Coping with Withdrawal Symptoms of Substance Abuse

“Experience is not what happens to you; it is what you do with what happens to you.” Aldous Huxley

Substance Abuse is a major concern worldwide, India being no exception. Alcohol, which was once used as part of rituals and medicaments, has now become a global problem that attracts close attention from mental health professionals. Alcohol as an addictive phenomenon is not yet fully conceptualised by society; therefore, patients are not worried about their addiction, and the majority of referrals are not seriously made to identify the situation. Ethyl alcohol is one of the ten most dangerous drugs for human health. Its marked ability to induce physical dependence (Nutt et al., 2007) and abuse affects the whole organism, particularly causing serious damage to the digestive, central nervous and cardiovascular systems.

The Growing Burden of Alcohol Dependence

Today, Alcohol is the third largest health care problem in India. It hampers the socio-economic-political arena of a human being. Patients often approach treatment facilities when the situation becomes grave enough that they themselves might not be able to handle their behaviour and pattern of addiction. The majority of such patients are brought to De-addiction Centres by force or persuasion. Although short-term treatment of substance abuse is quite effective, preventing relapse often proves to be far more challenging. A majority of those patients who are brought by force or persuasion relapse within a year of starting treatment, with the first three months being the most vulnerable period.

Relapse can be a frustrating experience, and it usually has several adverse consequences for patients, caregivers and therapists. Alcoholism is a common illness and a chronic disease characterised by cravings for alcohol, inability to limit alcohol use and continuing to drink despite side effects such as physical and social problems. There are many alcohol-dependent patients in hospital departments, which entail high costs in medical services. Repeated hospitalisation has become a major setback that challenges the efficacy of treatment and the treating team in most of the de-addiction centres all over the world.

Types of Substance Abuse

According to the mental health clinician’s handbook, Diagnostic and Statistical Manual of Mental Disorders (DSM V), all of the substances have disorders of two types: substance use disorders and substance-induced disorders. Substance use disorders include abuse and dependence. Substance-induced disorders include withdrawal, intoxication and various psychiatric aspects (dementia, psychosis, anxiety, mood disorder, etc.) that the substance induces when it is used.

List of Addictions to Substances

Substance use disorders in the DSM V provide a list of addictions relating to the following substances:

• Alcohol
• Tobacco
• Opioids (like heroin)
• Prescription drugs (sedatives, hypnotics, or anxiolytics like sleeping pills and tranquillisers)
• Cocaine
• Cannabis (marijuana)
• Amphetamines (like methamphetamine, known as meth)
• Hallucinogens
• Inhalants

List of Impulse Control Disorders

The DSM V lists disorders where impulses cannot be resisted, which could be considered a type of addiction. The following is a list of the recognized disorder which is related to impulse control:

• Intermittent explosive disorder (compulsive aggressive and assaultive acts)
• Kleptomania (compulsive stealing)
• Pyromania (compulsive setting of fires)
• Gambling

List of Addictions-Behavioural

It has been strongly suggested that one of the types of addiction is behavioural addiction. The following is a list of behaviours that have been noted to be addictive:

• Food (eating)
• Sex
• Pornography (attaining, viewing)
• Using computers / the internet
• Playing video games
• Working
• Exercising
• Shopping

Need for Psychosocial Interventions

Today, blending medications and psychosocial interventions in the treatment of substance abuse is the norm and has considerable support in the research literature. Successful treatment of substance use disorders may involve the use of multiple specific interventions which may vary over time for any individual patient and which may involve more than one clinician. Collaborative treatment integrates medication and psychotherapy approaches for the patient.

Coping strategies and stress of Substance Abuse

Coping refers to the beliefs and actions we use to deal with stress. It has been defined as “a conscious, rational way of dealing with the anxieties of life”. According to Lazarus and Launier, coping represents the efforts, having both action-oriented and intrapsychic dimensions, to manage, that is to master, tolerate, reduce, minimise, environmental and internal demands and conflicts, which tax or exceed a person’s resources.

A research (Orford & Guthrie, 1976) found that the coping strategies like pleading, threatening, and arguing; avoiding, keeping out of the way; withdrawing sexuality; being indulgent (giving a drink to help with hangover, going without to give the drinker money, etc.); controlling access to drink (Pouring it away, making rules not to allow it in the house, etc.); attacking or competing; taking greater control or responsibility (e.g. over money matters or childcare); seeking outside help; are taking steps towards separation. According to Lazarus & Folkman, behavioural and cognitive efforts are used to manage external and internal demands that are appraised as taxing or exceeding one’s resources.

Stress as a Trigger for Substance Use and Relapse

There is a good amount of empirical evidence available on psychosocial stress. The classic stress theory and coping refer to general everyday challenges that threaten or exceed individual coping resources as distress. If alcohol is consumed in such acute stress situations, it contributes to the development of a chronic stress syndrome; at the same time, however, alcohol may serve to maintain the distress syndrome if it is consumed as a self–administered remedy for chronic psychological stress.

Stress has been a ubiquitous explanation for a wide variety of illness and maladies, ranging from the physical (e.g., heart disease, gastrointestinal disorders) to the emotional and behavioural (e.g., depression, substance use). Consistent with this understanding, numerous studies have demonstrated that life stressors increase the likelihood of alcohol and drug relapse for substance abusers after addiction treatment and are associated with poorer addiction treatment outcomes.

The importance of coping behaviour in preventing relapse has led to the implementation of coping skills training as a major component of nearly all empirically supported treatments for alcohol use disorders. Yet, there is scant evidence that the implementation of effective coping strategies following coping skills training is a mediating mechanism of improved outcomes.

Given these discrepant findings, it is critical to gain a better understanding of individual variation in the coping-drinking relationship following treatment. Prolonged long-term stress may tax the coping resources of substance abusers in early recovery who may have depleted resources such as social support, financial assets, and occupational opportunities before entering treatment. Experiencing long-term stress may also result in adaptation or habituation, decreasing the likelihood of initiating effective coping efforts and increasing negative affective states that are common precursors of substance relapse.

What are the withdrawal symptoms in Substance Abuse & how to manage them?

Perhaps one is drinking alcohol or abusing drugs; dealing with withdrawal symptoms can be difficult, and when unsuccessful, can lead to relapse. A person is coping with cravings by instituting good habits that effectively circumnavigating his/her attention from the substance to the new, healthy practice. If you’ve tried to quit before, you know that this can be the worst part of beginning recovery. If you’ve relapsed in the past, you may not know that these feelings do not last forever.

Identifying Withdrawal Symptoms

Substance alters a person’s ability and quality to think rationally and exercise good judgment. It happens especially when experiencing withdrawal symptoms. Our brain will always try to rationalise just about any reason to make taking the substance a good idea. Substance Withdrawal symptoms can include:

• Increased sensitivity to pain
• Irritability
• Emotional instability, anxiety and depression
• Restlessness or insomnia
• Sweating, hot flashes
• Flu-like symptoms: weakness, body aches and headaches
• Lack of or increased appetite

These symptoms alone don’t always lead to relapse. Other social, emotional and psychological problems can contribute to relapse as well. These symptoms include:

• A negative or positive emotional state: Moving to substance abuse because the patient feels bad or because the patient wants to increase their good feelings.
• Social situations: Turning to substance abuse due to social pressure, because you’re in circumstances in which substance use is occurring, or because of conflict with another person.
• Physical discomfort
• Strong cravings or temptation to use drugs
• Testing personal boundaries: many people use just “one more time” because they think they can stop at any point.

Physical Activities

Healthy life routine activities like yoga and exercising are very helpful in keeping your mind off that. Yoga is likely to help balance and centre a person, as well as meditation and can prove valuable in avoiding cravings. For example, if a person has a smoking problem and is unable to quit smoking for fear of gaining weight. Working out just a few times in a week or month can negate this result and make it easier for them to quit.

Support Systems

Support of family and friends, and even counselling groups, can be very encouraging for someone if they want to quit and are working to quit. Also, talking about your habits can help quell the desire to use.

Preparation

Withdrawal symptoms from substance abuse include depression, anxiety and many physical effects. Knowing what to expect during withdrawal from the substance, one can make a healthy action plan to help combat the desires. If one is prone to anxiety or other mental illness, identify ways to work through the panic. Meditation, breathing exercises, and sensory strategies can help with this.

Medications

There are medications available to help with withdrawal from a variety of substances. Methadone and Disulfiram are two of the most important treatment method which would treat withdrawal from heroin and alcohol, respectively. There are multiple factors associated with withdrawal from substance abuse. Also, treatments may be meted out in professionally guided brief or extended interventions, or in self-help approaches. All these, taken together, can be instrumental in achieving maintenance of abstinence, the return of the drug user to mainstream life, and promotion of well-being in the patient and his family.

However, it needs to be kept in mind that pharmacological, psychosocial and coping strategies approach to the management of withdrawal from alcohol/drug abuse tends to go hand in hand, i.e. they are complementary to each other, and the best results have generally been obtained by a combined approach. Hence, in the treatment of patients with alcohol/drug abuse (or dependence), psychosocial management and coping strategies of the patient are of equal, if not less, importance as pharmacological management.