It is not uncommon to hear the expression “being with the monkey” when talking about drug addicts who are experiencing tremors, nervousness or outbursts of anger at a time when they do not have drugs.

These are situations in which these people are suffering greatly and experiencing variable symptomatology. This is a colloquial way of talking about the withdrawal syndrome, a problem we are going to talk about in this article .

What is withdrawal?

Withdrawal syndrome is understood to be the set of symptoms caused in the body physically and mentally dependent on a substance when it is suddenly withdrawn. Such withdrawal may refer to a complete cessation of consumption or to a reduction in the quantity and/or frequency of consumption, and the symptoms are not due to other medical or mental illnesses (although it may exacerbate symptoms of some illness).

Generally, withdrawal from consumption is intentionally caused by the subject with dependency, in order to eliminate the aversive consequences that addiction is causing in his life. It can also occur due to involuntary circumstances in which it is not possible to access the substance in question, such as hospitalization, travel or imprisonment. A third option is that the subject is unable to acquire it despite being unwilling to stop using, due to lack of suppliers or economic capacity to acquire it.

Withdrawal syndrome generates a high level of suffering and discomfort . The specific symptoms of this type of syndrome will depend on the type of substance being consumed, and are usually the opposite of those that would appear with an intoxication of such substances. Craving or intense desire and craving for use usually occurs in response to the discomfort caused by the absence of the substance. Other common symptoms are tremors and spasms, headaches, muscle pain, digestive problems such as nausea and vomiting, dizziness, agitation or hallucinations.

The evolution of the symptomatology and its intensity depend not only on the type of drug but also on the type, quantity and frequency of previous consumption, being linked to the level of dependence and addiction presented by the subject. In addition to the drug consumed in itself, the problems associated with withdrawal syndrome will intensify if the cessation of consumption occurs in an environment where it is easy to acquire the drug. Also the way of seeing the world or perceiving and facing the problems will have an effect, having greater discomfort for example inhibited people who do not express their feelings (especially the negative ones).

Why does it happen?

The reason for withdrawal is something that many people, especially those who suffer from it, ask themselves. The direct reason is the cessation or sudden reduction of consumption , which has been carried out in such a way that the subject’s body The organism has become accustomed to the substance, generating a tolerance to it (which in turn is what causes consumption to increase in quantity and frequency) and accustoming the body to function with the substance.

The body, balanced before the acquisition of dependency, learns to maintain a new balance in which the drug or substance in question comes into play. The substance, which served as a booster initially, over time loses some of this role and is transformed into something necessary to avoid the discomfort associated with its lack.

A sudden withdrawal causes the organism, which depended on the substance, to suddenly find that it lacks something that makes it work. The balance or internal homeostasis that the body had learned to maintain with the drug becomes unbalanced all at once, generating withdrawal syndrome until it can keep itself in balance. But depending on how the withdrawal is done, the imbalance can generate very severe repercussions.

The need for a gradual withdrawal

It is important to keep in mind that the removal of the substance should not be done suddenly. Despite the fact that the cessation of consumption in drug addicts is essential and can save their lives (both figuratively and literally), suddenly cutting off the supply of a substance on which our body is dependent can have fatal consequences. Withdrawal syndrome is not something to be taken lightly: it is a dangerous reality that in many cases can have permanent consequences, leading to coma and even death .

In this sense, the type of drug must be taken into account: it is not the same to get rid of coffee as to get rid of cocaine or heroin . Also the level of dependency. Withdrawal is necessary, but it must be done in a controlled way (often different drugs are used, for example), in a gradual and controlled way to avoid severe physiological effects and reduce the risk of a life-threatening withdrawal syndrome.

It is necessary to let the body get used to functioning without so much substance until it can function completely without it. Sometimes it may be necessary to use substitute substances , such as methadone, as long as the substance is not consumed but dangerous symptoms are kept at bay, admission to detoxification centres or hospitalisation of the subject to keep him/her stabilised. In some cases, a subject has been induced into a coma in order to have better control of the situation.

Alcohol, benzodiazepines and opiates are some of the main substances with withdrawal syndromes that could become life-threatening, mostly due to cardiorespiratory failure . This is why it is necessary to schedule their withdrawal.

Different types of withdrawal

As we have seen, the type of symptoms will depend largely on the substance, the degree of dependence on it and even the biological characteristics of the dependent person. The following are some of the most well-known withdrawal syndromes among those listed by the DSM-5.

1. Of tobacco

The abstinence syndrome caused by tobacco is probably one of the best known and experienced worldwide, and the cessation of its consumption is something that many users have considered. Irritability, insomnia, anxiety, concentration problems, depression and eating disorders are its main symptoms. It is annoying, but it is one of the least harmful withdrawal syndromes and is not usually dangerous.

2. Of alcohol

Chronic alcohol users who stop using alcohol may experience different types of withdrawal syndromes of varying severity. Common symptoms are tachycardia and sweating, insomnia, hand tremor s, agitation and anxiety, hallucinations and convulsions. In extreme cases it is possible for the subject to develop delirium tremens, which can lead to death.

3. Of stimulants

Within this category we include amphetamines, cocaine and other stimulants. Withdrawal from these substances generates dysphoric mood, increased appetite, fatigue, nightmares and sleep problems as some of the most well-known symptoms.

4. Of sedatives, hypnotics and anxiolytics

The use and dosage and the monitoring of the recommended consumption and withdrawal guidelines avoid this type of withdrawal syndrome, which can occur both in those who use them therapeutically and in those who use them recreationally and/or without control when withdrawing consumption in one go. Tremors, hyperactivity of the autonomic nervous system, tachycardia, nausea and vomiting, hallucinations, agitation and anxiety are some of the most typical symptoms.

5. Of opiates

Sudden withdrawal from opium and its derivatives (such as heroin) leads to a potentially life-threatening withdrawal syndrome. Dysphoria, nausea, pain, diarrhea, fever, insomnia, or withdrawal are some of the common symptoms in subjects who are abstinent from opium derivatives.

6. Of cannabis

Cannabis is a very popular substance, especially among young people, and is perceived as generally harmless. Recently, however, the existence of an abstinence syndrome has been described, which can occur in subjects who consume daily or almost daily . This syndrome is characterised by restlessness, depression, loss of appetite, nervousness and uneasiness and on occasions alterations may arise such as fever, spasms, abdominal pain or headache.

7. Caffeine

Although many people can argue with this, frequent, prolonged, daily caffeine consumption can lead to a certain level of caffeine dependency and withdrawal with abrupt cessation. Fatigue and sleepiness, headache, flu-like symptoms, irritability or dysphoria are typical symptoms of withdrawal.

Bibliographic references:

  • American Psychiatric Association. (2013). Diagnostic and statistical manual of mental disorders. Fifth edition. DSM-V. Masson, Barcelona.