• Lack of self-control
• Increased craving or an uncontrolled urge for the substance or behavior
• Lack emotional response
• Deny behavior is causing problems
• Desire to cut down on use with an unsuccessful effort
• Use or behavior interferes with school, home, or work
• Pursuit of substance or activity consumes time
• Continued use or behavior despite social and interpersonal problems
• Risky and physically harmful behavior
• Increased tolerance leads to increased amounts of substance use

A shared symptom of addiction is a withdrawal effect, psychological and/or physical, that occurs when a person tries to slow down or stop use and/or behavior. Psychologically, a person withdrawing from addiction may have increased anxiety, depression, irritability, and rapid emotional changes. Drug withdrawal symptoms are different depending on the drug of choice. The following is a list of specific withdrawal symptoms to common addictive substances:

Alcohol. Withdrawal symptoms from alcohol can be life-threatening if you are a heavy drinker and quit abruptly. You must work with your physician to make sure that you safely recover from alcohol abuse. Alcohol withdrawal symptoms include:

• Insomnia
• Nausea/vomiting
• Seizures
• Tremors
• Hallucinations
• Anxiety
• Agitated behavior
• Delirium tremens

Delirium tremens (DT) is a life-threatening withdrawal state that can occur up to a few days after quitting alcohol. This severe form of alcohol withdrawal with symptoms of delirium, deep sleep, stupor, seizures, and hallucinations. A person with DT may have an irregular heartbeat which is a life-threatening situation. In these cases, you must be monitored 24/7  by a medical professional.

Benzodiazepines. This class of drugs is often prescribed to treat muscle spasms, anxiety, panic disorder, and some types of seizure disorders. Benzodiazepines (known as “benzos”) are central nervous system depressants and cause a relaxing and euphoric effect in the body. Withdrawal symptoms include nausea, abnormal body sensations, detachment from reality, anxiety, and insomnia. Some people will experience seizures and panic attacks when withdrawing.

Opiates. Opioids attach to and activate opioid receptors found throughout the body and release dopamine to produce a highly euphoric effect. Dependence can develop after an incredibly short time of use, even when prescribed. Acute opioid withdrawal symptoms include:

• Trouble sleeping
• Nervousness or anxiety
• Nausea, vomiting, and/or diarrhea
• Excessive sweating
• Muscle cramps and body aches
• Flu-like symptoms
• Runny nose
• Hot and cold flashes
• Severe psychological distress

Methamphetamines. Withdrawal symptoms from methamphetamines include anxiety, fatigue, hypersomnia, psychosis, and depression. The most challenging aspect for methamphetamine addicts is not just the physical symptoms of withdrawal but the intense desire to use methamphetamine.

Nicotine. Withdrawal symptoms of nicotine use include:

• Depression
• Irritability
• Frustration
• Anger
• Anxiety
• Difficulty concentrating
• Restlessness
• Cravings
• Impaired performance
• Increased appetite and weight gain
• Sleep disturbances
• Impatience

Stimulants (i.e., cocaine).This class of drugs works with the brain’s reward center by blocking the removal of dopamine from the synapses. Withdrawal from stimulants such as cocaine is rarely physically dangerous but can cause severe psychological distress. Abruptly quitting the use of stimulants may result in an intense mood change and cause the following symptoms:

• Psychotic episodes
• Depression
• Irritability
• Hallucinations
• Extreme lethargy or tiredness
• Self-harm ideation
• Nervousness

Each person has a unique set of withdrawal symptoms. If you are trying to recover from an addiction, seek professional help at once. The physical symptoms of withdrawal of certain substances (especially alcohol) can be life-threatening.

The reward center in the brain that helps to regulate feelings of pleasure and mood is known as the nucleus accumbens. Dopamine, a neurotransmitter, is released by the nucleus accumbens after some behaviors and substance use and reaches the reward center through the bloodstream. The release of dopamine causes a pleasurable sensation that motivates humans to repeat the behavior that induced the good feeling again. This can result in a vicious cycle where a person continues the behavior or use the substance that created this good feeling and is unable to quit. A person may engage in an activity or use a substance for the first time and not realize that this choice will lead to an addiction. An addiction may begin just as a casual habit and continued use of substance or engagement in a behavior can turn into a compulsion.

A primary cause of the development of an addiction to a substance involves genetic heritability. Addiction is thought to be moderate to highly inheritable depending on the environment of someone who inherits the predisposition to addiction. There have been specific genes linked to addiction, including the A1 allele of the dopamine receptor gene DrD2 and the lack of the Htr1b gene. Many influential factors can lead a person to develop an addiction. These are included in the following section.

• Not enough parental supervision
• Poverty
• Poor social skills
• Availability of drugs at home or school
• Aggressive behavior in childhood
• Early use of substances
• Highly addictive substance (i.e., nicotine, heroin, crack)
• Being an adolescent
• Having a mental disorder (i.e., depression)
• Family history of addiction
• Chaotic home and abuse
• Peer influences
• Poor school achievement
• Availability and cost of addiction source
• High stress
• Exposure to trauma

Your doctor will most likely refer you to a psychiatrist, psychologist, or a licensed alcohol and drug counselor to diagnose addiction. You may be asked to take a blood or urine test to check the amount of substance in your body. But, usually, these tests are used to monitor your drug use during treatment and recovery. The diagnosis of addiction is based on set criteria established by the psychiatric medical diagnosis manual known as the Diagnostic and Statistical Manual of Mental Disorders (DSM-5). The criteria for the diagnosis of substance use addictions include:

• Impaired control over substance use
• Social impairment
• Risky use of the substance
• Pharmacological adaptation or tolerance

If you are struggling with addiction, you have many resources available to you to help you in your first step to recovery. The SAMSHA National Helpline provides confidential free help from public health agencies at 1-800-662-4357. Remember that addiction is a chronic treatable illness that can be life-altering and life-threatening. There is hope for you! You only have to take the first step.

Medication-assisted treatment (MAT).MAT is indicated for the treatment of those addicted to opioids (i.e., heroin and prescription opiate pain relievers). This form of treatment combines medication with counseling and behavioral therapies. Prescribed medications work to normalize the chemistry of the brain while blocking the euphoric effects of opioids and alcohol. These medications also relieve cravings and help the body to return to normal without the negative and euphoric effects of the substance of choice for the addict.

Alcohol-dependence medication. Disulfiram is a medication that when taken in combination with alcohol will cause extremely uncomfortable side effects, including nausea, vomiting, and flushing. Naltrexone is used to block opiate receptors that are responsible for the rewarding effects of drinking and cravings.

Opiate-dependence medication. There are three FDA-approved medications to treat opiate use disorder: methadone, buprenorphine, and naltrexone. Methadone and buprenorphine help to reduce withdrawal symptoms or eliminate them altogether. All three block the effects of opioids used illicitly while reducing cravings to use.

Cognitive Behavioral Therapy (CBT). CBT is a therapeutic technique that can be used to treat many different types of addiction, such as alcohol, food, and nicotine addictions. This form of therapy will help you will learn how to identify triggers, develop coping skills, and recognize unhealthy behavioral patterns that lead to addictive tendencies.

12-Step programs. Usually used to treat alcohol and substance abuse. 12-step programs take place in a group therapy setting where each participant works to understand as a group how addiction negatively affects life at many levels, including social, emotional, physical, and spiritual. Therapy begins with acceptance, then moves to the concept of surrendering to a higher power. Attending regular meetings is a central theme in 12-step programs.

Contingency management. This form of behavioral therapy is successful in combatting relapse and maintaining sobriety. Contingency management therapy reinforces or rewards positive behavioral change, such as a “clean” urine sample, with an award of some type (i.e., vouchers or monetary rewards).

Rational Emotive Behavior Therapy (REBT). Negative thoughts and feelings of self-defeat can be debilitating and make recovery difficult to achieve. REBT is a form of therapy that helps you recognize negative thought patterns and use the power of rational thinking within yourself to defeat self-doubt.

Some people find that traditional methods of treating addiction do not align with their needs or preferences and they may look for an alternative approach to treating their addiction. There are different treatments available, however, it is important to consult with your doctor about these treatments. Withdrawal symptoms can be life-threatening in severe cases and you need to make sure any home remedy or alternative supplementations do not interfere with your current medications. Many of these alternative choices may remedy uncomfortable symptoms and help further your relaxation and response to stressors and anxiety.

Meditation. Stress and addiction are tightly linked, with many turning to a substance or behavior to help cope with daily life challenges. Stress can also cause someone to relapse during recovery. Mindfulness-based therapies, like guided meditation, can help to build within yourself a system of stress management that helps you healthily gain control of your life. If you are interested in finding a therapist who uses mindfulness-based intervention in their practice, look for those who specialize in Mindfulness-Based Cognitive Therapy (MBCT), Dialectical Behavior Therapy (DBT), or Acceptance and Commitment Therapy (ACT).

Yoga. A gentle yoga program can help you to take control of your life while building inner and outer strength through breathing and stretching exercises mediated around meditation. While you move through different poses you can set your intentions in a positive light while affirming thought practices centered around patience and trust in yourself.

Acupuncture. Acupuncture therapy involves the manual insertion of needles into specific points known as acupoints in the body to exert a therapeutic effect. A new form of acupuncture, electroacupuncture, uses a mild electrical current through the needles to stimulate acupoints. Studies have shown that acupuncture may increase the levels of neurotransmitters and hormones (epinephrine, serotonin, dopamine, etc.) that mediate substance abuse.

Aromatherapy. Essential oils can help ease the symptoms of withdrawal and promote mental clarity and relaxation. Rosemary essential oil can help to revive a “cloudy” mind that is often experienced by those in recovery. Lavender essential oil is a renowned relaxant that can be used in a vaporizer, a room diffuser, or apply a few drops into a clean cloth and breathe in the scent throughout the day.

Vitamin supplementation. Substance use disorders usually lead to nutritional deficiencies. Alcoholism decreases digestive enzymes, increases glucose levels, and leads to significant decreases in the intake and absorption of vitamins and minerals. Important vitamins to supplement in recovery are vitamins A and C, B-vitamins, calcium, magnesium, vitamin D, and zinc. Opioids slow digestion and causes constipation. A person in recovery from opiate addiction may have severe diarrhea, nausea, and vomiting. Staying hydrated is important as well as eating a nutritious diet. In all cases, working closely with a dietitian in your steps to recovery will help with your withdrawal symptoms and build your health and strength.

• Stay active
• Pay attention to your mental health
• Practice relaxation exercises
• Eat healthily!
• Get enough sleep
• Make new friendships
• Find a new hobby
• Keep a gratitude journal
• Gain control of your finances
• Be honest with yourself and others

Complications of addiction will depend on the behavior or substance causing the addiction. These include contracting sexually transmitted diseases if you struggle with sex addiction or getting hepatitis C or HIV by using non-sterilized needles if you are injecting drugs. Other complications include:

• Fatal constipation from opiate use
• Damage to nasal cartilage from snorting cocaine
• Cancer of the mouth, nose, and throat from smoking
• Dental decay from methamphetamine use
• Violent behaviors
• Overdose leading to coma and death
• Fetal damage or death
• Psychosis from hallucinogens
• Suicide
• Poverty
• Criminal behavior

If you are struggling with an addiction, help is a phone call away. SAMSHA National Helpline:

1-800-662-4357

A trigger is a stimulus that makes someone want to engage in addictive behavior. These cues are triggered by emotional, environmental, or social situations that remind people in recovery of their past. They can be a memory, a  place, or a situation that compelled you to begin your addiction in the first place. When you are in your recovery program, these triggers may overpower your will and you may use the substance or engage in behavior you are trying to stop. Addiction usually involves a daily routine that includes specific cues, or triggers, can greatly increase a craving that leads to a relapse. Common substance abuse triggers include:

• Holidays
• Paraphernalia
• Empty pill bottles
• Parties
• Payday
• Television
• Cash or credit cards
• Former drug-stash places
• Neighborhoods
• Bars and clubs
• Hotels
• Concerts
• A friend’s home
• Former drug dealers
• Spouses or partners
• Co-workers
• Friends
• Family
• Stress and anxiety
• Depression
• Emotional states (anger, jealousy, hate, shame, guilt)
• Smells
• Feeling criticized, overwhelmed, or inadequate

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