alcohol withdrawal syndrome

Abstinence Syndrome


alcohol withdrawal symptoms timeline
substance abuse treatment and Tratamientos para Trastornos por Uso de Sustancias
symptoms of alcoholism


From Wikipedia, the free encyclopedia Jump to: navigation, search
Abstinence syndrome is a characteristic set of signs and symptoms that occur after stopping (or, in some cases, decreasing) consumption of a drug, be it a drug or a drug of abuse.

The clinical picture of a given abstinence syndrome varies according to the drug consumed. Identification of the type of drug used is important for the correct treatment, but abuse of more than one type of drug is common.

Some drugs act as external neurotransmitters, replacing the organic neurotransmitters that "turn off". If the drug is abruptly cut off, the chemical processes that allow communication between the neurons are interrupted, severing the communication of the nervous system with the rest of the body, which can, in the limit, lead the individual into abstinence to death. Heroin, especially, has this effect. Alcohol, marijuana, and cocaine also act as external neurotransmitters, but to a lesser extent, so that abstinence crises are usually less severe. [1]

The installation of an abstinence syndrome tends to be faster in the case of drugs with a shorter half-life. Its course typically ranges from a few days to two weeks, but symptoms are described that can persist for months, in the case of alcohol, tobacco or cocaine (prolonged withdrawal syndrome).

Symptoms, which are linked to damage to the brain, occur during the state of sobriety and may be described as difficulty concentrating, memory problems, exaggerated emotional reaction or apathy, sleep disturbances or disorders, motor coordination problems, and sensitivity to stress. Prolonged withdrawal syndrome can trigger relapses frequently, but its symptoms can usually be reversed.

Index
1 Alcohol
2 Opioids
3 Crack
4 Cocaine
5 External links
6 External links
Alcohol
Main article: Alcoholism
Alcohol withdrawal begins a few hours after stopping consumption and can lead to insomnia, tremors, anxiety, dysphoria, nausea or vomiting, restlessness, agitation, increased sweating, increased heart rate, and other signs of nervous system hyperactivity autonomous When more severe, it can progress to convulsions and delirium tremens. Its severity is usually proportional to the amount of alcohol ingested in 24 hours and to the number of previous episodes.

Opioids
Main article: Opioids
Opioid withdrawal syndrome occurs with pupillary dilation, lacrimation, rhinorrhea, yawning, sneezing, anorexia, abdominal pain, nausea, vomiting, diarrhea and piloerection. It does not cause seizures or delirium. But in the case of heroin, for example, abrupt discontinuation of the drug may lead the chemical dependent to death from cardiac arrest, respiratory failure, or dehydration. This is because the drug functions as an external neurotransmitter, replacing the organic neurotransmitters in the communication between the nervous system and the rest of the body. The organic neurotransmitters "realize" that there is an external neurotransmitter acting, and "turn off". When the heroin is severed abruptly, the chemical processes that allow the communication between the neurons are interrupted; the communication of the nervous system with the rest of the organism is cut off. This directly affects the muscles, the cardiorespiratory system and the digestive system. In Brazil, a heroin-dependent person with abstinence status should be referred to an emergency medical service to be treated with regular doses of methadone, the only drug that can be used in the country to treat the drug's chemical dependency. [1]

Crack
Main article: Crack
The crack dependent hardly eat or sleep, which causes a rapid process of malnutrition and weight loss that is more intense than that produced by cocaine. A crack-dependent adult can lose up to ten pounds in just one month. In addition, one becomes negligent in the care of one's own body. Neurologically, the use of crack can lead to headaches, dizziness, inflammation of cerebral vessels, etc. The high temperature of the crack smoke can cause lesions in the larynx, trachea and bronchi, which leads to the appearance of pneumonia and tuberculosis. There is usually cough, chest pain, shortness of breath, and bloody sputum. In addition, crack causes the release of adrenaline, increased heart rate, elevated blood pressure, arrhythmias and eventually, ischaemia and acute myocardial infarction. Crack also causes nausea, loss of appetite, flatulence, abdominal pain and diarrhea. Serious psychiatric conditions such as delusions, hallucinations, paranoia, etc. can also occur. [2]The so-called "craving" and transient paranoid symptoms are the main components of crack withdrawal. The "fissure" is often referred to as an indispensable need for the body, indispensable to life, and described as a "worse than hunger" will. Abstinence causes great physical and psychic suffering; the individual is taken by great anxiety and obsessive thoughts about the ways to get the drug. The individual can not stand still: "The body hurts, the mind hurts, the heart freezes, the mouth of the stomach hangs." The goal of crack-obsessed search is not only to get pleasure, but also to ease your discomfort. The obsessive contours of the crack fissure rob the individual of his ability to choose and his discernment, although he is aware of his physical and moral degradation. Due to the symptomatic similarities between addiction and obsessive-compulsive disorder, they both share a similar etiology. [3]

Although deaths during the detoxification process are frequent, there is no proven relationship between the death of users of crack cocaine (refined coca paste base baking soda and water) and drug withdrawal, unlike what happens in the case of alcohol and heroin dependents. According to experts, these deaths would be caused by the association of chemical dependence with starvation or other diseases.

In 1999, Unifesp researchers published the results of a clinical study [4] based on spontaneous reports of crack users undergoing their first psychiatric evaluation, in which they reported using marijuana to alleviate withdrawal symptoms. For nine months, the researchers monitored 25 patients, aged 16 to 28 years, heavily dependent on crack, as diagnosed using the Composite International Diagnostic Interview (CIDI) [5] and according to ICD-10 and DSM- IV. According to the researchers, 17 (68%) of these individuals stopped using crack and reported that the use of cannabis had alleviated the symptoms of craving and produced subjective and behavioral changes, helping them to overcome crack addiction.

Ibogaine is also a promising drug in the treatment of crack dependence in some cases. But "treating addiction is something complex, it's something that can not be solved in a snap," says psychiatrist Dartiu Xavier da Silveira, leader of a team at the Federal University of São Paulo that is researching the use of the substance in the treatment of dependents . Ibogaine is produced from the root of iboga, a shrubby plant of the Apocynaceae family native to central Africa and traditionally used in religious rituals. [6]

Cocaine
Main article: Cocaine
The withdrawal syndrome of stimulants such as cocaine and amphetamines resembles a depressive episode, with fatigue, hypersomnia, depressive or irritable mood and appetite variation.There is not necessarily a daily pattern of cocaine use. Binge (ie, intense use, repeated at very short intervals) is characteristic, alternating with short periods of reduced consumption or abstinence, without the intention of definitively abandoning drug use. Once the euphoria of the substance has subsided, there is depression. Thus, during withdrawal, periods of intense craving for cocaine (craving or "fissure" [7]) and other withdrawal symptoms, such as fatigue, anecdony, and depression, eventually lead to re-use of the drug, establishing the vicious circle of chemical dependency. Patient studies show that extracellular dopaminergic levels fall and are not normalized within a 12-hour period, with the degree of suppression of dopamine release being proportional to the number of hours of continuous prior cocaine use. Animal studies demonstrate the involvement of other mechanisms in this process, such as deficiency in serotonergic neurotransmission. A well-defined abstinence syndrome is observed in many chronic users or even those who use the drug for a few days in the binge.

Cocaine abstinence typically occurs in three phases, which show the progression of signs and symptoms following cessation of drug use: [8]

Crash, that is, a drastic mood depression and energy reduction that occurs between 15 and 30 minutes after the drug is stopped and can last from eight hours to up to four days. Crash is associated with depletion of neurotransmitters in the synaptic cleft as a result of cocaine use. The user may experience depression, anxiety, paranoia and an intense desire to use the drug, which decreases after one to four hours, when the "fissure" for drug use is replaced by the "fissure" by sleep: hypersomnia, with an aversion to the use of more cocaine. The individual awakens a few times to eat, eating large amounts of food, and goes back to sleep.
Late dysphoric syndrome: begins after the crash, ie between 12 and 96 hours after cessation of use, and may last from two to 12 weeks. In the first four days, the individual presents strong drowsiness and intense desire for the consumption of the drug. After this period, a prolonged abstinence syndrome, dysphoric, marked by anecdotal, irritability and apathy, as well as craving, of variable intensity according to the individual, is started. The user may become depressed, have memory problems and manifest suicidal ideation. At this stage the risks of relapse are greater, given the individual's difficulty in bearing the dysphoric symptoms of "fissure" (anxiety, depression, restlessness).
Extinction phase: phase in which the dysphoric symptoms diminish or cease altogether. The "fissure" happens intermittently, tending to decrease in intensity, over months or even years.
The severity of cocaine dependence and withdrawal syndrome depends on the intensity of previous consumption and the presence of comorbid psychiatric disorders. The biggest difficulty is to overcome craving, which can be of two types: anecdotal and conditioned. The anorexic has as its source the inability to take pleasure and generates the desire for the stimulating effect of the drug. The conditioning is triggered by environmental stimuli that make the individual remember moments of experiencing euphoric sensations. Despite all the difficulties, the cocaine withdrawal syndrome does not endanger the life of the user, being considered safe when conducted with technical knowledge and in an adequate environment.