating, anxiety, tremors, fluctuations in blood pressure and heart rate, seizures, delirium tremens (the “DTs” — a state of extreme agitation, hallucinations, hyperactivity, tremors, and confusion), psychosis [everydayhealth.com]

    Anxiety, insomnia, nausea, perspiration, body aches, and tremors are just a few of the physical and psychological symptoms of drug and alcohol withdrawal that may occur during detoxification. [medical-dictionary.thefreedictionary.com]

    Abstract Physiological dependence on benzodiazepines is accompanied by a withdrawal syndrome which is typically characterized by sleep disturbance, irritability, increased tension and anxiety, panic attacks, hand tremor, sweating, difficulty in concentration [ncbi.nlm.nih.gov]

Workup

Evaluation The workup required depends on the severity of the patient's condition. [9] [10] [11] Tests to be considered include: Glucose - liver disease due to alcoholism may reduce glycogen stores, and ethanol impairs gluconeogenesis. [statpearls.com]

[…] tests may be indicated in cases of possible withdrawal, depending on the clinical scenario: Serum glucose Arterial blood gas analysis CBC Comprehensive metabolic panel Urinalysis Cardiac biomarker measurements Prothrombin time Toxicology screening See Workup [emedicine.medscape.com]

Treatment

Limited evidence supports the use of gabapentin or carbamazepine for the treatment of mild or moderate alcohol withdrawal as the sole treatment or as combination therapy with other medications; however, gabapentin does not appear to be effective for treatment [en.wikipedia.org]

One methadone MAT product, Dolophine, is indicated both for treatment of pain and for treatment of opioid addiction, and already has the boxed warning for NOWS. [fda.gov]

Medical Complications of Drug Use 840 Acute and Chronic Pain 863 Substance Use Disorders in Individuals with CoOccurring Psychiatric Disorders 904 Epidemiology and Emerging Public Health Perspectives 913 HIVRelated Medical Complications and Treatment [books.google.com]

An addiction treatment and long-term recovery program is necessary to achieve long-term sobriety. Without such a treatment program, the likelihood of recurrence of abuse and, therefore, the recurrence of withdrawal syndrome is high. [medical-dictionary.thefreedictionary.com]

Duration of treatment may be 14, 30, 60 or 90 days or longer. Post-treatment counseling and support are recommended to help you sustain long-term recovery. [promises.com]

Prognosis

Prognosis A closely observed, medically managed detoxification typically results in a safe and tolerable withdrawal experience for the patient. Detoxification is only a short-term solution for obtaining abstinence. [medical-dictionary.thefreedictionary.com]

Prognosis With appropriate therapy, withdrawal is well tolerated. Poor prognostic factors are primarily related to comorbidities. [unboundmedicine.com]

Prognosis in childhood epilepsy. Follow-up study of 148 cases in which therapy had been suspended after prolonged anticonvulsant control. N Engl J Med. 1972 Jan 27; 286 (4):169–174. [ PubMed ] [ Google Scholar ] Gardos G, Cole JO, Tarsy D. [ncbi.nlm.nih.gov]

Etiology

The withdrawal response is relieved immediately by consuming additional alcohol. [1] [2] [3] [4] Etiology The body attempts to maintain homeostasis. [statpearls.com]

Etiology Neonates Maternal alcohol, caffeine, opioid, sedative-hypnotic, or SSRI use may result in a neonatal abstinence syndrome. [unboundmedicine.com]

ETIOLOGY Not all patients who take benzodiazepines will experience a discontinuance syndrome when the drug is stopped. Several conditions must be present before the discontinuance syndrome is likely: Duration of treatment. [encyclopedia.com]

An indeterminate part of these observed increases has resulted from more liberal use of prescription opiates in pregnant women to palliate a wide variety of etiologies of acute or chronic pain. [pediatrics.aappublications.org]

Epidemiology

Medical Complications of Drug Use 840 Acute and Chronic Pain 863 Substance Use Disorders in Individuals with CoOccurring Psychiatric Disorders 904 Epidemiology and Emerging Public Health Perspectives 913 HIVRelated Medical Complications and Treatment [books.google.com]

Epidemiology Withdrawal from drugs and alcohol is a common medical problem. Five to ten percent of the population has alcoholism. As many as 5% of these patients may develop delirium tremens (DT) when they withdraw from chronic alcohol use. [statpearls.com]

Probability and predictors of transition from first use to dependence on nicotine, alcohol, cannabis, and cocaine: results of the National Epidemiologic Survey on Alcohol and Related Conditions (NESARC). [brainblogger.com]

[…] benzodiazepines and selective serotonin re-uptake inhibitors Addiction. 2012 May;107(5):900-8 DOI : 10.1111/j.1360-0443.2011.03686.x Nyberg K, Buka SL, Lipsitt LP Perinatal medication as a potential risk factor for adult drug abuse in a North American cohort Epidemiology [lucperino.com]

Epidemiology The most common life-threatening withdrawal syndrome, alcohol withdrawal, rarely occurs in children. Neonates born to alcohol-dependent mothers are at risk. [unboundmedicine.com]

Pathophysiology

Pathophysiology Altered CNS neurochemistry is the most important and clinically relevant aspect of withdrawal pathophysiology. Under normal conditions, the CNS maintains a balance between excitation and inhibition. [unboundmedicine.com]

Pathophysiology The body, when exposed to any type of substance attempts to maintain homeostasis. When exposed, it produces counter-regulatory mechanisms and processes that attempt to keep the body in balance. [emedicine.medscape.com]

Prevention

[…] and Treatment of Addiction Among African Americans 1250 The Public Health Approach to the Prevention of Substance Abuse 1255 Medical Education in Substance Abuse The Acquisition of Knowledge Attitudes and Skills 1269 Education and Training of Clinical [books.google.com]

To help to prevent Wernicke syndrome, alcoholics should be administered a multivitamin preparation with sufficient quantities of thiamine and folic acid. [en.wikipedia.org]

Prevention The most effective way to prevent alcohol withdrawal syndrome is to avoid drinking or drinking only in moderation. Moderate drinking is officially defined as 1 drink or less per day for women and 2 drinks or less per day for men. [medicalnewstoday.com]

According to these guidelines, the rationale for MAT during pregnancy is to prevent complications of opioid abuse, addiction and withdrawal, and encourage prenatal care and drug treatment. [fda.gov]

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