Managing Withdrawal Symptoms with Meds

Entering alcohol or drug rehab is a monumental, life-changing decision and the first step to a healthier, more satisfying life. However, detox must take place before the hard work of recovery can begin, and it’s no secret that detox is tough. Don’t let fear of withdrawal delay addiction treatment, because the discomfort is only temporary. In many cases, medications can ease the symptoms and make detox less intimidating.

The severity of withdrawal depends on a number of factors, including the substance of abuse, (including prescription drugs) and duration of use, as well as the existence of medical problems such as heart or liver disease. Some withdrawal symptoms, including headaches, anxiety, nausea, vomiting, sweating, irritability, insomnia and mild tremors are uncomfortable but relatively mild. Medications can alleviate the symptoms and make them more bearable. Meds can also help prevent serious, life-threatening symptoms such as seizures, delirium tremens (DTs), hallucinations, heart attacks and strokes.

Alcohol - Withdrawal from alcohol is significant and doctors often prescribe diazepam, lorazepam, or other benzodiazepines to relieve insomnia, anxiety and seizures. Benzodiazepines are sedatives that can become addictive when improperly used, but the drugs are needed for only a few days.

Medications such as propranolol and clonidine are types of adrenergic medications often prescribed for their ability to moderate the body’s reaction to stress, including elevated blood pressure and pulse rate. They are often used in conjunction with benzodiazepines. Alcohol is a sedative, and the body has adjusted to the sedative effect similar to a spring pushing back against a load.  This body’s adaptation to the sedative attempts to maintain some kind of homeostasis, or balance.  When the sedative is suddenly removed by not drinking, the “spring”, or new place of balance that was pushing against the sedative is now overcompensating.  This is what leads to anxiety, and the many physical symptoms of withdrawal from alcohol.  Medications manage these situations while the body is finding a new set point.  This happens within a few days for physical symptoms.  It takes a bit longer for a new “thinking” set point, this starts after detox. 

Anti-seizure medications are used if seizures are a possibility – usually in people who have used large amounts of alcohol or benzodiazepines.  Researchers at the National Institute on Alcohol Abuse and Addiction also believe that anti-seizure drugs may help with anxiety, depression and irritability. They are not heavily sedating, and are not addictive.

Heroin, morphine and other opiates - Buprenophine is one of three drugs approved by the FDA for medically supervised withdrawal and maintenance treatment of opiate addiction.  Although buprenophine is a type of opioid, it has some properties that allow opiate addicts to taper use of the drugs without serious withdrawal symptoms or severe cravings. Buprenophine is prescribed as Subutex or Suboxone.  Suboxone contains naloxone which is a medicine that immediately reverses opiates. When taken as instructed, the naloxone is inactive.  If Suboxone is injected, It will cause immediate withdrawal symptoms.  This is done to deter abuse of Suboxone.  They are relatively safe and present little chance of overdose when taken properly. Other FDA-approved drugs for relief of opiate withdrawal are methadone and naltrexone.  Vivitrol is a long acting form of naltrexone given as a monthly injection.  It can help with craving as well as act as an opiate blocker.  It also helps with alcohol craving and has been shown to diminish relapse rates when used for several months after treatment.  It should be remembered, that these medicines treat symptoms of withdrawal, not the underlying cause of the disease of addiction.  Simply replacing the drug of choice with buprenorphine or methadone can give a false sense of security because lives improve and feelings improve, but it must be remembered, the disease of addiction is far more complex.  They should be considered crutches for a broken leg that still needs surgery.

Cocaine, amphetamines and other stimulants – Currently, there are no FDA-approved medications specifically for withdrawal from stimulants.  Symptoms during detox are related to removal of a regular stimulant that has used up our brain’s dopamine and energy.  This leads to fatigue, lack of motivation, and “anhedonia” or lack of enjoyment of anything.  Sometimes medications like Topamax or Wellbutrin are used to help with these symptoms.  Antidepressants are often prescribed for depression that accompanies withdrawal, and Propranolol can be useful for sweating, anxiety and palpitations.

Benzodiazapines – Benzodiazepines should not be stopped abruptly without a replacement medication as there is a definite risk of seizures.  Benzodiazepines dissolve in fatty tissues in our bodies, which includes our brain, so they take several weeks to be totally out of our body after stopping them.  Anti-seizure medicines are given for 4-6 weeks as our body’s clear of the drugs.  Books talk about tapering off slowly, but that has little success.  The best way is to stop them completely while replacing them with other more effective medications that will prevent a seizure and also treat anxiety.  People are very fearful of stopping benzodiazepines because of the severe anxiety they suffer, but this can be treated very successfully during detox and long term, usually much more effectively than the anxiety has been treated in the past. 

Marijuana- Marijuana is definitely addictive and associated with a withdrawal syndrome that includes anxiety and insomnia.  These are managed during detox and during recovery. 

Located in Destin, Florida; Roland Reeves, MD and the staff at Destin Recovery use a wide range of evidence-based (proven) tools. Destin Recovery’s medical professionals treat the chronic brain changes and resulting life issues that are the symptoms of the disease. The “need for relief” that is described as craving is quenched in healthy long lasting ways. Destin Recovery believes all addiction treatment should include medical treatment by a hands-on addiction doctor combined with counseling therapy and self-help groups. Therapy must include learning in fun and productive ways how to truly engage in life and relationships while living and experiencing the present moment.