Addicts and Alcoholics Continue To Use Not To Get High but Due To Fear of Withdrawal

A recent research study utilizing rats, summarized in ScienceDaily for November 07, 2013, concluded that the reason rats continue to use cocaine is not because they are chasing the cocaine high but to avoid the consequences of a reduction in their levels of cocaine; that is, they continue to use to avoid withdrawal and its negative physical and emotional consequences.

Addicts and alcoholics and those who strive to help them, would probably respond to this study’s conclusions with a loud: “Duh!” Even though the addict or alcoholic may in part be motivated to continue to use because he/she is trying to get “high”, the truth is that most addicts and alcoholics no longer achieve the “high” but use basically due to their fear of withdrawal.

Withdrawal in this context is defined to include the physical signs and symptoms of withdrawal usually associated with abrupt cessation of use of a substance such as cocaine (see below), after chronic use to the point of development of tolerance and tissue dependence, as well as the signs and symptoms of a more subjective nature associated with psychological dependence upon a substance.

Also included within the withdrawal definition is the apprehension felt by the addict or alcoholic facing abstinence and recovery that he/she will now have to face all of the pain and vicissitudes of life without the drug used as a primary coping mechanism for years. The individual will be aware of the fact that recovery will require facing the pain and consequences of active addiction (e.g., harm caused to loved ones), again without his/her drug. Fear of withdrawal as defined is an imposing obstacle to the willingness of an addict or alcoholic to choose abstinence and recovery, and is a powerful motivator to continue to use in the face of overwhelming consequences from such use.

Here is a summary of the phases of cocaine withdrawal, as an example:

Stage One

The “crash” is a part of early withdrawal/recovery. Lasts a week to up to 12 days. Symptoms are opposite of the drug’s stimulant effects: depression, lack of hope; extreme fatigue and lack of energy (anergia); tendency to sleep a lot; be very hungry. Cravings for cocaine occur which are usually not pursued due to the extreme fatigue and anergia.

Stage Two

Lasts 2 weeks to 3 months. Depression continues, with peaks of intense cravings for cocaine which are untriggered. Without support and strong motivation (internal or external), the cravings to use will win out.

Stage Three

Can last 3 months to two years, characterized by anhedonia, a profound pleasurelessness, lack of feelings, boredom, difficulty feeling excitement or pleasure. The anhedonia is caused by a combination of the psychological stress from loss of the use of cocaine (sometimes referred to as a grief reaction as strong as that from the death of a loved one) and the neurochemical dysfunction of the mechanisms in the brain relating to production of feel good chemicals such as dopamine.

Because most alcoholics and addicts will have experienced the extremely unpleasant signs and symptoms of withdrawal from their drug (most do not have 24/7 access to their drugs), the reason for ongoing use is primarily to avoid withdrawal as broadly defined here; it is a good thing to have science confirm this well known truth.

As always, comments are invited. Jan Edward Williams, www.alcoholdrugsos.com, 11/07/2013.