Abstinence syndromes

The abstinence syndrome (synonym, withdrawal symptom) is observed after withdrawal of a dtug to which a person is addicted. For example, the abstinence syndrome after alcohol withdrawal is characterized by tremor, nausea, tachycardia, sweating and sometimes hallucinations. 

When a patient does not have a painful terminal illness, drug dependence must be avoided. Signs of drug dependence include occurrence of withdrawal symptoms (acute abstinence syndrome) when tiie narcotic is discontinued, requests for tiie narcotic at frequent intervals around tiie clock, personality changes if the narcotic is not given immediately, and constant complaints of pain and failure of tiie narcotic to relieve pain. Although these behaviors can have other causes, the nurse should consider drug dependence and discuss the problem with tiie primary health care provider. Specific symptoms of tiie abstinence syndrome are listed in Display 19-3. 

Ethanol also reduces the activity of the noradrenergic system in the locus coeruleus, and alterations in norepinephrine activity may account for some aspects of intoxication and the abstinence syndrome. The 0.2 antagonist clon-idine and the P-receptor antagonist propranolol reduce some symptoms of alcohol withdrawal (Bailly et al. 1992 Carlsson and Fasth 1976 Dobrydnjov et al. 2004 Kahkonen 2003 Petty et al. 1997 Wong et al. 2003). 

A protracted abstinence syndrome may follow the acute opioid withdrawal syndrome and last for many weeks (Martin et al. 1973). In one study ofher-oin addicts detoxified with methadone, withdrawal distress peaked at day 20,... 

Hien DA, Nunes E, Levin FR, et al Posttraumatic stress disorder and short-term outcome in early methadone treatment. J Subst Abuse Treat 19 31-37, 2000 Himmelsbach CK The morphine abstinence syndrome, its nature and treatment. Ann Intern Med 13 829-839, 1941... 

Clinical Signs and Symptoms of Intoxication and Abstinence Syndrome... 

An abstinence syndrome after long-term, low-dose treatment has also been described (Busto et al. 1986a Covi et al. 1973 Petursson and Lader 1981b Tyrer et al. 1981). Reported symptoms include muscle twitching, abnormal perception of movement, depersonalization or derealization, anxiety, headache, insomnia, diaphoresis, difficulty concentrating, tremor, fear, fatigue, lowered threshold to perception of sensory stimuh, and dysphoria. 

Caffeinism A dependence on caffeine characterised by an abstinence syndrome on withdrawal. 

Milhorn HT Jr. (1992). Pharmacologic management of acute abstinence syndromes. Am Fam Physician. 45(1) 231-39. 

The abstinence syndrome, evoked in animals by the withdrawal of nicotine, appears to be similar to that seen following opiate withdrawal (Malin et al. 1992). Furthermore, Malin and co-workers have reported that the abstinence syndrome can be provoked by the administration of the opiate antagonist, naxolone, to nicotine-treated rats (Malin et al. 1993). These results suggest that the abstinence syndrome... 

MaUn DH, Lake JR, NewUn-Maultsby P, Roberts LK, Lanier JG, Carter VA, Cunningham JS, Wilson OB (1992) Rodent model of nicotine abstinence syndrome. Pharmacol Biochem Behav 43 779-784... 

MaUn DH, Lake JR, Schopen CK, Kirk JW, Sailer EE, Lawless BA, Upchurch TP, Shenoi M, Rajan N (1997) Nicotine abstinence syndrome precipitated by central but not peripheral hexametho-nium. Pharmacol Biochem Behav 58 695-699... 

The question remains, are the nicotine withdrawal phenomena in the rodent models sufficiently aversive to exert a motivational effect This can be tested by whether rodents will avoid an enviromnent associated with precipitated nicotine abstinence syndrome, in comparison with an enviromnent associated only with a saline injection. Significant place aversion conditioned to nicotine withdrawal has been repeatedly observed in rodent models (Balfour 2002 Goktalay et al. 2006 Malin et al. 2006 Suzuki et al. 1996 Watkins et al. 2000). 

An abstinence syndrome can be promptly precipitated in nicotine-infused rats by blocking nicotinic receptors with the competitive antagonist DHpE (Epping-Jordan et al. 1998 Malin et al. 1998a), or by inactivating them with noncompetitive antagonists mecamylamine (Malin et al. 1994), hexamethonium (Malin et al. 1997), or chlorisondamine (Hildebrand et al. 1997). 

---