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The Diagnostic and Statistical Manual of Mental Disorders (DSM-5) describes the 11 criteria that clinicians use to determine whether someone struggles with addiction. One of those criteria is repeated attempts to stop abusing the drug and then relapsing back into substance abuse. For drugs including nicotine, marijuana, alcohol, opioids, cocaine, and benzodiazepines, among many other substances, trying to quit without help increases the risk that the person will relapse and continue abusing drugs. This is because other features of addiction, including intense cravings, uncomfortable withdrawal symptoms, and compulsive behaviors mean that the person cannot control their mental or physical state without help.
Of course, there are stories of people successfully quitting drugs or alcohol cold turkey. The idea that a person can just put down an intoxicating substance and not pick it back up is enticing. However, this continues the longstanding stigma that addiction involves willpower, and a person with strong enough will can just quit abusing a substance. The medical understanding of addiction, however, considers addiction a chronic disease that changes the brain and behaviors. No one just stops having a chronic disease, whether it is addiction, diabetes, hypertension, or asthma.
Instead of stigmatizing substance abuse, it is important to understand how medical professionals approach detox, which is the controlled, monitored process of ending the body’s physical dependence on a substance. The medical detox process manages withdrawal symptoms, which occur as the last dose of the drug is metabolized out of the body and the brain attempts to reach chemical equilibrium on its own. The process can take a few days or a few weeks, depending on how the detox process is handled.
For some people who have not abused a substance for a long time, withdrawal symptoms can be eased with over-the-counter drugs like ibuprofen or moderate exercise. For people who have abused potent drugs for a long time, though, a medication-assisted treatment (MAT) like buprenorphine, naltrexone, or bupropion can offer important, prescription relief from intense cravings and body aches, although the process of tapering off the MAT means detox takes longer.
Withdrawal symptoms from various drugs may include:
Some drugs, like alcohol and benzodiazepines, have life-threatening side effects like hallucinations, high fevers, or seizures, so getting medical attention for this process is essential.
For most other drugs, withdrawal symptoms are uncomfortable, but not life-threatening; however, the discomfort, especially psychologically, can increase the risk of relapsing back into substance abuse.
Psychological and physical discomfort can be alleviated in two main ways: with medical intervention and with support from friends and family.
Once the body’s tolerance to drugs or alcohol has started to lower, relapse is more dangerous than withdrawal symptoms. People who relapse and consume the amount of drugs or alcohol they took before may poison themselves, leading to an overdose. Although relapse is considered part of the chronic disease of addiction, finding ways to prevent relapse or to get the person back into treatment before they overdose must be part of rehabilitation. This is why detox is only the first step in the longer process of recovery from addiction.
Signs of a relapse into substance abuse include:
Quitting substance abuse without help does not work, no matter what urban legends exist. Medical detox and comprehensive behavioral therapy are both key medical interventions to overcoming addiction. In addition, support from friends and family to foster a safe drug-free environment is also crucial to healing.