Understanding withdrawal and detox during residential addiction rehabilitation

9th August 2024 / Written by Harbor London

When users attempt to stop using substances, without accountability or a strong support network, the likelihood of relapse is high11. There can also be severe withdrawal symptoms, including seizures, organ damage, and, in some cases, death12.

Substance Use Disorders (SUDs) are complex conditions that profoundly impact both physical and psychological health, relationships, home life, as well as work stability1. Prevalence also varies among different racial and ethnic groups, with higher rates observed in Black individuals2, but up to 60% of an individual’s vulnerability to SUD is attributable to genetics3. Understanding the nuances between detox and withdrawal is critical in the context of SUD addiction rehabilitation. Differentiating these terms is essential for developing effective treatment plans and ensuring patients receive appropriate care.

 

The aim of this blog is to provide a comprehensive understanding of detox and withdrawal, detailing the symptoms associated with different substances, and emphasising the importance of professional supervision during these processes.

 

Impact of addiction on the brain

 

SUDs can lead to both short- and long-term health effects, varying in severity depending on many factors1. Physiological impacts of chronic substance use can include increased blood pressure and heart rate, risk of myocardial infarction, seizures, liver disease, immunosuppression, digestive irregularities, kidney disease, and pneumonia1. These physical changes can persist long after substance use has ceased, highlighting the necessity of comprehensive medical oversight and care during rehabilitation and recovery.

 

The psychological and emotional effects are equally significant. Substance use can alter brain areas involved in other mental health conditions4. Chronic use of psychoactive drugs that precede symptoms of a mental health condition can alter brain physiology that can lead to an increased chance of individuals developing that mental health condition1,5. For instance, frequent cannabis use in adolescents can increase the risk of psychosis in adulthood3, whereas alcohol dependency over extended periods of time can lead to difficulties in learning and memory, as well as elevated symptoms of anxiety or depression1. Nicotine can disrupt the development of brain circuits controlling attention and learning, causing irritability, sleep problems, and depression upon withdrawal1. Interestingly, research on how both nicotine and schizophrenia affect the brain has generated a suggested explanation for the high rate of nicotine use among those living with the condition6. It noted that presence of abnormalities in particular circuits of the brain may both predispose individuals that use nicotine to developing schizophrenia, as well as increase the rewarding effects of using nicotine7. It is essential to recognise, however, that having both a SUD and a mental disorder does not always imply causation8.

 

Substances like opioids, cocaine, and nicotine flood the brain with dopamine; up to 10 times more than the level that comes as a result of natural rewards9. This makes the brain physiologically less sensitive to dopamine over time9, which affects focus, memory, learning, decision-making, and judgement – driving individuals to seek drugs out of habit rather than rational choice9. Repeated drug use can further damage the prefrontal cortex, impairing the ability to recognise the harms of addiction and making it difficult to stop using the substance even when aware of its severe consequences10.

 

When users attempt to stop using substances, without accountability or a strong support network, the likelihood of relapse is high11. There can also be severe withdrawal symptoms, including seizures, organ damage, and, in some cases, death12. Therefore, professional supervision during detoxification is essential to ensure safety and provide the necessary support for successful rehabilitation.

 

Detox vs. withdrawal: understanding the key differences

 

Detox and withdrawal are terms often used interchangeably when discussing the challenges of addiction rehabilitation for substance use disorders, but they refer to distinct processes. Understanding the difference can make the journey to overcoming substance use disorder seem more familiar and manageable13.

 

Detoxification refers to the process through which the body and brain releases the addictive chemicals stored during substance use13. This process involves handling withdrawal and providing medical supervision, assistance, and support until the drug is completely out of the system.

 

On the other hand, withdrawal is a physiological response to the cessation or reduction in the use of a substance to which the body has become dependent14. The various types of withdrawal symptoms may involve different combinations of physical, mental, and emotional manifestations – some of which can prove dangerous if left medically unsupervised14.

 

Detoxification can be an intense process but plays a crucial role in easing withdrawal symptoms13. Withdrawal symptoms typically start within hours of when a person stops using drugs or alcohol and reach their peak intensity within a few days. Usually, these symptoms last for about a week before declining. The exact side effects of detox vary depending on a patient’s body chemistry, the type of drug used, and the duration of the addiction13. The abrupt cessation of some substances can be dangerous and sometimes fatal14, and so is not advised by the majority of medical professionals11-15.

 

The process of detox and withdrawal

 

Detoxification and withdrawal are crucial steps in overcoming SUDs. Professionals tailor care to ease withdrawal symptoms and closely monitor the individual’s health. Factors such as a person’s physical condition, level of dependency, genetic predispositions, and the specific substance used all play crucial roles in shaping the detox experience14. For instance, alcohol withdrawal symptoms might last from a few days to several weeks, while opioids might present challenges for up to two weeks or longer.

 

This variability underscores the importance of personalised care. Each individual’s detox and withdrawal experience is unique, requiring a tailored approach that considers their specific needs and circumstances.

 

Alcohol detox and withdrawal

 

Timeline and Symptoms: The first signs of alcohol withdrawal may appear within several hours after the last drink, and peak over the course of 24-72 hours16. Clients may experience hallucinations within 12-24 hours, seizures within the first 48 hours, and delirium tremens typically develops 48-72 hours after heavy drinking stops; lasting for 3-4 days, but potentially up to 8 days14.

 

Alcohol is a central nervous system depressant, slowing brain functioning and changing the way that nerves interact16. Since the brain begins to work harder to simply retain nervous system functioning in this state of depression, abrupt cessation after chronic dependence can cause significant excitation which results in severe physiological manifestations as the body tries to restore equilibrium14,16.

 

Opioid detox and withdrawal

 

Timeline and symptoms: Some degree of opioid dependence may develop after short periods of use, even when taken according to a prescription17. The onset and duration of withdrawal symptoms vary depending on whether the opioid is short-acting or long-acting. Withdrawal from short-acting opioids, such as heroin and certain prescription painkillers, typically begins 8-24 hours after the last use and lasts an average of 4-10 days15. For longer-acting opioids, such as methadone, withdrawal symptoms may not emerge until 2-4 days after the last use and can last up to 10 days15,18. Withdrawal symptoms can range from anxiety, frustration, and insomnia to severe flu-like symptoms, increased heart rate, and mood changes18. Physical withdrawal symptoms generally subside within a week, while psychological cravings may persist longer, but decrease in intensity over time18.

 

Although withdrawal from opioids isn’t always life-threatening, the discomfort can lead to immense physical and psychological distress, potentially driving individuals toward relapse19. So, professional supervision during opioid withdrawal is crucial to manage symptoms effectively and support recovery.

 

Benzodiazepine detox and withdrawal

 

Timeline and symptoms: Withdrawal symptoms from benzodiazepines can vary greatly in severity and typically begin within 24 hours of the last dose, with peak severity often occurring within the first two weeks20. However, symptoms can last anywhere from a few days to several months20. There is no definitive guide to the symptoms, timeline, or severity of benzodiazepine withdrawal, as each individual may experience withdrawal differently20, but the withdrawal process generally unfolds in three phases:

 

  • Early withdrawal: Also known as rebound symptoms, these occur shortly after discontinuation and depend on the drug’s half-life. Symptoms of the original condition, such as anxiety or insomnia, may return during this phase20.
  • Acute withdrawal: This phase begins within a few days of stopping benzodiazepines and can last from 5 to 28 days, with some symptoms potentially persisting for several months20. This stage is often the most challenging, as it includes a range of physical, mental, and emotional symptoms.
  • Protracted withdrawal: For up to 25% of individuals, certain withdrawal symptoms can last for 12 months or longer21.

 

Long-term use of benzodiazepines increases the risk of dependency and severe withdrawal symptoms. Because of the prolonged withdrawal symptoms, detox requires ongoing management to prevent relapse and support recovery20.

 

Understanding behavioural and process addiction withdrawal

 

All stimulating entities have the potential to be addictive22, however behavioural/process addictions – unlike substance dependencies – do not involve ingesting a substance but rather the behaviour itself and the feelings it elicits. Behavioural addictions can be driven by an individual’s higher sensitivity to reward and lower sensitivity to punishment, meaning they focus more on the thrill of the activity than its possible negative consequences23. Despite this difference, behavioural addictions share similarities with substance dependencies in how they alter brain chemistry, as well as the symptoms during withdrawal24-26.

 

Furthermore, underlying mental health conditions such as depression, anxiety, or obsessive-compulsive disorder can exacerbate behavioural addictions23. These cause not only chemical changes in the brain but also anatomical and pathological changes, leading to various forms of cerebral dysfunction known collectively as hypofrontal syndromes24. Research indicates that behavioural addictions share similar neurobiological correlates with substance use disorders25. One significant neural network implicated in behavioural addiction is the salience network; alterations in which can result in craving and impaired control over behaviour26.

 

Withdrawal from behavioural addictions can produce symptoms similar to those experienced during substance withdrawal due to changes in brain chemistry22. These symptoms can include:

  • Physical: headache, nausea, and abdominal pain22.
  • Psychological/emotional: irritability, anxiety, depression, feelings of sadness when unable to engage in the addiction, and a sense of emptiness or hopelessness23.

 

The role of Harbor in addiction rehabilitation

 

At Harbor, we understand the complexities and challenges of arresting the progression of an addiction. We adopt a unique, personalised approach to rehabilitation, ensuring that each client receives the highest level of care tailored to their specific needs and medical history. Our one-client-at-a-time, discrete, wrapped around care model guarantees a bespoke experience, allowing us to focus solely on the individual, providing the most effective and comprehensive care possible.

 

We incorporate a range of effective behavioural therapies such as Cognitive Behavioural Therapy (CBT), Dialectical Behaviour Therapy (DBT), mindfulness and meditation practices, and hypnotherapy. These therapies help clients develop coping mechanisms, manage stress, and overcome the anxieties associated with withdrawal and detoxification. In addition to behavioural therapies, our clinical team can utilise therapeutic medications that can help to treat opioid, alcohol, and nicotine addiction and alleviate symptoms detox and withdrawal. This combination of therapeutic and medicinal interventions ensures a whole person approach to treatment, addressing both the symptoms and the root causes of addiction.

 

Contact our team today to learn more about how we can support you or your loved one on the path to recovery. We are here to answer any questions you might have and walk you through the admissions process.

 

References

  1. Medical news today – effects of drug abuse
  2. SAMHSA racial and ethic differences in SUDs
  3. PubMed – The genetics of substance dependence
  4. PubMed – Co-occurring psychotic and addictive disorders
  5. NIH – Why is there comorbidity between substance use disorders and mental illnesses?
  6. PubMed – tobacco dependence in schizophrenia
  7. Oxford academic – Schizophrenia to High Risk of Cigarette Smoking 
  8. NIH – Substance Use and Co-Occurring Mental Disorders
  9. Yale medicine – how an addicted brain works
  10. NIH – the biology of addiction
  11. American addiction centers – Can I Quit Drugs Without Rehab?
  12. NCBI – Alcohol withdrawal syndrome
  13. Gateway foundation – detox and withdrawal
  14. American addiction centers – withdrawal timelines
  15. WebMD – addiction and detox
  16. WebMD – Alcohol withdrawal
  17.  NIH – withdrawal management
  18. Medical News Today – opioid withdrawal timeline
  19. NIH – prescription drugs misuse
  20. Medical News Today – Benzo withdrawal
  21. Wiley – Benzodiazepine dependence and its treatment
  22. NIH – behavioural addiction
  23. UKAT – behavioural addiction
  24. NIH – pornography addiction
  25. Cambridge core – Neurobiological Foundations of Behavioral Addictions
  26. Frontiers – Neurobiological Perspectives in Behavioral Addiction
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