Realizing that you have a problem with drugs and need help is a powerful moment; rather than being an admission of defeat, admitting that you need help is an act of courage that speaks to your desire to live a healthier and more fulfilling life. Often, it speaks to your desire to live, period. But for many users, the prospect of getting clean and sober is intimidating. Even if you strongly recognize the need for recovery, the process of that recovery can seem like a painful and difficult journey, especially when your addiction is likely to produce distressing withdrawal symptoms. For certain types of drugs, however, medications are available that ease or even eliminate withdrawal symptoms, support your engagement in early treatment and recovery, and create a positive start to your recovery journey.
Dr. Steven Batki is considered one of the leading experts on addiction medicine in the country. As Consulting Psychiatrist at Alta Mira, he manages the medical and psychiatric needs of all clients, including the creation of personalized, medically-supervised detox plans that address the needs of those going through the detox and withdrawal process. In this interview, he shares his insights about the use of medications to minimize or prevent withdrawal symptoms and how pharmacological treatments can pave the way for long-term recovery.
The Neuroadaptive Effects of Addiction and Withdrawal
To understand how pharmacological withdrawal treatment works, you must first understand how withdrawal itself works. “The phenomena that occur during withdrawal are all due to neuroadaptation, or adaptation of the central nervous system to taking drugs over long periods of time,” Dr. Batki says.
Chronic use of drugs leads to brain changes or adaptations that can be thought of as resulting in the opposite kind of symptoms or effects than what the drugs of abuse produce. This is because when we take drugs that affect certain neurotransmitters in the brain, and during the process of taking those drugs we end up reducing or “down-regulating” the amount of those neurotransmitters that our own brain makes, or we reduce the number of the receptors on brain cells that are affected by those drugs.
For example, alcohol increases GABA-related neurotransmission in the brain (GABA is a relaxing, sedating chemical that alleviates anxiety and acts as an anticonvulsant). Chronic alcohol consumption reduces our brain’s natural GABA production, so that if alcohol use is suddenly discontinued, we are left with a “GABA deficit”.
When we stop drinking and we’re no longer getting this artificially high GABA effect from the alcohol, we are left with a brain that has inadequate amounts of its own GABA. That will lead to all the opposite effects — rather than relaxation, there’s going to be anxiety. Rather than sedation, there’s going to be excitability. Rather than anticonvulsant effects, there might be seizures.
For individuals addicted to alcohol, opioids, and benzodiazepines, the natural withdrawal process can be deeply distressing both emotionally and physically, leading many to return to drug use in order to stave off the physical and psychological pain of these withdrawal symptoms.
In some cases, withdrawal can be life-threatening, if the brain is unable to stabilize rapidly enough to prevent the emergence of dangerous symptoms such as seizures. As a result, it is imperative to seek medical attention if you are withdrawing from long-term, chronic alcohol or benzodiazepine addiction. Withdrawal from opioid addiction, while not life-threatening, is often intensely uncomfortable.
How Withdrawal Medications Work
The judicious use of certain medications can dramatically minimize or eliminate withdrawal symptoms in early recovery from certain types of drugs of abuse, providing both mental and physical comfort while reducing the urge to use. In the case of alcohol and benzodiazepine addiction, they can even be essential to the withdrawal process by preventing physical harm from seizures.
Medications are used to alleviate withdrawal symptoms by essentially making up for — or correcting — the neuroadaptation that drug use has caused. If chronic alcohol consumption reduces your levels of GABA, then we can give a medication that provides some of that GABA effect, and then withdraw or taper that medication in a gradual fashion to prevent the emergence of the withdrawal syndrome.
The pro-GABA effects of a medication such as phenobarbital can help in treating withdrawal from benzodiazepines such as Xanax, allowing you to safely and gradually detox from drugs of addiction with minimal withdrawal symptoms.
In the case of opioid withdrawal, opioids themselves are typically employed to alleviate withdrawal symptoms and allow the brain time to recover by gradually removing the effects of opioids from the body. Because they are longer-lasting and have lower risk profiles, medications such as buprenorphine (Suboxone) offer significant therapeutic benefits and provide safe and comfortable withdrawal from drugs of abuse. Adjunctive use of the non-opioid blood pressure medication Clonidine may also allow for reduced reliance on opioid medications.
Unfortunately, withdrawal medications are not available for all types of drugs. “We do not have detox medications proven to be effective for cannabis or for stimulants such as methamphetamine or cocaine, or for certain other drugs classified as hallucinogens or dissociative anesthetics like ketamine,” Dr. Batki tells me. But for the addictions for which treatments are available, medications can make a big impact, and might mean the difference between recovery and relapse.
While withdrawal medications can be a critical part of early recovery, the nature of your treatment must be tailored to your specific needs. This is especially true if you are experiencing a co-occurring mental health disorder, which may complicate withdrawal by augmenting withdrawal symptoms.
The best example of this is a patient with severe anxiety disorders or severe mood disorders, particularly depression. Individuals who are very anxious and have benzodiazepine addiction or alcohol use disorder are going to have both a benzodiazepine or alcohol withdrawal syndrome when they stop using, and they’ll also have their pre-existing anxiety disorder adding to it. They might be much more anxious and agitated when they go through withdrawal than a person who does not have an underlying anxiety disorder.
Similarly, people with depression often have more severe depressive symptoms during withdrawal than someone without underlying depression. As a result, those with co-occurring mental health disorders may require withdrawal symptom-reducing medication longer or at higher doses.
As useful as withdrawal medications can be, creating positive withdrawal experiences that fortify recovery requires more than just pharmacological intervention. Dr. Batki believes that psychosocial support, a sober living environment, and relapse prevention medications can all be essential to both reducing the severity of withdrawal syndromes and preventing relapse:
12-step support groups provide a community that can offer extremely valuable psychological support and encouragement. Having a sober living environment can protect against impulses to relapse to substance use when experiencing withdrawal symptoms, experiencing one’s own uncomfortable or painful emotions, or experiencing the day-to-day stresses that come with life. Having relapse prevention medications that reduce craving, especially stress-induced craving, can be really helpful. Spiritual practice, exercise, good nutrition, and holistic lifestyle changes are also extremely important.
What exactly withdrawal looks like will be different for each person, but with the right supports, it is possible to have a healthy and comfortable experience that serves as the foundation for long-term recovery, personal growth, and profound inner transformation.
Alta Mira offers comprehensive treatment for people struggling with addiction as well as co-occurring mental health disorders and process addictions. Contact us to learn more about our internationally renowned programs and staff, and how we can help you or your loved one start the journey toward lasting recovery.