The Relationship Between Withdrawal and Addiction
Withdrawal and addiction are closely tied in many people’s minds. Does withdrawal from a substance mean you are addicted? Which one comes first? Can you have an addiction without experiencing withdrawal?
Your body constantly completes complex processes at a cellular level to keep you alive. Countless chemical reactions are necessary to do everything from sending messages from your brain to your hand, so you can pick up your fork, to converting the food in your stomach into the energy your heart needs to keep pumping. Human beings are truly resilient marvels of nature.
In fact, your body is so adept at carrying out life processes that, over time, it can adapt and function fairly well despite your intake of alcohol or drugs. Depending on the potency and chemical makeup of the substance, ingestion of most substances can eventually rewire your body to believe that the substance is necessary to your continued existence.
Often, individuals start considering stopping substance or alcohol use after they experience their first withdrawal symptoms. This can be the first tangible evidence of substance use disorder because its effects are both apparent and significant.
Some may believe they are not addicted because they can still function without using for a few days. Others may think they need the substance because of physical changes when they try to stop. Any time you experience withdrawal, it’s critical to assess your substance use and examine ways that it may be affecting other parts of your life.
If your use has reached a point where you wonder if you’re addicted, you likely are. Withdrawal is considered a medical condition and must be managed under proper supervision. If you or a loved one are experiencing withdrawal or wondering if this signals an addiction, reaching out for help is important so you can formulate a safe and effective recovery plan.
Addiction is considered the inability to stop using a substance despite the negative effects that result from one’s use. Academic, professional, and familial difficulties resulting from continued use of a substance usually indicate that an individual is addicted.
Today, we look at addiction as a behavioral phenomenon. Assessing addiction is about looking at the behaviors and feelings that come with substance use. Many signs and symptoms indicate substance use has progressed to addiction. An individual does not need every symptom to be considered addicted.
The determination is based on an honest assessment of how substance abuse has changed your emotions, actions, and thoughts. Feeling that you must have the substance daily is one hallmark sign. Individuals with addiction may have near-constant thoughts about how to acquire the substance and maintain use. They devote too much time to planning and recovering from their use. They often act in a way unlike their normal behavior without the drug. Addicted individuals hide their substances and lie about their use. If you have any of these strong indicators, you may be experiencing an addiction.
Withdrawal is a telltale sign of addiction. If you try to stop or inadvertently must go without the addictive substance and begin to feel ill, agitated, or anxious, it’s likely that you’re in the beginning stages of detoxification.
Why Does Withdrawal Happen?
Before an individual can experience withdrawal, they must be physically dependent on a substance. As their use progresses, individuals begin to develop a tolerance to the substance. They will require greater and more frequent doses to obtain the same results. It becomes a perpetuating problem because, with some substances, tolerance may simply build and build, allowing the substance to take greater hold in a person’s system.
Eventually, sustained use will cause biochemical changes in the body that lead to dependence. While addiction is largely behavioral, dependence is biological. It’s what causes withdrawal.
Substances affect the brain differently. However, our bodies are so effective at living that they will adapt to the presence of depressants, stimulants, or benzodiazepines. They substitute in for certain neurotransmitters, altering how our nervous system operates. They also create biochemical reactions that cause cravings. The body stops producing naturally occurring chemicals because there is already a steady supply.
Once they stop taking the substance, a dependent individual becomes physically sick from withdrawal as their system tries to reorient itself to the lack of what it thinks it needs. If you’ve ever skipped your morning cup of coffee or tried to reduce your sugar intake, you’ve likely experienced some mild withdrawal symptoms such as a headache or slight irritability.
A person can be physically dependent on a substance without being addicted. Cardiac medications and antidepressants can lead to physical dependence. The withdrawal felt when stopping these medications does not indicate addiction because the individual’s life is not negatively affected by taking them.
On the other hand, if you or a loved one are questioning whether you are addicted, withdrawal is one of the telltale signs. If you experience withdrawal symptoms after not drinking alcohol for a few days, and your drinking causes you to miss work assignments, you are likely dealing with addiction.
What Are the Signs of Withdrawal?
The signs and symptoms of withdrawal vary based on the substance you’re dependent on and the extent of your tolerance. Generally, all forms of withdrawal will present as physical illness. Your brain, which has grown accustomed to the substance, must continue carrying out normal life functions and adjust to the absence of the drug or alcohol. This change leaves it scrambling to carry out the necessary neurological reactions in the absence of the chemicals.
As a result, you may become ill. If you experience withdrawal symptoms, it’s important to seek treatment. Your symptoms likely indicate addiction. Unaddressed, substance use disorders could lead to medical problems or further complications if you try towithdraw on your own.
People become dependent on opioids because they disrupt pain by interacting with the central nervous system. Their presence alters the brain’s production of endorphins and raises dopamine levels. Withdrawal may present as:
• Muscle aches
• Anxiety and irritability
• Chills and goosebumps
Prescription stimulants treat ADHD and sleep disorders. They can be misused or consumed illegally to create a high. Individuals can quickly become physically dependent on the feelings they create. Withdrawal symptoms are generally not life-threatening, but you must be aware of changes in your thoughts. Signs include:
• Restlessness and agitation
• Slowed activity and response time
• Suicidal thoughts
Sedatives are used medically to treat anxiety and emotional disorders. They can be abused for their calming effects. Withdrawal is mostly physical and highlighted by:
• Elevated heart rate
• Sleeping difficulty
• Numbness, tingling, or burning
Detoxing from benzodiazepine use must be supervised by a medical professional, as sudden withdrawal can be extremely harmful or even fatal.
Alcohol is a depressant. It’s legal and socially acceptable, making its consumption widespread. Alcohol use disorder leads to a tolerance that requires greater and greater amounts to achieve the original effects. This can lead to physical dependence.
Alcohol withdrawal can be extremely traumatic and dangerous for the body depending on how advanced the individual’s dependence is. Supervised detoxification is important because individuals with severe dependence may experience delirium tremens (the DTs), which can cause heart attacks or strokes. Withdrawal symptoms include:
• Shakiness, particularly in the hands
• Nausea and vomiting
• Difficulty in sleeping
• Excessive sweating
Dangers of Withdrawal
An addicted individual who is also physically dependent must go through withdrawal as part of their recovery. Depending on the substance, unsupervised withdrawal can be dangerous and potentially fatal. However, detoxifying from a substance is safe under trained supervision and medical care.
It’s important to reach out for help if you’ve tried to reduce or stop your substance use and felt withdrawal symptoms. Unsafely detoxing can result in seizures, hallucinations, self-harm, or violence that results from agitation and aggression.
Opioids and Withdrawal
Withdrawal and recovery from opioids are unique challenges. Opioid addiction often begins after taking pain medication that was prescribed to treat post-traumatic, post-surgical, or chronic pain. Physical dependence comes quickly with opioids. When a person decides to taper off, withdrawal symptoms can be intense. The individual is then faced with separating their pain level from their need for the opioid.
Unsupervised withdrawal from opioids is very challenging. It takes a strong support system and collaboration with medical providers. Overdose is the biggest risk of unsupervised opioid withdrawal and recovery. Clients may make it a few weeks into detoxification and then take too high a dose if they return to use.
Withdrawal and Recovery
Once an individual is both addicted and physically dependent, withdrawal is a necessary part of recovery. Supervised and guided withdrawal is called detoxification. Medical providers and counselors help clients to safely withdraw from the substance completely or guide a gradual step-down with the assistance of medication.
Depending on the level of physical dependence and the extent of addiction, you may detox as an outpatient. Sometimes, the physical dependence on opioids or alcohol is so advanced that detoxification can only be done safely at an inpatient facility. Either way, you will receive medication to lessen the adverse physical side effects of withdrawal. Additionally, you will be monitored to ensure that your mood changes and negative thoughts do not lead to self-harm.
Addiction and physical dependence are not the same thing. It’s important to remember that detoxing and going through withdrawal do not mean addiction issues are resolved. Detox breaks the physical dependence, which itself is a symptom of and perpetuator of addiction.
Once you have completed physical withdrawal, which can take weeks for stimulants and up to months for opioids and alcohol, you will still need to address the causes of your addiction. Psychosocial therapy, 12-step programs, group therapy, and aftercare planning are all possible ways to help you do this.
Breaking physical dependence is a crucial step in recovery, but you must also address the reasons behind your drive to use. Together with a counselor and support system, you can build strategies and techniques for dealing with your compulsion to use the substance while gaining insight into yourself.
Withdrawal can occur with virtually any substance your body becomes physically dependent on. While not every case of withdrawal means addiction, most cases of addiction feature withdrawal. If you’ve felt ill when trying to reduce your substance use or alcohol consumption, and you’ve dealt with difficulties in your life and intense cravings for the substance when you reduce, withdrawal is likely indicating addiction.
If you believe you’re experiencing an addiction to drugs or alcohol, reach out to us for help. Together, you and our empathetic and skilled staff at First City Recovery Center can discuss your use. Then, we can work together on the correct treatment plan to manage withdrawal, address the substance use disorder, and build the foundation needed for you to continue through recovery.
Dr. Vahid Osman, MD is a psychiatry specialist in Indianapolis, IN.
Dr. Osman completed a residency at Austin State Hospital. He has over 32 years of experience in Psychiatry & Behavioral Health. He is board certified by the American Board of Psychiatry and Neurology.