Psychology
Tolerance and Withdrawal Syndrome
Tolerance refers to the body's reduced response to a substance over time, requiring higher doses to achieve the same effect. Withdrawal syndrome occurs when a person experiences physical and psychological symptoms upon discontinuing or reducing the use of a substance to which they have developed a dependence. These phenomena are commonly associated with substance abuse and addiction.
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11 Key excerpts on "Tolerance and Withdrawal Syndrome"
eBook - ePubPrinciples of Addiction
Comprehensive Addictive Behaviors and Disorders, Volume 1
- (Author)
- 2013(Publication Date)
- Academic Press(Publisher)
Individuals who are deprived of a drug after an extended period of regular use frequently experience a number of symptoms, with the cluster of symptoms being referred to as withdrawal. Withdrawal from substances can include changes in appetite and weight, nausea, sleep disturbance, sweating, aches and pains, diarrhea, seizures, convulsions, and more. Symptoms can range in severity from minor irritants that may not be perceptible to the individual experiencing them, to serious conditions that carry a risk of permanent injury or death. These symptoms can emerge as early as 30 min to a few hours after the time of last drug use and can persist for days, weeks, or even months. Not all dependent users will experience significant withdrawal symptoms when usage is stopped, and the symptoms they do experience may change over time within a single withdrawal period (i.e. new symptoms appearing 1 week into the deprivation period as others are remitting), or across episodes of withdrawal (i.e. different symptoms experienced from one attempt to stop drug use to another). Different symptoms may follow different time courses during withdrawal, with some symptoms emerging later, or lasting longer. During an episode of withdrawal, administration of the drug to which the individual has become dependent will alleviate the withdrawal syndrome. Although the specific symptoms of withdrawal vary substantially across drug types, and span a variety of domains (e.g. physical, cognitive, etc.), two withdrawal symptoms that occur almost universally across drug types are craving and disturbance in affect.Tolerance and Withdrawal
A discussion of drug withdrawal requires some understanding of the mechanisms of chemical dependence. Repeated administration of drugs of abuse often results in the development of tolerance, in which the potency of the drug (the amount of the substance required to produce an effect) is reduced across time. Tolerance can be described as a reduction in the physiological or subjective effects of a drug across repeated administrations of the same dose, or as a pattern in which increasing amounts of the substance are needed to achieve the same effects produced previously by lower doses. The mechanisms underlying tolerance can be described as dispositional, functional, or learned/behavioral. Both dispositional and functional tolerances result from physiological responses to the maintained presence of a drug within the system. Dispositional tolerance results from processes that reduce the distribution of the drug to its site of action, such as increased production of enzymes that break down the substance before it can exert its effects. Functional tolerance results from physiological changes that cause sites of action to be less responsive to the presence of the drug. As a direct result of the development of functional and dispositional tolerance, drug abstinence after a period of maintained exposure often results in the production of physiological states opposite of those produced by the drug. This abstinence effect is the withdrawal syndrome referenced above and, as previously noted, is associated with reports of negative affect and drug craving in humans, as well as drug-seeking behaviors in both human and animal models of drug dependence.
- Richard Gross, Nancy Kinnison(Authors)
- 2017(Publication Date)
- Routledge(Publisher)
2. Withdrawal, as manifested by either of the following: a. The characteristic withdrawal syndrome for the substance (varies from substance to substance) b. The same (or a closely related) substance is taken to relieve or avoid withdrawal symptoms. 3. The substance is often taken in larger amounts and over a longer period than was intended. 4. There is a persistent desire or unsuccessful efforts to cut down or control substance use. 5. A great deal of time is spent in activities necessary to obtain the substance (e.g. visiting multiple doctors or driving long distances), use the substance (e.g. chain smoking) or recover from its effects. 6. Important social, occupational or recreational activities are given up or reduced because of substance use. 7. The substance use is continued despite knowledge of having a persistent physi-cal or psychological problem that is likely to have been caused or exacerbated by the substance (e.g. current cocaine use despite recognition of cocaine-induced depression, or continued drinking despite recognition that an ulcer was made worse by alcohol consumption). Specify if: ● With physiological dependence : evidence of tolerance or withdrawal (i.e. either item 1 or 2 is present). ● With psychological dependence : no evidence of tolerance or withdrawal (i.e. nei-ther item 1 nor 2 is present).
No longer available |Learn more- (Author)
- 2014(Publication Date)
- Library Press(Publisher)
________________________ WORLD TECHNOLOGIES ________________________ Chapter- 9 Substance Dependence According to the current Diagnostic and Statistical Manual of Mental Disorders (DSM-IV), substance dependence is defined as: When an individual persists in use of alcohol or other drugs despite problems related to use of the substance, substance dependence may be diagnosed. Compulsive and repetitive use may result in tolerance to the effect of the drug and withdrawal symptoms when use is reduced or stopped. This, along with Substance Abuse are considered Substance Use Disorders .... Substance dependence can be diagnosed with physiological dependence, evidence of tolerance or withdrawal, or without physiological dependence. The related concept of drug addiction has many different definitions. Some writers give in fact drug addiction the same meaning as substance dependence, others for example provide drug addiction a narrower meaning which excludes drugs without evidence of tolerance or withdrawal symptoms. Definition Drug addiction is a pathological or abnormal condition which arises due to frequent drug use. The disorder of addiction involves the progression of acute drug use to the development of drug-seeking behavior, the vulnerability to relapse, and the decreased, slowed ability to respond to naturally rewarding stimuli. The Diagnostic and Statistical Manual of Mental Disorders (DSM-IV) has categorized three stages of addiction: preoccupation/anticipation, binge/intoxication, and withdrawal/negative affect. These stages are characterized, respectively, everywhere by constant cravings and preocc-upation with obtaining the substance; using more of the substance than necessary to experience the intoxicating effects; and experiencing tolerance, withdrawal symptoms, and decreased motivation for normal life activities. By the American Society of Addiction Medicine definition, drug addiction differs from drug dependence and drug tolerance.
- Ilana Belle Glass(Author)
- 2016(Publication Date)
- Taylor & Francis(Publisher)
The original description of the alcohol dependence syndrome (Edwards and Gross, 1976) emphasized that the observable phenomena were often, but not always, clustered together. Further, this empirical description did not imply any particular underlying cause. Although the original description referred specifically to alcohol dependence, this has subsequently been expanded to include other drugs. Seven elements of the syndrome were identified, each of which may be subject to patho-plastic influences. In other words, their expression may be coloured by personality and cultural factors. Some later commentators have made a distinction between ‘physical’ and ‘psychological’ dependence. This arbitrary distinction was not made in the original description of the syndrome and underestimates the frequent cooccurrence of physical and psychological symptoms.Increased tolerance to the drug This refers to the observation that with repeated doses the drug produces less effect or, alternatively, that increased quantities of the drug are required to produce the same effect. The mechanisms which underlie tolerance will be described in greater detail in later chapters, but it may be best regarded as a form of homeostatic response. Clinically an escalation in the quantity of drug consumed per unit time is evidence of such a reduced sensitivity. The severely dependent person is able to tolerate doses of the drug often greater than that which would cause death in the non-dependent. Different drugs vary widely in the rate at which tolerance develops. Significant tolerance to alcohol may take many years to develop, compared to a more rapid development in the case of opiates and cocaine. Tolerance generally continues to increase over time, but in the case of alcohol, tolerance can decline in the later stages of the syndrome.Repeated withdrawal symptoms
eBook - PDFWiley Concise Guides to Mental Health
Substance Use Disorders
- Nicholas R. Lessa, Walter F. Scanlon, Irving B. Weiner(Authors)
- 2006(Publication Date)
- Wiley(Publisher)
Current protocols for the detoxi- fication of specific mood-altering substances as well as opioid maintenance ther- apies currently being used will also be reviewed. Physiological dependence is usually characterized by the symptoms of toler- ance and withdrawal. Tolerance is characterized by the following: 1. A need for markedly increased amounts of the substance to achieve intox- ication or the desired effect. 2. Markedly diminished effect with continued use of the same amount of the substance (APA, 2000, p. 197). Withdrawal is characterized by the following: 1. The development of a substance-specific syndrome due to the cessation of (or reduction in) substance use that has been heavy and prolonged. 2. The substance-specific syndrome causes clinically significant distress or impairment in social, occupational, or other important areas of function- ing. 3. The symptoms are not due to a general medical condition and are not better accounted for by another mental disorder (APA, 2000, p. 202 ). The symptoms of withdrawal are, minimally, physically and psychologically un- comfortable and, at worst, potentially life-threatening. Physiological dependence is 89 CHAPTER 5 a medical condition with a clear biological basis. Consequently, the assessment and treatment of withdrawal is medically based and may require either inpatient or outpatient detoxification in order to achieve stabilization. Clinicians in the field with little detoxification experience often view the process with trepidation. Hopefully, this chapter will ease the fear about the process of detoxification. A Biological Understanding of Intoxication To understand the process of intoxication, one must get a basic understanding of how drugs affect the brain. Much of this discussion is taken directly from the National Institute on Drug Abuse’s (NIDA) slide presentation Understanding Drug Abuse and Addiction: What Science Says (NIDA, 2004). Certain parts of the brain govern specific functions of the body.
No longer available |Learn more- (Author)
- 2014(Publication Date)
- Learning Press(Publisher)
______________________________ WORLD TECHNOLOGIES ______________________________ Chapter- 1 Substance Dependence According to the current Diagnostic and Statistical Manual of Mental Disorders (DSM-IV), substance dependence is defined as: When an individual persists in use of alcohol or other drugs despite problems related to use of the substance, substance dependence may be diagnosed. Compulsive and repetitive use may result in tolerance to the effect of the drug and withdrawal symptoms when use is reduced or stopped. This, along with Substance Abuse are considered Substance Use Disorders .... Substance dependence can be diagnosed with physiological dependence, evidence of tolerance or withdrawal, or without physiological dependence. By the American Society of Addiction Medicine definition, drug addiction differs from drug dependence and drug tolerance. It is, both among scientists and other writers, quite usual to allow the concept of drug addiction to include persons who are not drug abusers according to the definition of the American Society of Addiction Medicine. The term drug addiction is then used as a category which may include the same persons who, under the DSM-IV, can be given the diagnosis of substance dependence or substance abuse. The terms abuse and addiction have been defined and re-defined over the years. The 1957 World Health Organization (WHO) Expert Committee on Addiction-Producing Drugs defined addiction and habituation as components of drug abuse: Drug addiction is a state of periodic or chronic intoxication produced by the repeated consumption of a drug (natural or synthetic). Its characteristics include: (i) an overpowering desire or need (compulsion) to continue taking the drug and to obtain it by any means; (ii) a tendency to increase the dose; (iii) a psychic (psychological) and generally a physical depen-dence on the effects of the drug; and (iv) detrimental effects on the individual and on society.
- Steven B. Karch, MD, FFFLM, MD, FFFLM, Steven B. Karch(Authors)
- 2007(Publication Date)
- CRC Press(Publisher)
23 CHAPTER 4 Treatment of Withdrawal Syndromes Joanna Banbery, M.B.B.S. The Leeds Addiction Unit, Leeds, U.K. CONTENTS 4.1 Understanding Withdrawal Syndromes .................................................................................. 23 4.1.1 Detoxification ............................................................................................................. 24 4.2 Opiate-Specific Withdrawal Syndrome .................................................................................. 25 4.2.1 Detoxification Using Methadone ............................................................................... 25 4.2.2 Detoxification Using Buprenorphine ......................................................................... 26 4.2.3 Detoxification Using Adrenergic Agonists ................................................................ 28 4.2.4 Naltrexone-Assisted Detoxification ............................................................................ 28 4.3 Stimulant-Specific Withdrawal Syndrome ............................................................................. 28 4.4 Hypnotic and Sedative Withdrawal Syndrome ...................................................................... 30 4.4.1 Management of Withdrawal ....................................................................................... 31 References ........................................................................................................................................ 31 4.1 UNDERSTANDING WITHDRAWAL SYNDROMES A withdrawal syndrome is the constellation of physiological and behavioral changes that are directly related to the sudden cessation (or reduction in use) of a psychoactive drug to which the body has become adapted. The Diagnostic and Statistical Manual of the American Psychiatric Association in its revised fourth edition (DSM-IV-R) 1 requires three criteria to be fulfilled before a diagnosis of substance withdrawal can be made.
eBook - PDFIntroduction to Psychiatry
Preclinical Foundations and Clinical Essentials
- Audrey Walker, Steven Schlozman, Jonathan Alpert(Authors)
- 2021(Publication Date)
- Cambridge University Press(Publisher)
It is worth emphasizing that individuals can meet criteria for having a substance use disorder without developing physiologic tolerance or withdrawal. Typically, individuals having a substance use disorder can recognize negative consequences related to their patterns of substance use, yet substance use persists because of more powerful neurobiological incentives to use substances, either for pleasure/ reward or to experience relief from stress or withdrawal syndromes. These natural incentives frequently override judgment or otherwise interferes with efforts to stop using substances, particularly when access to substances is readily available. It is important to note that substance use disorders occur along a continuum of severity; it is thus possible to have a mild, moderate, or severe substance use disor- der. Moreover, some but not all substance use disorders progress; some individuals have mild problems for many years without developing more serious consequences. Acute Intoxication Individuals acutely under the influence of a substance display recognizable clini- cal signs and symptoms of substance intoxication evident on mental status exam and physical exam. Acute intoxication states are specific to the substance being used (as noted previously) and are described in terms of neurological depressant, stimulant, or hallucinogenic effects. Polysubstance use produces mixed effects; severe medical sequelae (e.g., cardiac arrhythmia, seizure, autonomic instability, respiratory depression) are seen with polysubstance use, high-dose or intravenous substance use, and substance use in medically compromised individuals. Abstinence Syndromes Abstinence syndromes are characteristic of individuals with physiological depend- ence as part of a substance use disorder. With repeated substance use, the brain will
- Gary L. Fisher, Nancy A. Roget, Gary L. Fisher, Nancy A. Roget(Authors)
- 2008(Publication Date)
- SAGE Publications, Inc(Publisher)
Tolerance puts the user at risk for a dangerous and potentially harmful withdrawal of a drug, as well as physical discomfort and pain. No matter the type of tolerance that develops, users must be aware that even though they may be adapting to a certain drug, they are still putting themselves at risk. Maria Theresa Wessel, Jeanne Marie Martino-McAllister, and Elizabeth C. Gallon See also Brain Chemistry and Addiction; Craving; Neurobiology of Addiction; Reverse Tolerance; Substance Dependence; Substance Use Disorders Tolerance ——— 923 Further Readings Burnett, M., & Drake, R. (2005). Evidence-based practices: Shaping mental health services toward recovery. Rockville, MD: Substance Abuse and Mental Health Services Administration, National Mental Health Information Center. Retrieved September 15, 2007, from http://mentalhealth.samhsa.gov/cmhs/communitysupport/ toolkits/cooccurring/workbook/chapter1.asp Goldberg, R. (2003). Drugs across the spectrum (4th ed.). Belmont, CA: Thomson/Wadsworth. Hanson, G. R., Venturelli, P. J., & Fleckstein, A. E. (2006). Drugs and society (8th ed.). Sudbury, MA: Jones & Bartlett. McKim, W. (2003). Drugs and behavior: An introduction to behavioral pharmacology (5th ed.). Upper Saddle River, NJ: Prentice Hall. National Institute on Drug Abuse. (2007). NIDA InfoFacts: Understanding drug abuse and addiction . Retrieved September 15, 2007, from http://www.nida.nih.gov/ Infofacts/understand.html T REATMENT , H ISTORY OF Written records pertaining to addictions to alcohol and other drugs have existed since at least the colonial period in America. Society’s reactions to addiction have varied widely from benign neglect to religious or moral sermonizing to attempts at scientific and med-ical treatments. As addictions take a large toll on the social and economic aspects of the community, treat-ment of addictions in modern America has become a societal imperative as well as part of government pro-gramming and big business.
- Stephen F. Davis, William Buskist, Stephen F. Davis, William F. Buskist(Authors)
- 2007(Publication Date)
- SAGE Publications, Inc(Publisher)
However, before the biochemical processes and subsequent effects can occur, drug-seeking behavior must take place. Drug-seeking behavior, or the use of psychoactive substances, is the focus of this chapter. Whether the substance use is characterized as disor-dered will be a major point of discussion, given that drug-seeking behavior is ubiquitous across time and cultures. Thus, it is important to distinguish between typical and expected patterns of substance use versus more problem-atic behaviors, up to and including substance abuse and dependence. According to the Diagnostic and Statistical Manual of Mental Disorder , Fourth Edition, Text Revision ( DSM-IV-TR ; American Psychiatric Association [APA], 2000), substance abuse is characterized by the repeated use of a drug despite evidence of recurrent and significant negative consequences of drug seeking, such as damage to bodily organs (e.g., liver, brain), occupational impair-ments (e.g., absenteeism, being fired), legal difficul-ties (e.g., multiple DUI convictions), and interpersonal problems (e.g., family estrangement, divorce). Substance dependence involves many of these consequences plus the added features of tolerance , withdrawal , and compulsive drug taking (APA, 2000). Tolerance means that the sub-stance user needs to take increasingly greater amounts of the drug to achieve the desired effects, whereas with-drawal suggests there is a maladaptive pattern of behavior, physiology, and cognition when the user stops taking the substance. In addition to tolerance and withdrawal, the compulsive drug-seeking behavior becomes a major focus of a person’s life (acquiring, using, recovering), which often includes several unsuccessful attempts to cut down or quit and some acknowledgment that it is causing sig-nificant problems in several areas of functioning. Indeed,
eBook - PDFTreating Addictions
The Four Components
- An-Pyng Sun(Author)
- 2018(Publication Date)
- Routledge(Publisher)
For example, only people with heavy and prolonged use of alcohol may develop withdrawal symp- toms once they cease or reduce alcohol consumption, as their bodies have adapted to the presence of alcohol (American Psychiatric Association [APA], 2013). Also, substances in the categories of central nervous systems depressants or “downers,” like alcohol, sedatives, hypnotics, anxiolytics, and 248 PHARMACOTHERAPY opioids are likely to have common physical withdrawal symptoms (APA, 2013). On the other hand, although withdrawal symptoms may also hap- pen to central nervous system stimulants (such as amphetamines and cocaine), tobacco, and cannabis, their signs and symptoms tend to be less apparent (APA, 2013). In addition, not everyone who shows withdrawal symptoms will have severe withdrawal symptoms; only a small portion of individuals among those with withdrawal symptoms will have severe symptoms. Withdrawal is uncomfortable and can be dangerous (Mee-Lee et al., 2013). To take alcohol as an example, the diagnosis of alcohol withdrawal disorder requires at least 2 of the 8 criteria—“autonomic hyperactivity” (e.g., sweating, pulse rate > 100 bpm); “increased hand tremor”; “insomnia”; “nausea or vomiting”; “transient visual, tactile, or auditory hallucinations or illusions”; “psychomotor agitation”; “anxiety”; and “generalized tonic- clonic seizures” (APA, 2013, p. 499). Alcohol withdrawal symptoms usually occur “within several hours” to “a few days” after a person stops or decreases alcohol use. However, protracted withdrawal symptoms, such as lower intensities of anxiety, autonomic dysfunction, and insomnia may follow acute withdrawal and last for 3–6 months. The opioid withdrawal symptoms may not be as potentially fatal as the alcohol withdrawal syn- drome (Gordon & Dahl, 2011), but they can be extremely uncomfortable and painful.
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