While research suggests that global rates of drug usage are staying roughly the same, perhaps even decreasing slightly year on year, an increasing number of individuals are seeking treatment and support from social services. Addiction is a very complex phenomenon, both psychologically and physiologically, and the route to sobriety will vary between individuals according to their individual circumstances and history of drug use.
What Is Addiction?
Defining addiction is not as simple as one might expect. The simplest definitions of addiction define it by the presence of withdrawal symptoms when a substance is withdrawn from an individual. The problem with this seemingly logical definition is that it encompasses a large number of people using medicine legitimately and with a prescription, as well as anyone who finds they can’t function in the morning without coffee. In fact, caffeine addiction is probably the most common form of addiction, alongside addictions to tobacco and alcohol.
A big part of addiction is psychological and there are many complex psychological phenomena involved. For example, smokers begin to associate their preferred brand and the smell and taste of tobacco with the activation of reward pathways in the brain. This ‘ritualisation’ is a feature of most addictions. A big part of assisting someone overcoming an addiction is to help them break these bonds and develop new, healthier ones. This is a long and difficult process and dealing with the psychological effects of addiction often takes much longer than dealing with the immediate physical withdrawal, also known as acute withdrawal.
Because of this, more refined definitions of addiction consider both the physical dependence and the psychological factors involved. A more balanced definition of addiction than the one above would add that the addiction must impair the individual’s life and cause them harm. After all, some patients are physically dependent on the drugs they are prescribed, but they still experience a higher quality of life than they would without the drugs.
How to Manage It
Different drugs have different withdrawal symptoms. Typically, these are the reverse of the drug’s usual effect on the body. Below is a quick guide to the most commonly encountered drugs and their withdrawal effects.
Caffeine: While caffeine addiction is widespread, exact numbers are hard to calculate as not all caffeine drinkers are addicts and many of those who are, don’t know. However, long-time heavy coffee drinkers may experience heart problems as they get older (heart issues are a relatively common effect of aging. Evidence suggests that only extremely heavy caffeine usage is dangerous to the heart) and thus they may be advised to reduce their caffeine intake. It is only at this point that the physical and psychological effects manifest. Caffeine addiction is minor in all senses and relapse is not destructive as caffeine is widely, easily, and legally available. However, it is worth understanding its effects precisely because it is so common.
Anxiety is a common effect of withdrawal from most drugs and caffeine often makes anxiety worse, meaning that someone experiencing withdrawal is likely to stop drinking coffee. The usually minor effects of caffeine withdrawal become significant when piled on top of something more serious.
Common effects of caffeine withdrawal include headaches, lethargy and irritability, constipation, low mood, muscle pains, and difficulty concentrating. These are the exact opposite of the effects caffeine usually has on the body.
Cannabis: Cannabis is not physically addictive and does not produce physical withdrawal symptoms. However, it can be psychologically addictive, although the minimal effect cannabis has on dopamine levels in the brain is believed to be what makes it significantly less addictive than many other drugs. If, however, an individual’s cannabis use is occurring despite its negative impact on the user’s life then it should be treated as an addiction like any other.
Because the withdrawal effects of cannabis are psychological, they consist primarily of anxiety and mood swings. Many long-term cannabis users also experience a period they describe as ‘boring’ where they have little interest in their usual activities but they do not experience the persistent low mood characteristic of depression. Treatment for cannabis withdrawal should be supportive psychological treatments such as cognitive behavioural therapy (CBT). Some users also find 12-step programs helpful.
Amphetamines: Amphetamines vary in their addiction potential, but all forms of it carry a significant risk of physical and psychological dependence. Amphetamines produce a dramatic increase in certain neurotransmitters, namely serotonin, dopamine, and noradrenaline. Different amphetamines affect the levels of these chemicals differently and some over-the-counter decongestants contain amphetamines in the form of pseudoephedrine, although the effects of pseudoephedrine are primarily on noradrenaline, making it unattractive as a recreational drug.
Amphetamines are structurally related to a particular trace amino acid that occurs naturally in the brain and is involved in mediating the release of neurotransmitters. Amphetamines are able to hijack this process and artificially trigger a much larger release of neurotransmitters, in particular dopamine and serotonin. This mechanism of action encourages users to binge on the drug, experiencing a significant ‘crash’ when the effects wear off. If the drug is used continuously for several days in a row, the user will experience acute withdrawal symptoms.
Amphetamine withdrawal usually begins with extreme lethargy and excessive sleeping. This is followed by a persistent feeling of hunger, which often leads to overeating and, in some cases, may cause stomach pain and discomfort as the user eats too much food because the feeling of hunger won’t go away.
Amphetamine withdrawal also has a significant psychological component, as its use causes an acute imbalance in neurotransmitter levels. In long term users, it can take months for the balance to be restored and during this time the user will experience mood swings, irritability, and anxiety. In addition, amphetamine withdrawal is likely to involve intense cravings, whether these have a psychological or physiological basis, or a combination of the two is a matter of some debate amongst addiction specialists.
Benzodiazepines and alcohol: Benzodiazepines are sedative drugs used to treat anxiety and sometimes insomnia. Although they have become far less commonly prescribed over the last few decades as their addictive nature has been revealed, they are still among the most commonly prescribed drugs in the world. Benzodiazepines work by enhancing the action of the body’s natural inhibitory hormone: gamma-aminobutyric acid (GABA). Alcohol works in the same way and although both substances exert their effects via different mechanisms of actions, they are similar enough that withdrawal from one can be tempered by administering the other.
Withdrawal from benzodiazepines or from alcohol should be carried out under medical supervision, as it is one of the few withdrawal syndromes that can kill otherwise healthy individuals. Usually, a long-acting benzodiazepine such as diazepam will be prescribed and the dose gradually reduced to minimise the withdrawal effects. This is an effective treatment for withdrawal from either benzodiazepines or alcohol. Sudden withdrawal from either substance can cause seizures, catatonia, hallucinations, and delusions, as well as extreme mood swings, which can result in suicidal or homicidal ideation. The nature of withdrawal symptoms from these substances also necessitates the involvement of trained medical professionals.
If the patient lives with friends or family, you should encourage them to pursue CPR certification, as this could prove life-saving given that withdrawal from both the above substances puts considerable strain on the heart.
Relapsing is a serious risk for users who have built up a significant tolerance to a drug. Tolerance will drop as withdrawal from the drug sets in and so users may take what they think is a small dose, but is, in fact, a potentially lethal dose. You should make the patient aware of this, especially as studies suggest that as many as 90% of heroin and morphine users will relapse at some point.
Overcoming drug addiction is a long and difficult battle and can be challenging for everyone involved, including social workers. The best thing you can do for your client is to learn as much as you can about the nature of various common drugs and their withdrawal syndromes.