Addiction Guide

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For the Addicts and Those Who Love Them​

 

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Addiction Guide:​

​

Addiction defined by ASAM: The American Society of Addictive Medicine
SOURCE​

Definition of Addiction:
Addiction is a primary, chronic disease of brain reward, motivation, memory and related circuitry. Addiction affects neurotransmission and interactions within reward structures of the brain, including the nucleus accumbens, anterior cingulate cortex, basal forebrain and amygdala, such that motivational hierarchies are altered and addictive behaviors, which may or may not include alcohol and other drug use, supplant healthy, self-care related behaviors. Addiction also affects neurotransmission and interactions between cortical and hippocampal circuits and brain reward structures, such that the memory of previous exposures to rewards (such as food, sex, alcohol and other drugs) leads to a biological and behavioral response to external cues, in turn triggering craving and/or engagement in addictive behaviors.

The neurobiology of addiction encompasses more than the neurochemistry of reward.1 The frontal cortex of the brain and underlying white matter connections between the frontal cortex and circuits of reward, motivation and memory are fundamental in the manifestations of altered impulse control, altered judgment, and the dysfunctional pursuit of rewards (which is often experienced by the affected person as a desire to “be normal”) seen in addiction--despite cumulative adverse consequences experienced from engagement in substance use and other addictive behaviors. The frontal lobes are important in inhibiting impulsivity and in assisting individuals to appropriately delay gratification. When persons with addiction manifest problems in deferring gratification, there is a neurological locus of these problems in the frontal cortex. Frontal lobe morphology, connectivity and functioning are still in the process of maturation during adolescence and young adulthood, and early exposure to substance use is another significant factor in the development of addiction. Many neuroscientists believe that developmental morphology is the basis that makes early-life exposure to substances such an important factor.

Genetic factors account for about half of the likelihood that an individual will develop addiction. Environmental factors interact with the person’s biology and affect the extent to which genetic factors exert their influence. Resiliencies the individual acquires (through parenting or later life experiences) can affect the extent to which genetic predispositions lead to the behavioral and other manifestations of addiction. Culture also plays a role in how addiction becomes actualized in persons with biological vulnerabilities to the development of addiction.


Other factors that can contribute to the appearance of addiction, leading to its characteristic bio-psycho-socio-spiritual manifestations, include:

• The presence of an underlying biological deficit in the function of reward circuits, such that drugs and behaviors which enhance reward function are preferred and sought as reinforcers
• The repeated engagement in drug use or other addictive behaviors, causing neuron-adaptation in motivational circuitry leading to impaired control over further drug use or engagement in addictive behaviors
• Cognitive and affective distortions, which impair perceptions and compromise the ability to deal with feelings, resulting in significant self-deception
• Disruption of healthy social supports and problems in interpersonal relationships which impact the development or impact of resiliences
• Exposure to trauma or stressors that overwhelm an individual’s coping abilities;
• Distortion in meaning, purpose and values that guide attitudes, thinking and behavior;
• Distortions in a person’s connection with self, with others and with the transcendent and the presence of co-occurring psychiatric disorders in persons who engage in substance use or other addictive behaviors.

Addiction is characterized by2:

• Inability to consistently Abstain;
• Impairment in Behavioral control;
• Craving; or increased “hunger” for drugs or rewarding experiences;
• Diminished recognition of significant problems with one’s behaviors and interpersonal relationships; and
• A dysfunctional Emotional response.
• The power of external cues to trigger craving and drug use, as well as to increase the frequency of engagement in other potentially addictive behaviors, is also a characteristic of addiction, with the hippocampus being important in memory of previous euphoric or dysphoric experiences, and with the amygdala being important in having motivation concentrate on selecting behaviors associated with these past experiences.

Although some believe that the difference between those who have addiction, and those who do not, is the quantity or frequency of alcohol/drug use, engagement in addictive behaviors (such as gambling or spending)3, or exposure to other external rewards (such as food or sex), a characteristic aspect of addiction is the qualitative way in which the individual responds to such exposures, stressors and environmental cues. A particularly pathological aspect of the way that persons with addiction pursue substance use or external rewards is that preoccupation with, obsession with and/or pursuit of rewards (e.g., alcohol and other drug use) persist despite the accumulation of adverse consequences. These manifestations can occur compulsively or impulsively, as a reflection of impaired control.

Persistent risk and/or recurrence of relapse, after periods of abstinence, is another fundamental feature of addiction. This can be triggered by exposure to rewarding substances and behaviors, by exposure to environmental cues to use, and by exposure to emotional stressors that trigger heightened activity in brain stress circuits.4

In addiction there is a significant impairment in executive functioning, which manifests in problems with perception, learning, impulse control, compulsivity, and judgment. People with addiction often manifest a lower readiness to change their dysfunctional behaviors despite mounting concerns expressed by significant others in their lives; and display an apparent lack of appreciation of the magnitude of cumulative problems and complications. The still developing frontal lobes of adolescents may both compound these deficits in executive functioning and predispose youngsters to engage in “high risk” behaviors, including engaging in alcohol or other drug use. The profound drive or craving to use substances or engage in apparently rewarding behaviors, which is seen in many patients with addiction, underscores the compulsive or avolitional aspect of this disease. This is the connection with “powerlessness” over addiction and “unmanageability” of life, as is described in Step 1 of 12 Steps programs.

Addiction is more than a behavioral disorder. Features of addiction include aspects of a person’s behaviors, cognitions, emotions, and interactions with others, including a person’s ability to relate to members of their family, to members of their community, to their own psychological state, and to things that transcend their daily experience.


Behavioral manifestations and complications of addiction, primarily due to impaired control, can include:

• Excessive use and/or engagement in addictive behaviors, at higher frequencies and/or quantities than the person intended, often associated with a persistent desire for and unsuccessful attempts at behavioral control;
• Excessive time lost in substance use or recovering from the effects of substance use and/or engagement in addictive behaviors, with significant adverse impact on social and occupational functioning (e.g. the development of interpersonal relationship problems or the neglect of responsibilities at home, school or work);
• Continued use and/or engagement in addictive behaviors, despite the presence of persistent or recurrent physical or psychological problems which may have been caused or exacerbated by substance use and/or related addictive behaviors;
• A narrowing of the behavioral repertoire focusing on rewards that are part of addiction; and
• An apparent lack of ability and/or readiness to take consistent, ameliorative action despite recognition of problems.

Cognitive changes in addiction can include:

• Preoccupation with substance use;
• Altered evaluations of the relative benefits and detriments associated with drugs or rewarding behaviors; and
• The inaccurate belief that problems experienced in one’s life are attributable to other causes rather than being a predictable consequence of addiction.

Emotional changes in addiction can include:

• Increased anxiety, dysphoria and emotional pain;
• Increased sensitivity to stressors associated with the recruitment of brain stress systems, such that “things seem more stressful” as a result; and
• Difficulty in identifying feelings, distinguishing between feelings and the bodily sensations of emotional arousal, and describing feelings to other people (sometimes referred to as alexithymia).

The emotional aspects of addiction are quite complex. Some persons use alcohol or other drugs or pathologically pursue other rewards because they are seeking “positive reinforcement” or the creation of a positive emotional state (“euphoria”). Others pursue substance use or other rewards because they have experienced relief from negative emotional states (“dysphoria”), which constitutes “negative reinforcement.“ Beyond the initial experiences of reward and relief, there is a dysfunctional emotional state present in most cases of addiction that is associated with the persistence of engagement with addictive behaviors. The state of addiction is not the same as the state of intoxication. When anyone experiences mild intoxication through the use of alcohol or other drugs, or when one engages non-pathologically in potentially addictive behaviors such as gambling or eating, one may experience a “high”, felt as a “positive” emotional state associated with increased dopamine and opioid peptide activity in reward circuits. After such an experience, there is a neurochemical rebound, in which the reward function does not simply revert to baseline, but often drops below the original levels. This is usually not consciously perceptible by the individual and is not necessarily associated with functional impairments.

Over time, repeated experiences with substance use or addictive behaviors are not associated with ever increasing reward circuit activity and are not as subjectively rewarding. Once a person experiences withdrawal from drug use or comparable behaviors, there is an anxious, agitated, dysphoric and labile emotional experience, related to suboptimal reward and the recruitment of brain and hormonal stress systems, which is associated with withdrawal from virtually all pharmacological classes of addictive drugs. While tolerance develops to the “high,” tolerance does not develop to the emotional “low” associated with the cycle of intoxication and withdrawal. Thus, in addiction, persons repeatedly attempt to create a “high”--but what they mostly experience is a deeper and deeper “low.” While anyone may “want” to get “high”, those with addiction feel a “need” to use the addictive substance or engage in the addictive behavior in order to try to resolve their dysphoric emotional state or their physiological symptoms of withdrawal. Persons with addiction compulsively use even though it may not make them feel good, in some cases long after the pursuit of “rewards” is not actually pleasurable.5 Although people from any culture may choose to “get high” from one or another activity, it is important to appreciate that addiction is not solely a function of choice. Simply put, addiction is not a desired condition.

As addiction is a chronic disease, periods of relapse, which may interrupt spans of remission, are a common feature of addiction. It is also important to recognize that return to drug use or pathological pursuit of rewards is not inevitable.

Clinical interventions can be quite effective in altering the course of addiction. Close monitoring of the behaviors of the individual and contingency management, sometimes including behavioral consequences for relapse behaviors, can contribute to positive clinical outcomes. Engagement in health promotion activities which promote personal responsibility and accountability, connection with others, and personal growth also contribute to recovery. It is important to recognize that addiction can cause disability or premature death, especially when left untreated or treated inadequately.

The qualitative ways in which the brain and behavior respond to drug exposure and engagement in addictive behaviors are different at later stages of addiction than in earlier stages, indicating progression, which may not be overtly apparent.

As is the case with other chronic diseases, the condition must be monitored and managed over time to:

• Decrease the frequency and intensity of relapses;
• Sustain periods of remission;
• Optimize the person’s level of functioning during periods of remission.

In some cases of addiction, medication management can improve treatment outcomes. In most cases of addiction, the integration of psychosocial rehabilitation and ongoing care with evidence-based pharmacological therapy provides the best results. Chronic disease management is important for minimization of episodes of relapse and their impact. Treatment of addiction saves lives †

Recovery from addiction is best achieved through a combination of self-management, mutual support, and professional care provided by trained and certified professionals.​

______________________________________

† See ASAM Public Policy Statement on Treatment for Alcohol and Other Drug Addiction, Adopted: May 01, 1980, Revised: January 01, 2010

‡ see ASAM Public Policy Statement on The Relationship between Treatment and Self Help: A Joint Statement of the American Society of Addiction Medicine, the American Academy of Addiction Psychiatry, and the American Psychiatric Association, Adopted: December 01, 1997

Explanatory footnotes:

1. The neurobiology of reward has been well understood for decades, whereas the neurobiology of addiction is still being explored. Most clinicians have learned of reward pathways including projections from the ventral tegmental area (VTA) of the brain, through the median forebrain bundle (MFB), and terminating in the nucleus accumbens (Nuc Acc), in which dopamine neurons are prominent. Current neuroscience recognizes that the neurocircuitry of reward also involves a rich bi-directional circuitry connecting the nucleus accumbens and the basal forebrain. It is the reward circuitry where reward is registered, and where the most fundamental rewards such as food, hydration, sex, and nurturing exert a strong and life-sustaining influence. Alcohol, nicotine, other drugs and pathological gambling behaviors exert their initial effects by acting on the same reward circuitry that appears in the brain to make food and sex, for example, profoundly reinforcing. Other effects, such as intoxication and emotional euphoria from rewards, derive from activation of the reward circuitry. While intoxication and withdrawal are well understood through the study of reward circuitry, understanding of addiction requires understanding of a broader network of neural connections involving forebrain as well as midbrain structures. Selection of certain rewards, preoccupation with certain rewards, response to triggers to pursue certain rewards, and motivational drives to use alcohol and other drugs and/or pathologically seek other rewards, involve multiple brain regions outside of reward neurocircuitry itself.

2. These five features are not intended to be used as “diagnostic criteria” for determining if addiction is present or not. Although these characteristic features are widely present in most cases of addiction, regardless of the pharmacology of the substance use seen in addiction or the reward that is pathologically pursued, each feature may not be equally prominent in every case. The diagnosis of addiction requires a comprehensive biological, psychological, social and spiritual assessment by a trained and certified professional.

3. In this document, the term "addictive behaviors" refers to behaviors that are commonly rewarding and are a feature in many cases of addiction. Exposure to these behaviors, just as occurs with exposure to rewarding drugs, is facilitative of the addiction process rather than causative of addiction. The state of brain anatomy and physiology is the underlying variable that is more directly causative of addiction. Thus, in this document, the term “addictive behaviors” does not refer to dysfunctional or socially disapproved behaviors, which can appear in many cases of addiction. Behaviors, such as dishonesty, violation of one’s values or the values of others, criminal acts etc., can be a component of addiction; these are best viewed as complications that result from rather than contribute to addiction.
4. The anatomy (the brain circuitry involved) and the physiology (the neuro-transmitters involved) in these three modes of relapse (drug- or reward-triggered relapse vs. cue-triggered relapse vs. stress-triggered relapse) have been delineated through neuroscience research.

Relapse triggered by exposure to addictive/rewarding drugs, including alcohol, involves the nucleus accumbens and the VTA-MFB-Nuc Acc neural axis (the brain's mesolimbic dopaminergic "incentive salience circuitry"--see footnote 2 above). Reward-triggered relapse also is mediated by glutamatergic circuits projecting to the nucleus accumbens from the frontal cortex.

Relapse triggered by exposure to conditioned cues from the environment involves glutamate circuits, originating in frontal cortex, insula, hippocampus and amygdala projecting to mesolimbic incentive salience circuitry.

Relapse triggered by exposure to stressful experiences involves brain stress circuits beyond the hypothalamic-pituitary-adrenal axis that is well known as the core of the endocrine stress system. There are two of these relapse-triggering brain stress circuits – one originates in noradrenergic nucleus A2 in the lateral tegmental area of the brain stem and projects to the hypothalamus, nucleus accumbens, frontal cortex, and bed nucleus of the stria terminalis, and uses norepinephrine as its neurotransmitter; the other originates in the central nucleus of the amygdala, projects to the bed nucleus of the stria terminalis and uses corticotrophin-releasing factor (CRF) as its neurotransmitter.

5. Pathologically pursuing reward (mentioned in the Short Version of this definition) thus has multiple components. It is not necessarily the amount of exposure to the reward (e.g., the dosage of a drug) or the frequency or duration of the exposure that is pathological. In addiction, pursuit of rewards persists, despite life problems that accumulate due to addictive behaviors, even when engagement in the behaviors ceases to be pleasurable. Similarly, in earlier stages of addiction, or even before the outward manifestations of addiction have become apparent, substance use or engagement in addictive behaviors can be an attempt to pursue relief from dysphoria; while in later stages of the disease, engagement in addictive behaviors can persist even though the behavior no longer provides relief.

Physical Dependence​

Physical dependence refers to a state resulting from chronic use of a drug that has produced tolerance and where negative physical symptoms of withdrawal result from abrupt discontinuation or dosage reduction- NCI Dictionary of Cancer Terms". Retrieved 2008-12-21

Difference Between Addiction and Physical Dependence​

Addiction—or compulsive drug use despite harmful consequences—is characterized by an inability to stop using a drug; failure to meet work, social, or family obligations; and, sometimes (depending on the drug), tolerance and withdrawal. The latter reflect physical dependence in which the body adapts to the drug, requiring more of it to achieve a certain effect (tolerance) and eliciting drug-specific physical or mental symptoms if drug use is abruptly ceased (withdrawal). Physical dependence can happen with the chronic use of many drugs—including many prescription drugs, even if taken as instructed. Thus, physical dependence in and of itself does not constitute addiction, but it often accompanies addiction. This distinction can be difficult to discern, particularly with prescribed pain medications, for which the need for increasing dosages can represent tolerance or a worsening underlying problem, as opposed to the beginning of abuse or addiction. -Principles of Drug Addiction Treatment: A Research-Based Guide (Third Edition)

Another Take link​

 

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The Cycle of Addiction
The cycle of addiction is a representation of a set of commonalities
that addicts seeking recovery frequently experience

"THE ADDICTION CYCLE"
Staying Sober, by Terrence T. Gorski & Merlene Miller​

• 1 Short-term gratification
  [*]2 Long-term pain
  [*]3 Addictive thinking
  [*]4 Increased tolerance
  [*]5 Loss of control
  [*]6 Bio-psycho-social damage

1 SHORT-TERM GRATIFICATION: First there is short-term gratification. You feel good NOW. There is a strong short-term gain that causes you to assume the drug or behavior is good for you.

2 LONG-TERM PAIN AND DYSFUNCTION: The short-term gratification is eventually followed by long-term pain. This pain, part of which is from physical withdrawal, and part of which is from the inability to cope psycho-socially without drugs/alcohol, is the direct consequence of using the addictive chemical/s.

3 ADDICTIVE THINKING: The long-term pain and dysfunction trigger addictive thinking. Addictive thinking begins with obsession and compulsion. Obsession is a continuous thinking about the positive effects of using alcohol and drugs. Compulsion is an irrational urge or craving to use the drug to get the positive effect even though you know it will hurt you in the long run. This leads to denial and rationalization in order to allow continued use. Denial is the inability to recognize there is a problem. Rationalization is blaming other situations and people for problems rather than drug use.

4 INCREASED TOLERANCE: Without your being aware that it is happening, more and more of the drug is required to produce the same effect.

5 LOSS OF CONTROL: The obsession and compulsion become so strong that you cannot think about anything else. Your feelings and emotions become distorted by the compulsion. You become stressed and uncomfortable until finally the urge to use is so strong that you cannot resist it. Once you use the addictive chemicals or the addictive behaviors again, the cycle starts all over.

6 BIO-PSYCHO-SOCIAL DAMAGE: Eventually there is damage to the health of your body (physical health), mind (psychological health), and relationships with other people (social health). As pain and stress get worse, the compulsion to use the addictive drugs or behaviors to get relief from the pain increases. A deadly trap develops. You need addictive use in order to feel good. When you use addictively you damage yourself physically, psychologically, and socially. This damage increases your pain which increases your need for addictive use.

The Cycle of Addiction Is Characterized By:
Recovery Connections characteristics of the addiction cycle​

• Frustration and internal pain that leads to anxiety and a demand for relief of these symptoms
• Fantasizing about using alcohol and drugs or behaviors to relieve the uncomfortable symptoms
• Obsessing about using drugs and alcohol and how his or her life will be after the use of substances
• Engaging in the addictive activity, such as using substances to gain relief (acting out)
• Losing control over the behavior
• Developing feelings of remorse, guilt and shame, which lead to feelings of dissatisfaction
• Making a promise or resolve to oneself to stop the behavior or substance use
• After a period of time, the pain returns, and the addict begins to experience the fantasies of using substances again.

This cycle can rotate on a variable basis. For example, binge users rotate through this cycle more slowly. Daily users may rotate through the cycle of addiction daily or several times throughout the day. This cycle can be arrested at any point after the addict or alcoholic makes a decision or is forced to get help. Sometimes, the consequences that arise (legal, financial, medical or social) force the addict or alcoholic to stop using. However, in the absence of outside help, such as alcohol or drug detox followed by addiction treatment help, the substance abuse or addictive behavior is likely to return.

Bad Habits Are Hard To Break: Kicking The “Addiction” Cycle


By Mia Bolaris-Forget >here<
​

Everyone, or at least most of us, want to think we’re “improving” over time. Yet, there are things that simply seem to have a hold that just won’t let go. And, for many, one of those strongholds may be dealing with “addiction”. Whether you want to quit smoking, stop sweating the small stuff, walk away from that decadent dessert or from the computer that’s calling you after dinner, the key is gaining control. But how? The experts weigh in.

1. Define why you do or continue to do what you do: You’ve heard it said that before you can “fix” a problem, you must admit that there IS one. But, say experts, you also have to identify why the solution you’ve chosen is merely a “crutch”, adding that in most cases it’s the “drug” of choice to help us deal with depression, anxiety, unhappiness, pain, and numbs us from dealing with the reality of life.

2. Change your thought process: Start to think rationally rather than in ways that justify your behaviour. Sure you have to take a pill for your migraine, but you don’t have to light up a cigarette to deal with stress. Worse yet is those of us that know our behaviour is “bad” and should be dealt with, but choose to ignore it. In fact, they add that for some, it may be a welcome cover up for dealing with the real issue, usually something that is bothering us. So, if you can’t think it through yourself, ask others for help.

3. Change your pattern: Experts asset that the crutch we have is there for a reason, and we “need” it for a specific purpose. Therefore, if we don’t replace it, preferably with something positive, we likely won’t let it go. Find a suitable and satisfying alternative and remove the negative habit a little at a time.

4. Know your triggers: Take note of what triggers you habit and start dealing with these as well. If you must have a drink with supper, replace alcohol with water or juice. If you smoke with your cup of coffee, think about having tea instead or chewing gum rather than taking a drag. Also use the time that you’d normally use to feed your addition to do something (beneficial) for you. Also make sure to avoid pattern, places, etc. that will allow you to give in.

5. Clean house: Improve your life by improving how you live and redefining happiness and success. Refrain from carrying around cash so that you won’t be able to “feed your addiction.” you may even have to take an alternate route to work, so you don’t tempt yourself, for example, with fast food, and you may even have to “revise” your circle of friends.

6. Take responsibility for your actions and build a strong support system: Stop blaming others or the situation for doing what you do. How you cope is strictly up to you. But, say experts, it’s always good to have someone to answer and report to. Consider involving friends and family as you overcome you addiction and join a support group so you have an outlet for exchanging ideas with others just like you.

7. Treat yourself well Break down the task in more manageable segments but allow yourself to be “rewarded” with each little accomplishment, even if it wasn't of the caliber of level that you’d hoped for, wanted or expected

 

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Acute Withdrawal​

Acute Withdrawal are the Negative Symptoms Associated with Physical Dependence​

During the acute phase, when the person is fully immersed in detoxification, the brain is actually engaged in a series of operations that are by-products of the detoxification process and as such considered to be aberrations. Symptoms that indicate a person is experiencing Acute Withdrawal Syndrome may include:

• Demonstrating shakiness.
• Chills.
• Tremors.
• Anxiety.
• Stress.
• Depression.
• Difficulty thinking clearly or expressing one’s self coherently.
• Extremely volatile; mood swings.
• Presence of intermittent or persistent headaches.
• Sweating.
• Clammy skin.
• Pale skin.
• Weight loss or gain.
• Fatigue.
• Sleep disturbances – difficulty falling asleep; difficulty staying asleep; or a combination of both.
• Loss of appetite.
• Rapid heart-rate.
• Nausea and vomiting.
• Abnormal or involuntary movements of the eyelids.
• Dilated pupils.
• Depersonalization.
• Confusion.
• Psychosis.
• Convulsions and seizures.
• Muscle aches
• Tearing
• Sweating
• Insomnia
• Runny nose
• Abdominal cramping
• Diarrhea
• Chill bumps
• Restless leg syndrome
• Fibromyalgia like pain
• DTs.
• Seizures
• Death.

Partial list of drugs that cause physical dependence taken from here

All µ-opioids with any (even slight) agonist effect, such as (partial list) morphine, heroin, codeine, oxycodone, buprenorphine, nalbuphine, methadone, and fentanyl, but not agonists specific to non-µ opioid receptors, such as salvinorin A (a k-opioid agonist), nor opioid antagonists or inverse agonists, such as naltrexone (a universal opioid inverse agonist), loperamide hydrochloride.
All GABA agonists and positive allosteric modulators of both the GABA-A ionotropic receptor and GABA-B metabotropic receptor subunits, of which the following drugs are examples (partial list):

• Alcohols such as ethyl alcohol (alcoholic beverage) (cf. alcohol dependence, alcohol withdrawal, delirium tremens)
• Barbiturates such as phenobarbital, sodium thiopental and secobarbital
• Benzodiazepines such as diazepam (Valium), lorazepam (Ativan), and alprazolam (Xanax)
• Nonbenzodiazepines (z-drugs) such as zopiclone and zolpidem.
• Gamma-hydroxybutyric acid (GHB) and 1,4-butanediol
• Carisoprodol (Soma) and related carbamates (tybamate and meprobamate)
• Baclofen (Lioresal) and its non-chlorinated analogue phenibut
• Chloral hydrate
• Glutethimide
• Clomethiazole
• Methaqualone (Quaalude)

Gabapentin (Neurontin) and pregabalin (Lyrica), calcium channel modifiers that affect GABA
Antiepileptic drugs such as valproate, lamotrigine, tiagabine, vigabatrin, carbamazepine and oxcarbazepine, and topiramate
Possibly neuroleptic drugs such as clozapine, risperidone, olanzapine, haloperidol, thioridazine, etc.
Commonly prescribed antidepressants such as the selective serotonin reuptake inhibitors (SSRIs) and serotonin-norepinephrine reuptake inhibitors (SNRIs) (cf. SSRI/SNRI withdrawal syndrome)
Nicotine
Blood pressure medications, including beta blockers such as propranolol and alpha-adrenergic agonists such as clonidine
Androgenic-anabolic steroids
Glucocorticoids
Cocaine
Cannabis

 

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Post-Acute Withdrawal (PAWS)​

taken from various internet addiction resources​

There are two stages of withdrawal. The first stage is the acute stage, which usually lasts at most a few weeks. During this stage, you may experience physical withdrawal symptoms. But every drug is different, and every person is different.

The second stage of withdrawal is called the Post Acute Withdrawal Syndrome (PAWS). During this stage you'll have fewer physical symptoms, but more emotional and psychological withdrawal symptoms.

The PAWS symptoms can last from a few days to being perminant. Also many of the symtoms of PAWS will be present in periods of the addiction cycle.

The Symptoms of Post-Acute Withdrawal

The most common post-acute withdrawal symptoms are:

• Mood swings
• Anxiety
• Irritability
• Tiredness
• Variable energy
• Low enthusiasm
• Variable concentration
• Disturbed sleep
• Anhedonia (an inability to experience joy).
• Depression.
• Behaviors associated with OCD.
• Difficulty focusing.
• Disturbances in autonomic functioning.
• Lapses in memory.
• Hyper arousal with regards to stressful situations.
• Agitation.
• Inability to solve simple problems
• Disorganized thought patterns
• Difficulty sleeping or staying asleep
• Sexual dysfunction
• Mood swings
• Depression
• Drug or alcohol cravings
• Self imposed isolation
• Exhaustion
• Poor physical coordination (dry drunk)
• Memory troubles
• Lack of emotional response or inability to feel emotions
• fibromyalgia like pain
• change or changes in appetite
• fatigue
• Thoughts of suicide
• Racing thoughts
• apathy

THE BRAIN AND ADDICTION
Detailed PAWS thread is under construction and will have a link here when completed.