Originally posted on Eleanor Health

As the COVID-19 outbreak continues to put a strain on the nation’s healthcare system at-large, it also puts people with addiction at a greater risk for serious health problems, including withdrawal from alcohol, opioids and other drugs. In light of stay-at-home orders and the need to practice social distancing, some people with addiction may be unable to access substances. Others may think this is a good time to “go cold turkey” and quit their substance use.

In reality, suddenly stopping substance use, either involuntarily or voluntarily, can lead to withdrawal. Depending on the substance and severity of the addiction, withdrawal symptoms can be mild, moderate, severe, or potentially fatal. Withdrawal is especially high-risk for people with pre-existing medical conditions and pregnant women.

With many hospitals’ resources already exhausted, it may be difficult to seek timely medical help for withdrawal, especially if people are hesitant to leave their homes at this time. Here is what you need to know about withdrawal, some ways to manage withdrawal symptoms at-home and when to seek medical help.

Alcohol Withdrawal

In an effort to stop the spread of the novel coronavirus, most states have classified restaurants and bars as non-essential businesses, requiring them to shut their doors to patrons for the foreseeable future. Certain states have even required liquor stores to close. For people with an addiction to alcohol, these circumstances can pose a serious risk and increase their likelihood of withdrawal symptoms occurring.

For people who drink excessively, over time, the brain becomes used to the high level of alcohol being consumed. When the body’s level of alcohol suddenly drops, the brain becomes overstimulated, which causes uncomfortable physical and mental effects of withdrawal. Symptoms can begin within a few hours of a person’s last drink and peak usually peak around 72 hours after the last drink. The symptoms can include:

  • Trembling (body shakes, often most noticeably in the hands)

  • Headache

  • Nausea

  • Vomiting

  • Loss of appetite

  • Chest pain

  • Fever

  • Sweating (most noticeably from the palms or face)

  • Insomnia

  • Anxiety

The most severe syndrome of alcohol withdrawal is delirium tremens, which develops due to sudden and severe changes in the central nervous system. Often referred to as the DTs, the symptoms usually begin within 48 to 96 hours after the last drink but in some cases, may occur 7 to 10 days following the last time alcohol was consumed. After the initial onset, symptoms may worsen very quickly and can include:

  • Seizures

  • Confusion

  • Vivid hallucinations (seeing, feeling, or hearing things that aren’t there like bugs crawling on the skin)

  • Rapid mood changes and sudden bursts of energy

  • Fatigue and sleepiness

  • Tremors

Delirium tremens is the most severe withdrawal syndrome and could result in serious health problems or death if untreated. If a person develops any symptoms of delirium tremens, they should seek medical attention right away. During this time of the COVID-19 outbreak when it may be difficult to leave the house or see a medical professional in-person, telehealth can be an appropriate way to seek help. Due to the virus outbreak, many telehealth services are waiving co-pays at this time.

Benzodiazepines Withdrawal

Benzodiazepines are a group of medications, which like alcohol,  are central nervous system depressants. They are used to treat anxiety, panic disorders, insomnia, and seizures. Often referred to as benzos, some of the most familiar brand names include Valium, Xanax, Ativan, and Klonopin.

This class of medication can be habit-forming, even when prescribed at therapeutic doses. The body can become physically dependent on the medication, in as little as 30 days of use, which is why it is generally only prescribed for short-term use. As soon as physical dependency sets in, withdrawal can occur whenever a person reduces their dose or abruptly stops taking it altogether.

Depending on the specific benzodiazepine, the timeframe for experiencing withdrawal symptoms can begin in as little as 8 hours or as long as a week. With shorter-acting drugs like Xanax and Ativan, symptoms typically begin with 24 hours and peak after 72 hours. For longer-acting drugs like Klonopin and Valium, withdrawal usually begins within 48 hours to one week after the last dose. Because benzodiazepines work in the same part of the brain as alcohol,  symptoms of benzo withdrawal are the same as alcohol withdrawal and can include:

  • Seizures

  • Muscle spasms and tremors

  • Dizziness and lightheadedness

  • Ringing in the ears, blurred vision, and sensitivity to light

  • Anxiety, panic attacks, and depression

  • Insomnia

  • Headache

Like alcohol withdrawal, the most severe form of benzo withdrawal is delirium tremens (see earlier in this article).  The dTs are more likely to develop in individuals who have become dependent on shorter-acting benzodiazepines like Xanax and Ativan, but can also develop in those using longer-acting benzos.  If a person develops any symptoms of delirium tremens as a result of benzodiazepine withdrawal, they should seek medical attention right away.

Opioid Withdrawal

Opioids are a class of drugs used to treat pain, which can be divided into two categories: opiates and synthetic opioids. Opiates are drugs that originated from the opium poppy plant and include morphine, codeine, heroin, and opium. Synthetic opioids are prescription drugs manufactured in laboratories, like Oxycontin, Vicodin, and Dilaudid, but have similar effects to the drugs naturally derived from opium poppies.

Both categories of opioids can cause physical dependence and addiction. The longer a person takes opioids, the more their body needs to feel the same effects. If opioid usage is stopped suddenly, a person could begin to feel withdrawal symptoms within 24 hours of their last use, including:

  • Muscle aches

  • Restlessness

  • Anxiety, irritability, or agitation

  • Watery eyes and runny nose

  • Sweating

  • Insomnia

As time progresses, symptoms may change and become more intense-feeling after the first day. They include:

  • Diarrhea and stomach cramping

  • Nausea and vomiting

  • Rapid heartbeat and high blood pressure

  • Blurry vision

  • Goosebumps on the skin

At-Home Treatment for Withdrawal

To avoid developing severe symptoms of withdrawal, an individual should gradually reduce the amount of the substance used whether that is alcohol, benzodiazepines or opioids.  For example, if you typically drink a bottle of vodka daily, rather than stopping cold turkey, you would slowly reduce your drinking over several days — drinking ¾ of a bottle on day 1, half a bottle the second day and ¼ of the bottle on the third day.

While serious withdrawal symptoms require immediate medical attention, many of the milder symptoms can be treated at home with over-the-counter medicines or home remedies.

  • For nausea and vomiting: antacids (TUMS, Milk of Magnesia, Alka-Seltzer) and bismuth subsalicylate (Pepto-Bismol, Kaopectate)

  • For diarrhea: bismuth subsalicylate (Pepto-Bismol, Kaopectate) and loperamide (Imodium)

  • For muscle aches: ibuprofen (Advil) or acetaminophen (Tylenol)

  • For dehydration: water or Pedialyte/Hydralyte

  • For high blood pressure and checking vital signs: a blood pressure cuff (can be purchased from a drugstore or online retailer)

Withdrawal can be a stressful situation, made even more overwhelming by the virus outbreak. This may cause certain people to experience significant emotional changes as they go through the withdrawal process, including intense feelings of helplessness and suicidal thoughts.

Receiving emotional support and reassurance during withdrawal can make a world of difference in a person’s outlook. To access help while practicing social-distancing, there are a variety of hotlines and online resources that can help make withdrawal feel less overwhelming, including:

Even with the unusual circumstances caused by the COVID-19 outbreak, it is still possible to seek treatment for addiction. If you or someone you love is going through withdrawal, we’re here to help.

Contact us today to set up a virtual intake and start your #RecoveryForLife.

 

 

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Our mission at Eleanor Health is to help people struggling with addiction live amazing lives. As an integrated, multidisciplinary team, we’re focused on delivering whole-person, comprehensive care. We are passionate about transforming the quality, delivery, and accessibility of addiction treatment.…

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Durham
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