Chapter 9
Withdrawal. An Addict's Worst Nightmare.
When discussing the matter of withdrawal we need to reiterate what we have said about drugs and addictions to provide the context for the discussion on withdrawal. Drug addiction is perhaps one of the most disturbing challenges of modern times. This is an issue that has struck at the very core of society destroying families and bringing with it war, crime and destitution. In the US, it is currently estimated that over 23 million people use drugs on a regular basis, with a significant portion of this group being strongly addicted to alcohol and other controlled substances. This large number of users contributes generously to a global drug industry that generates over 400 billion dollars every year, a figure that roughly translates to about 1% of global trade. For those running these illicit empires, unimaginable fortunes stand to be made, but for those on the receiving end, a grim future soon follows. When discussing drugs and substance abuse, it not only includes illegal or controlled drugs, but also encompasses prescription medication and alcohol. According to the Drug Enforcement Administration's fact-sheet, controlled substances are divided into four major groups, depending on their chemical composition and mode of action. These groups are; a) Narcotics, which include heroine, morphine and oxycodone among others, b) Depressants, including barbiturates, benzodiazepines and many others, c) Stimulants, including cocaine, amphetamines and methamphetamines, and d) Hallucinogens, which include some commonly abused drugs like Ecstasy, LSD, Steroids and cannabis, which is the most extensively used illegal drug in the world. Apart from these major categories, there are other drugs of interest, most of which are prescription medicine like painkillers and sleep medication.
As we mentioned, a complete reliance on drugs and a strong compulsive desire to use them in order to perform day-to-day tasks is defined as addiction. However, there are numerous definitions of what addiction is, and this depends on which professional you ask. At times, addiction is even considered to be a mental disorder especially when the affected person totally loses control as a result of excessive or prolonged use. The feeling of euphoria or bliss achieved when a person uses a drug for the first time often becomes the motivator for recurrent use. Different drugs have varying modes of action but quite often, the general mechanisms by which addiction happens is similar for most substances. A drug induced alteration of neural or brain chemistry can result not only in mental disruptions but also in dependence on the causative drug. This is often referred to as psychological dependence. Drugs like cocaine, heroin, and marijuana often result in this type of addiction. Some normal day-to-day biological processes taking place in the body are also greatly affected by drug use. Prolonged use of various substances often results in a progressive disruption of these physiological processes, and ultimately, this causes tolerance. The onset of tolerance means, as we mentioned, that the affected person will have to use more and more of the drug, in order to attain the desired high. Once this happens, it is referred to as a physical or physiological dependence and is a consequence of biological adaptation by the body as it adjusts to the constant presence of drugs. An excessive reliance on alcohol leads to this sort of addiction.
Currently, drug addiction is not a preserve of adults, and sadly, it is not uncommon to find children as young as 12 years of age, who are already dependent on one substance or the other. When an addict is denied access to drugs, or if they abruptly stop using them, an array of symptoms follow and this is referred to, as we have mentioned earlier, withdrawal. Withdrawal symptoms may be mild or hardly noticeable but in most cases they often result in violent ailment. Withdrawal only occurs in persons that have a psychological or a physiological dependence on drugs and each substance has its own unique symptoms. For example, withdrawal from alcohol can result in tremors, excessive perspiration, an irritable demeanour and even nausea. Opium derivatives like heroine and morphine, cause withdrawal symptoms that include diarrhoea, vomiting and at times, and depression. The list of signs and symptoms is rather lengthy but it appears that shaking and nausea are common in most cases. An important factor that can lead to variation in symptoms is the method of drug use. For instance, injectable drugs can cause serious venous and tissue damage resulting in feverish symptoms.
Before an addict is taken off drugs, a medical practitioner needs to be consulted and the activity has to be carried out under specialized conditions. The reason for this is that some withdrawal effect can be quite harsh and at times even fatal. Severe alcoholism is an example that stands out, and withdrawal from this has been known to be fatal. In cases where the addict is pregnant, withdrawal from drugs like opiates can actually lead to loss of the infant, a situation technically referred to as foetal withdrawal. The different phases of drug withdrawal are often a cause for alarm, and understanding them is important, especially when dealing with addicts. Going "cold turkey" is a term that has been coined for these different phases and it refers to the roller-coaster effect of withdrawal symptoms. During the initial stages of rehabilitation, the symptoms begin to appear and subsequently build up slowly over time, becoming progressively severe. Before the peak phase of withdrawal, some patients can become quite violent in an attempt to escape the authority or situation that is keeping them away from the drugs. Other patients can become gravely ill and at times even require emergency medical attention. After hitting the plateau stage, the symptoms start to dissipate and eventually, over a period of time, the patient gets better. Once the worst is over, it is imperative that a former addict is kept away from substances and any triggers that may cause a relapse. A trigger can also cause the re-occurrence of some withdrawal symptoms resulting in a burning urge to use. For example, the trigger for a recovering nicotine addict can be the smell of cigarette smoke which may lead to a craving for the same. The importance of keeping away from triggers cannot be overstated and it is one of the key support pillars for a recovering addict.
