Thursday, February 6, 2014

Lexicon of Madness -- Withdrawal Syndrome

Withdrawal Syndrome: A collection of signs and symptoms associated with sudden discontinuation of a substance. Contrary to popular belief, withdrawal from opioids (e.g., heroin, OxyContin) is rarely fatal. Withdrawal symptoms usually commence within 8 hours of the last dose, but only after one or two weeks of continuous use. The withdrawal syndrome is nasty and painful (especially considering that some researchers have found that heroin users have lower pain thresholds than non-users), and resembles the effects of influenza (e.g., diarrhea, vomiting, muscle cramps, abdominal cramps). Temperature dysregulation (either hypothermia or hyperthermia) and piloerection (gooseflesh) are often observed (hence the term, "cold turkey"). Withdrawal symptoms usually peak after about 72 hours and mostly resolve within one week. A repeat dose of the drug will quickly eliminate all withdrawal symptoms. Sudden withdrawal from alcohol, on the other hand, can be medically very serious, even fatal. Suddenly stopping heavy drinking can lead to tremulousness (the "shakes"), psychotic symptoms (e.g., delusions or hallucinations), seizures, and delirium tremens (the "DTs"). Delirium tremens is fatal in about 20% of untreated cases. It is marked by disorientation, visual or tactile hallucinations (e.g., seeing blood coming out of the walls or feeling insects crawling on one's skin), diaphoresis (heavy sweating), insomnia, anxiety, and hypertension. Benzodiazepines and fluid replenishment are the usual treatment for alcohol withdrawal. Withdrawal from cocaine and other amphetamines is usually marked by a physical and emotional crash -- depression, lethargy, ravenous hunger, and nightmares. There is anecdotal clinical evidence that long-term, heavy users of methamphetamine may experience permanent anhedonia after the cessation of drug use. People who drink large amounts of coffee during the workweek may experience caffeine withdrawal (headaches, irritability, and fatigue) on the weekends. The existence of a cannabis withdrawal syndrome has been controversial in the research literature. Heavy users who suddenly stop smoking marijuana may experience modest increases in irritability and restlessness, along with diminished appetite. The predominant cannabis withdrawal symptom, however, is the recovery of short-term memory abilities.

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