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Drug withdrawal, drug withdrawal syndrome, or substance withdrawal syndrome,[1] is
the group of symptoms that occur upon the abrupt discontinuation or decrease in the
intake of pharmaceutical or recreational drugs.
In order for 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 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 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 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 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.
Effect on homeostasis
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 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.[2] These methods include adapting the body's levels of
neurotransmitters, hormones, and other substances present to adjust for the
addition of the drug to the body.[3]
Substances
Addiction and dependence glossary[4][5][6][7]
addiction – a biopsychosocial disorder characterized by persistent use of drugs
(including alcohol) despite substantial harm and adverse consequences
addictive drug – psychoactive substances that with repeated use are associated with
significantly higher rates of substance use disorders, due in large part to the
drug's effect on brain reward systems
dependence – an adaptive state associated with a withdrawal syndrome upon cessation
of repeated exposure to a stimulus (e.g., drug intake)
drug sensitization or reverse tolerance – the escalating effect of a drug resulting
from repeated administration at a given dose
drug withdrawal – symptoms that occur upon cessation of repeated drug use
physical dependence – dependence that involves persistent physical–somatic
withdrawal symptoms (e.g., fatigue and delirium tremens)
psychological dependence – dependence that involves emotional–motivational
withdrawal symptoms (e.g., dysphoria and anhedonia)
reinforcing stimuli – stimuli that increase the probability of repeating behaviors
paired with them
rewarding stimuli – stimuli that the brain interprets as intrinsically positive and
desirable or as something to approach
sensitization – an amplified response to a stimulus resulting from repeated
exposure to it
substance use disorder – a condition in which the use of substances leads to
clinically and functionally significant impairment or distress
tolerance – the diminishing effect of a drug resulting from repeated administration
at a given dose
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Examples (and ICD-10 code) of withdrawal syndrome include:
F10.3 alcohol withdrawal syndrome (which can lead to delirium tremens)

F11.3 opioid withdrawal, including methadone withdrawal[8]
F12.3 cannabis withdrawal
F13.3 benzodiazepine withdrawal
F14.3 cocaine withdrawal
F15.3 caffeine withdrawal
F17.3 nicotine withdrawal
Prescription medicine
As noted above, many drugs should not be stopped abruptly[9] 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.[10] 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.[11]
Medication Appropriateness Tool for Comorbid Health Conditions in Dementia[12]

(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.[13]

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Drug withdrawal, drug withdrawal syndrome, or substance withdrawal syndrome,[1] is

Dependence arises in a dose-dependent manner and produces withdrawal symptoms that

The route of administration, whether intravenous, intramuscular, oral or otherwise,

F10.3 alcohol withdrawal syndrome (which can lead to delirium tremens)

Medication Appropriateness Tool for Comorbid Health Conditions in Dementia[12]

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