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An important principle that explains how a person’s system maintains its normal level of functioning is the principle of homeostasis.
Homeostasis refers to the property of a system, such as one’s physical system, in which the factors associated with the system’s functioning are regulated so the conditions remained relatively constant and stable in normal operating procedures. This allows the body to function efficiently. The properties change under certain conditions, such as exertion, duress, injury, and so forth, but the system attempts to maintain a consistent balance otherwise.
When a person’s body is exposed to any type of substance for a regular period of time, the substance throws off this sense of balance or homeostasis. The person’s internal system attempts to maintain homeostasis by using counter-regulatory processes to establish a new state of balance based on the presence of the drug in the system. These include modifying the levels of certain neurotransmitters, hormones, and other substances/processes in the body to adjust for the presence of the drug in the system. This may be an ongoing process. For instance, tolerance to a substance occurs when chronic use of the drug produces changes in the system so that more amounts of the drug are needed to produce the same effects that were once achieved at lower doses. The body keeps adjusting its set point for homeostasis, as an individual uses more and more of the drug. This leads to increased levels of tolerance.
When the person stops using the drug, the state of homeostasis in the body that has been developed as a result of regularly getting the drug is suddenly thrown off. This results in a state of imbalance that includes a number of issues with levels of hormones, neurotransmitters, and imbalances in other systems that result in what most people think of as withdrawal symptoms. People feel sick, psychologically thrown out of balance, and may even develop severe and potentially dangerous symptoms, such as seizures, depending on the type of drug they were using.
When people have developed both tolerance and withdrawal symptoms, they have become physically dependent on the drug. This means that they need regular exposure to the drug in order for their system to maintain its new level of homeostasis. Drug levels in the tissues will decrease if drug use is not continued. In addition, anyone experiencing withdrawal symptoms as a result of stopping a certain drug has assuredly developed some level of tolerance to it. The person’s system bases its set point on a certain level of the drug in its tissues. When this level drops, the system becomes unbalanced.
Physical dependence occurs with many drugs, including drugs that are taken for medicinal purposes only. The syndrome of physical dependence may be a symptom of addiction, but physical dependence is neither necessary nor sufficient for an individual to be addicted to a drug. Addiction represents the nonmedical use of drugs that results in negative consequences for the individual. People who continue to use drugs under the supervision of a physician for medical reasons may develop physical dependence on them, but they have not developed the disorder of addiction.
The American Psychiatric Association lists the diagnostic criteria for withdrawal from a number of different substances, including alcohol, stimulants, opioids, etc. These diagnostic criteria differ according to the class of drug. While the formal diagnostic criteria for withdrawal from each class of drug will not be listed here, a general description of the withdrawal syndrome for several classes of commonly abused drugs follows. Readers interested in learning more about specific withdrawal symptoms can refer to the American Psychiatric Association or other professional sources, such as Kaplan and Sadock’s Synopsis of Psychiatry or The Principles of Addiction Medicine by the American Society of Addiction Medicine.
Other withdrawal syndromes are recognized. Interested readers may wish to refer to the sources mentioned above regarding potential withdrawal symptoms associated with other substances not mentioned here.
Of course, any person can attempt a “cold turkey” approach to withdrawal. In some cases, such as with alcohol or benzodiazepine withdrawal, this could lead to a potentially dangerous situation. Given the current advances in medicine and the understanding of substance use disorders, there is no reason for anyone to attempt this approach these days.
Medically assisted treatment exists for the withdrawal process from many of the above-mentioned substances. In some instances, this may require a tapering strategy where a physician administers increasingly lower doses of the substance to an individual on a fixed schedule along with professional supervision and treatment in order to slowly detoxify the person from the substance. In other cases, such as withdrawal from narcotics, medications that are designed specifically to assist in the withdrawal process from these drugs can be given and tapered on a similar schedule. In many cases, medically assisted treatment will use other drugs to control cravings, to reduce the symptoms of withdrawal, and, in cases of alcohol or benzodiazepine withdrawal, to avoid serious symptoms such as seizures.
Medically assisted withdrawal procedures should only be performed by a licensed physician who is certified in addiction medicine or psychiatry and has experience treating the particular withdrawal syndrome in question.
Individuals who are not trained and certified in addiction medicine attempting to mimic professional medically assisted withdrawal treatment protocols on their own are creating a potentially dangerous and possibly fatal situation.
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