Drug users withdrawal symptoms

Given the low incidence of severe withdrawal symptoms and the modest effects on the mesolimbic dopamine (reward) system, most investigators have found that cannabis has a low abuse or addiction potential. However, it has been argued that if cannabis is a non-addictive substance, why is its use so widespread and why are there so many longterm and heavy users Finally, contrary to the evidence that cannabis can produce chronic tolerance, some regular users report that they require less drug to achieve the same high, or sensitisation (Chapter 3). Three possible explanations may account for this. First, chronic users may focus on the effects that they wish to achieve. Second, the... 

Modified and reprinted with permission from American Psychiatric Association. Diagnostic and Statistical Manual of Mental Disorders, 4th ed.r text revision. Washington, DC American Psychiatric Association, 2000 Sofuoglu M, Dudish-Poulsen S, Poling J, et al. The effect of individual cocaine withdrawal symptoms on outcomes in cocaine users. Addict Behav 2005,30 1 125-1134 and Patten SB, Barbui C. Drug-induced depression a systematic review to inform clinical practice. Psychoth Psychosom 2004 73 207-215. 

Another way to conceptualize drug problems is to examine psychological versus physical dependence on a substance. Psychological dependence is defined by beliefs A person thinks he or she needs the substance in order to cope. Physical dependence, on the other hand, is defined by actual physical changes related to drug use that may result in withdrawal symptoms and tolerance. However, to confuse matters, recreational users also may experience tolerance and withdrawal, so it is important to be careful when using these distinctions to define whether a person has a drug problem. 

This book is mainly concerned with the treatment of opiate misuse, for the simple reason that that is the form of drug misuse for which there are the most effective clinical approaches. As we have discussed, the treatment scene for opiate misusers, in contrast to other groups, is fundamentally altered by the widespread availability of the substitution option, in the form of methadone or alternative opioids. Physical dependence is part of the rationale for that approach, and the occurrence of clear-cut withdrawal symptoms also indicates the use of drugs such as lofexidine or clonidine, followed where possible by naltrexone. For reasons of severity of dependence and treatment options, it is therefore understandable that services are inclined to have caseloads dominated by opiate users. 

In this book there have not been systematic examinations of the conceptual status and details of dependent states on the various drugs, but it is certainly worth noting that a condition comprising true dependence on cannabis is now recognized. In many ways the three cardinal features of dependence on a substance are tolerance, craving and withdrawal symptoms, and these have clearly been shown particularly in users presenting for treatment. 

It is known, however, that drugs are readily available in many prisons, and the rate of adverse incidents and the time and effort spent in detecting smuggling of drugs in has been enough to persuade some authorities that at least the basics of treatment should be available. The most routine option has become to provide a detoxification for opiate misusers, with for instance lofexidine or dihydrocodeine, and also benzodiazepines will often be issued if there is a history of abuse of these and it is intended to avoid the possibility of fits with a short withdrawal course. The adverse incidents in custody and prisons have included some deaths in users of crack cocaine, with physical explanations postulated but no very satisfactory treatment for cocaine withdrawal indicated. Prison services have typically been wary of methadone, and in favouring lofexidine use it was encouraging that a randomized double-blind trial carried out by prison specialists found lofexidine to be as effective as methadone in relief of withdrawal symptoms (Howells et al. 2002). 

Flumazenil is a competitive benzodiazepine antagonist with a half-life of approximately 1 hour. It is available only as an intravenous injection. Since its half-life is shorter than the drugs which it is used to antagonise, its beneficial effects are temporary. It is perhaps best used as a means of establishing a diagnosis before instituting appropriate supportive therapy. Flumazenil has been reported as inducing withdrawal symptoms in some habitual benzodiazepine users. 

The more that users have used the drug in the past, the higher the marginal utility from the good in the present. This assumption, too, could be supported by the presence of neuroadaptation, as manifest in withdrawal symptoms or sensitization. 

Carpenter, Siri. The Changing Face of Marijuana Research. Monitor on Psychology, June 2001, pp. 40-42. Some people consider marijuana to be highly addictive and a gateway to harder drugs, while others believe it to be a social drug no more harmful than alcohol. Between these two positions lies the reality that marijuana affects individuals differently, as shown by variation in withdrawal symptoms. The identification of cannabis receptors in the brain has led to the realization that some marijuana users may be motivated to continue use in order to avoid withdrawal symptoms. However, about 40 percent of users seem not to experience drug dependence or withdrawal symptoms. Treatment plans need to take these different responses into account. 

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