The physical, psychological, emotional and behavioral dimensions of the withdrawal process mean that is length can vary. Each client experiences this process in a unique way and each substance is associated with a particular withdrawal syndrome.
A withdrawal syndrome is the predictable constellation of signs and symptoms following abrupt discontinuation of, or rapid decrease in intake of a substance that has been used consistently over time. The signs and symptoms of withdrawal are usually the opposite of the direct pharmacological effects of the substance (YSAS 2009).
The length of a withdrawal syndrome cannot be precisely defined but reliable estimates can be made. The psychological, emotional and behavioural dimensions of withdrawal are more difficult to define and a definite timeframe difficult to predict. Kenny and colleagues (2009) found that severity of the withdrawal symptoms and duration of the process are influenced by:
- The properties of the substance/s that the young person s withdrawing from (see half life of substances in the drug effects module)
- The level of dependence
- The number of substances being withdrawn from
- Other substances being used during the withdrawal
- Co-occurring physical illness and/or mental health issues
A range of issues can also impact on young people’s engagement with and experience of withdrawal care, including:
- Inadequate family and other social supports
- Transience and unstable living arrangements
- Poverty and an inability to meet basic needs
- Unresolved trauma and emotional dysregulation
- Mental health and behavioral problems that can emerge in the absence of substances
- A general lack of information about what to expect while withdrawing and treatments available
A word on nicotine and caffeine dependence…
The withdrawal process can often be exacerbated by nicotine and caffeine withdrawal. Some young people smoke cigarettes and/or many drink large amounts of coffee and energy drinks. There are also individuals who use tobacco when they are smoking cannabis. The use of these substances and their impact on withdrawal symptoms need to be taken into account. This can begin during assessment and then monitoring can occur during withdrawal care. It may be necessary to consider nicotine replacement therapy for some young people or symptomatic medication where needed.