What is the process of drug withdrawal?
Withdrawal consists of a physical detoxification and a subsequent weaning therapy. The detox is usually done on an outpatient basis (at home, accompanied by fixed doctor’s appointments) or as an inpatient (hospital, rehab clinic). During this time, the person affected receives close monitoring by doctors and psychotherapists as well as any necessary support with medication.
The focus is on physical weaning from dependence. Discussions with specialist staff are available to provide support. This is followed by the weaning therapy.
This usually takes place on an outpatient basis. If desired, the person affected is connected to accompanying programs via doctors, therapists or drug counseling centers. Psychotherapies are possible in one-on-one conversations or group meetings, such as Alcoholics Anonymous. These should help to build and maintain a regulated life without drugs.
What are the typical symptoms of drug withdrawal?
These vary depending on the substance and previous consumption patterns. In a sense, the withdrawal symptoms are the opposite of the effect of the drug in question.
- Opioids cause palpitations, diarrhea, vomiting, agitation, sweating, pain, blood pressure crises and dizziness.
These symptoms peak about 36-72 hours after the last dose and can last up to 8 days.
- Cannabinoids and hallucinogens cause only minor physical withdrawal symptoms in comparison. Fluctuating moods up to depressive moods and “flashbacks” are possible.
- Cocaine also shows only minor physical withdrawal symptoms, but enormous psychological withdrawal symptoms. Those affected suffer from massively fluctuating moods, anxiety and the extreme urge to take the drug again.
- The withdrawal symptoms of alcohol and benzodiazepines (tranquilizers) are similar and often severe: clouding of consciousness, disorientation, hallucinations (seeing “white mice”), palpitations, tremors, sweating, vomiting, blood pressure crises and seizures are possible.
Therapy during drug withdrawal
Withdrawal is a combination of medical and psychological treatment. In each case a doctor accompanies and monitors the detoxification process. Physical withdrawal symptoms are counteracted with medication if necessary.
Psychotherapeutic support is just as important. Those affected often suffer from psychological problems. Whether caused by the addiction or underlying it, cannot always be separated.
In conversations, one’s own addiction career, problems regarding housing, education or job as well as relationships with relatives and friends can be worked through. During a stay in the clinic, accompanying services such as ergotherapy, art therapy and music therapy are often available. In this way, a reorganization of addiction-free everyday life is already being worked towards during detoxification.
The same applies to the later connection to outpatient psychotherapy or group meetings (e.g. anonymous alcoholics). This is also an opportunity to meet other addicts and exchange ideas. In this way, the feeling of social isolation and shame, from which those affected often suffer, can be counteracted.
The withdrawal symptoms that occur during physical detoxification can be treated or at least alleviated by medication. This is particularly important in alcohol and benzodiazepine withdrawal, which can be associated with life-threatening complications. Depending on the physical condition, close monitoring of the circulation and the administration of fluids through the veins may be necessary.
In general, neuroleptics/antipsychotics and antiepileptics/anti-convulsants are the most commonly used drugs. The former have a dampening, calming and antipsychotic effect (i.e. they act against the loss of reality of a psychosis). They help with anxiety, restlessness and delusions.
To prevent seizures, antiepileptic/anti-convulsant drugs (i.e. anticonvulsant drugs) are usually administered. These originate from the treatment of epilepsy. Alcohol withdrawal can lead to severe physical withdrawal symptoms such as circulatory instability, seizures and nervous disorders caused by vitamin deficiency.
These must be considered and, if necessary, treated quickly.Here, in addition to the above-mentioned drugs, blood pressure reducers, sedatives such as clomethiazole, benzodiazepines and vitamins (B1, B6, B12, folic acid) are used. Benzodiazepine withdrawal is also often associated with severe withdrawal symptoms. These are similar to alcohol withdrawal.
In order to reduce their severity, a slow withdrawal (“sneaking out”) is common. This means that the person is weaned with steadily decreasing doses. As with alcohol withdrawal, anticonvulsants and antipsychotics are used as a preventive measure.
