Symptoms
Symptoms of physical dependence are primarily manifested as withdrawal symptoms when the substance is reduced or stopped. These symptoms are specific to the substance involved but can include:
Opioids: Muscle aches, sweating, anxiety, diarrhea, vomiting, goosebumps, dilated pupils.
Alcohol: Tremors, anxiety, agitation, seizures, hallucinations, nausea, vomiting.
Benzodiazepines: Anxiety, insomnia, tremors, seizures, muscle pain, panic attacks.
Stimulants: Fatigue, depression, increased appetite, disturbed sleep, anxiety, drug cravings.
Nicotine: Irritability, anxiety, difficulty concentrating, increased appetite, restlessness.
Causes
Physical dependence develops through repeated exposure to a substance over a period of time. The body's physiological systems adapt to the consistent presence of the substance. Key mechanisms include:
Neuroadaptation: Changes in neurotransmitter levels and receptor sensitivity in the brain.
Homeostasis: The body attempts to maintain a stable internal environment, and the substance becomes part of that balance.
Genetic Predisposition: Some individuals may be more susceptible to developing dependence based on their genetic makeup.
Frequency and Dosage: Higher doses and more frequent use of a substance increase the likelihood of developing dependence.
Medicine Used
Treatment for physical dependence often involves managing withdrawal symptoms. Medicines used can include:
Opioids: Methadone, buprenorphine (for opioid dependence); medications to manage specific withdrawal symptoms like loperamide (for diarrhea) and clonidine (for anxiety/high blood pressure).
Alcohol: Benzodiazepines (to manage withdrawal symptoms like anxiety and seizures); disulfiram, naltrexone, acamprosate (to prevent relapse).
Benzodiazepines: A slow, tapered reduction of the benzodiazepine dose is the primary approach; in severe cases, flumazenil may be used (with caution due to risk of seizures).
Nicotine: Nicotine replacement therapy (patches, gum, lozenges, inhalers), bupropion, varenicline.
Is Communicable
No, physical dependence is not a communicable disease. It is not caused by an infectious agent and cannot be transmitted from one person to another.
Precautions
Responsible Medication Use: Take prescription medications exactly as prescribed by a doctor and discuss any concerns about dependence.
Avoid Self-Medication: Do not use substances to cope with stress or emotional problems.
Education: Understand the risks of dependence associated with certain substances.
Alternative Therapies: Explore non-pharmacological methods for pain management, anxiety relief, and sleep problems.
Professional Help: Seek professional help if you suspect you are developing physical dependence on a substance.
How long does an outbreak last?
There is no outbreak associated with physical dependence. The length of time withdrawal symptoms last depends on the substance used, the length of use, the dosage, and individual factors. Acute withdrawal symptoms may last from several days to weeks. Post-acute withdrawal symptoms (PAWS) can last for months or even years in some cases, depending on the substance.
How is it diagnosed?
Physical dependence is diagnosed based on the presence of withdrawal symptoms when the substance is stopped or reduced. Diagnosis typically involves:
Medical History: Assessment of substance use history, including frequency, dosage, and duration of use.
Physical Examination: Evaluation for signs and symptoms of withdrawal.
Patient Report: Description of withdrawal symptoms experienced.
Diagnostic Criteria: Clinicians use standardized criteria (e.g., from the DSM-5) to determine if physical dependence is present.
Timeline of Symptoms
The timeline of withdrawal symptoms varies greatly depending on the substance. However, a general outline is below. This is for informational purposes ONLY and specific timelines can vary widely.
Alcohol: Withdrawal symptoms can begin within hours of the last drink, peak within 24-72 hours, and subside within 5-7 days.
Opioids: Withdrawal symptoms typically start within a few hours to a day after the last dose, peak within 1-3 days, and last for 5-7 days.
Benzodiazepines: Withdrawal symptoms can start within 1-7 days after the last dose, depending on the half-life of the drug, and can last for several weeks to months.
Stimulants: Withdrawal symptoms ("the crash") can occur within hours of stopping the drug and last for several days to weeks.
Important Considerations
Withdrawal can be dangerous: Withdrawal from certain substances (e.g., alcohol, benzodiazepines) can be life-threatening and should be medically supervised.
Relapse: Physical dependence can increase the risk of relapse to substance use.
Comorbidity: Physical dependence often co-occurs with mental health disorders.
Individualized Treatment: Treatment should be tailored to the individual's specific needs and circumstances.
Long-Term Management: Recovery from physical dependence is often a long-term process that requires ongoing support.