Physical dependence is a physical condition caused by chronic use of a tolerance -forming drug, in which abrupt or gradual drug withdrawal causes unpleasant physical symptoms. Physical dependence can develop from low-dose therapeutic use of certain medications such as benzodiazepines, opioids, stimulants, antiepileptics and antidepressants, as well as the recreational misuse of drugs such as alcohol , opioids and benzodiazepines. The higher the dose used, the greater the duration of use, and the earlier age use began are predictive of worsened physical dependence and thus more severe withdrawal syndromes. Acute withdrawal syndromes can last days, weeks or months. Protracted withdrawal syndrome, also known as post-acute-withdrawal syndrome or "PAWS", is a low-grade continuation of some of the symptoms of acute withdrawal, typically in a remitting-relapsing pattern, often resulting in relapse and prolonged disability of a degree to preclude the possibility of lawful employment. Protracted withdrawal syndrome can last for months, years, or depending on individual factors, indefinitely. Protracted withdrawal syndrome is noted to be most often caused by benzodiazepines . To dispel the popular misassociation with addiction , physical dependence to medications is sometimes compared to dependence on insulin by persons with diabetes.
19-502: Vernon E. Johnson (August 23, 1920 – April 30, 1999) was an Episcopal priest and recovering alcoholic who devoted his life to a claimed method of alcohol intervention. Johnson's main achievements lie in the field of treatment of chemical dependency , especially alcoholism . Johnson did not believe that an alcoholic needed to "hit rock bottom" before recovery. He introduced the concept of intervention by family, friends, and employers. He supported "early intervention", because it interrupted
38-433: A discontinuation syndrome that manifests with physical side effects; e.g., there have been case reports of a discontinuation syndrome with venlafaxine (Effexor). Drug withdrawal Drug withdrawal , drug withdrawal syndrome , or substance withdrawal syndrome is the group of symptoms that occur upon the abrupt discontinuation or decrease in the intake of pharmaceutical or recreational drugs . In order for
57-509: A physician. The route of administration, whether intravenous , intramuscular , oral , or otherwise can also play a role in determining the severity of withdrawal symptoms. There are different stages of withdrawal as well; generally, a person will start to feel bad (crash or come down ), progress to feeling worse, hit a plateau, and then the symptoms begin to dissipate. However, withdrawal from certain drugs ( barbiturates , benzodiazepines , alcohol , glucocorticoids ) can be fatal. While it
76-432: A secondary consequence of the drug. When the drug is removed, these conditions may resurface and be confused with withdrawal symptoms. Genes that encode for the alpha5 nicotinic acetylcholine receptor affect nicotine and alcohol withdrawal symptoms. Homeostasis is the body's ability to maintain a certain chemical equilibrium in the brain and throughout the body. For example, the function of shivering in response to cold
95-463: A serious emergency and the need for immediate medical care. Sedative hypnotic drugs such as alcohol , benzodiazepines , and barbiturates are the only commonly available substances that can be fatal in withdrawal due to their propensity to induce withdrawal convulsions. Abrupt withdrawal from other drugs, such as opioids can cause an extremely painful withdrawal that is very rarely fatal in patients of general good health and with medical treatment, but
114-406: Is debated whether the entire antipsychotic drug class causes true physical dependency, a subset, or if none do. But, if discontinued too rapidly, it could cause an acute withdrawal syndrome. When talking about illicit drugs rebound withdrawal, especially with stimulants, it is sometimes referred to as "coming down" or "crashing". Some drugs, like anticonvulsants and antidepressants , describe
133-579: Is likely to cause a rather different reaction when discontinued compared to discontinuation of an opioid , such as heroin . Withdrawal symptoms from opiates include anxiety, sweating, vomiting, and diarrhea. Alcohol withdrawal symptoms include irritability, fatigue, shaking, sweating, and nausea. Withdrawal from nicotine can cause irritability, fatigue, insomnia, headache, and difficulty concentrating. Many prescription and legal nonprescription substances can also cause withdrawal symptoms when individuals stop consuming them, even if they were taken as directed by
152-478: Is more often fatal in patients with weakened cardiovascular systems; toxicity is generally caused by the often-extreme increases in heart rate and blood pressure (which can be treated with clonidine ), or due to arrhythmia due to electrolyte imbalance caused by the inability to eat, and constant diarrhea and vomiting (which can be treated with loperamide and ondansetron respectively) associated with acute opioid withdrawal, especially in longer-acting substances where
171-503: Is seldom fatal to the user, withdrawal from opiates (and some other drugs) can cause miscarriage, due to fetal withdrawal. The term " cold turkey " is used to describe the sudden cessation of use of a substance and the ensuing physiologic manifestations. The symptoms from withdrawal may be even more dramatic when the drug has masked prolonged malnutrition , disease, chronic pain , infections (common in intravenous drug use), or sleep deprivation , conditions that drug abusers often develop as
190-461: Is to produce heat maintaining internal temperature at around 37 °C (98.6 °F). Homeostasis is impacted in many ways by drug usage and withdrawal. The internal systems perpetuate homeostasis by using different counter-regulatory methods in order to create a new state of balance based on the presence of the drug in the system. These methods include adapting the body's levels of neurotransmitters, hormones, and other substances present to adjust for
209-600: Is usually managed by a slow dose reduction over a period of weeks, months or sometimes longer depending on the drug, dose and the individual. A physical dependence on alcohol is often managed with a cross tolerant drug, such as long acting benzodiazepines to manage the alcohol withdrawal symptoms. A wide range of drugs whilst not causing a true physical dependence can still cause withdrawal symptoms or rebound effects during dosage reduction or especially abrupt or rapid withdrawal. These can include caffeine , stimulants, steroidal drugs and antiparkinsonian drugs. It
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#1732797399946228-1916: The addition of the drug to the body. Examples (and ICD-10 code) of withdrawal syndrome include: As noted above, many drugs should not be stopped abruptly without the advice and supervision of a physician, especially if the medication induces dependence or if the condition they are being used to treat is potentially dangerous and likely to return once medication is stopped, such as diabetes , asthma , heart conditions and many psychological or neurological conditions, like epilepsy , depression , hypertension , schizophrenia and psychosis . The stopping of antipsychotics in schizophrenia and psychoses needs monitoring . The stopping of antidepressants for example, can lead to antidepressant discontinuation syndrome . With careful physician attention, however, medication prioritization and discontinuation can decrease costs, simplify prescription regimens, decrease risks of adverse drug events and poly-pharmacy, focus therapies where they are most effective, and prevent cost-related under-use of medications. Medication Appropriateness Tool for Comorbid Health Conditions in Dementia ( MATCH-D ) warns that people with dementia are more likely to experience adverse effects, and to monitor carefully for withdrawal symptoms when ceasing medications for these people as they are both more likely to experience symptoms and less likely to be able to reliably report symptoms. The latest evidence does not have evidence of an effect due to discontinuing vs continuing medications used for treating elevated blood pressure or prevention of heart disease in older adults on all-case mortality and incidence of heart attack. The findings are based on low quality evidence suggesting it may be safe to stop anti-hypertensive medications. However, older adults should not stop any of their medications without talking to
247-432: The diarrhea and emesis can continue unabated for weeks, although life-threatening complications are extremely rare, and nearly non-existent with proper medical management. Treatment for physical dependence depends upon the drug being withdrawn and often includes administration of another drug, especially for substances that can be dangerous when abruptly discontinued or when previous attempts have failed. Physical dependence
266-488: The drug category and not the mechanism. The individual agents and drug classes in the anticonvulsant drug category act at many different receptors and it is not possible to generalize their potential for physical dependence or incidence or severity of rebound syndrome as a group so they must be looked at individually. Anticonvulsants as a group however are known to cause tolerance to the anti-seizure effect. SSRI drugs, which have an important use as antidepressants, engender
285-429: The progression of the disease of alcoholism before the disease completely destroyed the alcoholic's life. Following his own recovery from alcoholism, in 1962 Johnson led a church group concerning alcohol intervention. As a Minnesota Episcopal priest, Johnson encouraged the incorporation of faith into the treatment and he convinced many churches to provide space for recovering alcoholics' support group meetings. Johnson
304-452: The symptoms of withdrawal to occur, one must have first developed a form of drug dependence . This may occur as physical dependence , psychological dependence , or both. Drug dependence develops from consuming one or more substances over a period of time. Dependence arises in a dose-dependent manner and produces withdrawal symptoms that vary with the type of drug that is consumed. For example, prolonged use of an antidepressant medication
323-633: The treatment of chemical dependency, the most famous being I'll Quit Tomorrow. Johnson died in 1999 from cancer . Physical dependence Physical dependence can manifest itself in the appearance of both physical and psychological symptoms which are caused by physiological adaptions in the central nervous system and the brain due to chronic exposure to a substance. Symptoms which may be experienced during withdrawal or reduction in dosage include increased heart rate and/or blood pressure, sweating, and tremors. More serious withdrawal symptoms such as confusion , seizures , and visual hallucinations indicate
342-577: Was also a member of faculty of the Rutgers University Summer School for Alcohol Studies. In 1966, he co-founded (along with Irene and Wheelock Whitney) the Johnson Institute, which aims to provide early intervention and help employers deal with employee drinking. The institute has also provided training to over 8,000 professionals. The Johnson Institute uses the "Minnesota Model", which Johnson constructed when he
361-513: Was leading the church group. Johnson's approach, known as a Johnson Intervention, has become the most widespread intervention technique for Alcohol Use Disorders, but critics argue that there is a lack of support for the approach in controlled research and that there is a potential for adverse results. In 2009, the Johnson Institute transferred its programs and products to the Hazelden Foundation. Johnson also wrote several books about
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