The emergency rooms are full of people on all kinds of drugs. Many hospital emergency rooms just let the alcohol-intoxicated patients lie there in a subacute area and “sleep it off.” The nursing staff monitors their vital signs (blood pressure, temperature, pulse, and respiration) and makes sure that patients don’t go into acute withdrawal. Some drugs can have a terribly uncomfortable withdrawal syndrome but they’re not medically dangerous. At least the withdrawal syndrome isn’t dangerous. A classic example is opiates/opioids. When people withdraw from heroin, Vicodin, Norco, or related drugs, the withdrawal is miserable and painful but in and of itself, it won’t kill anybody. No one dies from opiate withdrawal; they die from opiate overdose. However, other drugs like alcohol, benzodiazepines, and barbiturates can have a very dangerous withdrawal syndrome that can lead to death. When a patient withdraws from alcohol or Xanax or Valium, especially in combination, it can become highly dangerous. Patients can suffer hallucinations, seizures, and DTs and die from alcohol and sedative- hypnotic withdrawal. The severity of the withdrawal always depends on how long someone has been taking the drug and the dosage he or she has been taking, but if the use of these kinds of drugs is discontinued abruptly, the result can be death from strokes and seizures. Remember that tolerance is a physiological and neurological adaptation to the presence of a drug. After tolerance develops, abrupt discontinuation of the drug causes a recognized withdrawal syndrome to occur. Each class of drug results in a withdrawal syndrome that is characteristic of that class. There are recognized signs and symptoms that are very characteristic of opiate withdrawal syndrome, alcohol withdrawal syndrome, stimulant withdrawal syndrome, marijuana withdrawal syndrome, sedative-hypnotic withdrawal syndrome, nicotine withdrawal syndrome, etc. And when someone is getting off multiple substances, these withdrawal syndromes appear in combination. All these withdrawal syndromes involve an autonomic response. In other words, they activate the autonomic nervous system. The autonomic system is the part of the peripheral nervous system responsible for regulating involuntary body functions such as blood flow, heartbeat, digestion, and breathing. This system is further divided into two branches: the sympathetic division regulates the fight-or-flight response, while the parasympathetic division helps maintain normal body functions and conserves physical resources. So the autonomic nervous system governs functions like your heart rate, pulse, temperature, and blood pressure (the so-called vital signs). Substance withdrawal causes an autonomic nervous system disturbance, which results in physical shaking, elevated blood pressure, and elevated temperatures and can be very, very serious. It causes activation of the thalamus (a structure in the limbic system that connects areas of the cerebral cortex that are involved in sensory perception and movement with other parts of the brain), the locus coeruleus (LC), and the frontal cortex (FC). Certain drugs are used for specific effects in particular circumstances. For instance, a lot of serious substance users and practicing addicts drink alcohol, smoke pot, and take benzodiazepines or opiates to bring them down from stimulants, from the “speed rush” or the “cocaine high.” Brain chemistry also appears to play a role in what types of mind- and mood-altering substances people prefer, insofar as certain groups of people seem to gravitate toward certain classes of drugs. In my experience, depressed patients seem to be attracted to depressants, including alcohol. Many patients with bipolar disorder seem to love stimulants. Patients with attention deficit disorder (ADD) or attention deficit hyperactivity disorder (ADHD) often seem to like stimulants, too. And the curious thing about stimulants is that when “normal” people ingest them, they get stimulated, but for people with ADHD who take stimulants, the effects are paradoxica —stimulants seem to calm them down. Addiction treatment professionals sometimes hear patients say, “whenever I did coke or meth it made me feel more normal. It leveled me out.” Sometimes the use of stimulants is a form of self-medication for ADD/ADHD. The neurochemistry of these individuals is different from that of other people. This is why psychostimulant medications such as Ritalin and Adderall are prescribed for kids with ADHD. Now, ADHD is overdiagnosed and these medications overprescribed, but there are many kids with ADHD who have great difficulty sitting still in a classroom without Ritalin or Adderall. Paradoxically, these stimulants calm them down and help them concentrate. People with psychotic disorders frequently use a tremendous amount of nicotine and pot. If you’ve ever worked in a psychiatric hospital or with people who struggle with psychotic disorders like schizophrenia,you’ve observed how many cigarettes they tend to smoke. Somehow, this fits with their brain chemistry, and the action of smoking and the effects of nicotine and marijuana are subjectively soothing to them. By the way, intoxication can be confused with psychiatric conditions. When somebody comes in to the emergency room wired and manic from using large quantities of meth or cocaine, even an experienced psychiatrist cannot distinguish that drug-induced state from a psychiatrically-based manic decompensation. However, the average person with an addiction problem who goes to a treatment facility will receive treatment primarily from addiction counselors unless he or she is in a state of acute intoxication, requires medically supervised detoxification, or has a co-occurring psychiatric condition that requires medication. It’s important for addiction therapists to understand that they are going to treat the vast majority of addicted persons, whereas physicians will be involved in the treatment of a relative minority of them—though there will likely be some gradual shifts as more pharmacological options become part of the addiction treatment continuum. This blog post is an excerpt from The therapist’s Guide to Addiction Medicine – A Handbook for Addiction Counselors and Therapists – by Barry Solof, MD, FASAM; Published by Central Recovery Press (CRP).

Las Vegas Recovery Center is an inpatient and outpatient rehab in Las Vegas. We provide addiction and chronic pain recovery services at our campus in northwest Las Vegas.