In the context of substance abuse, tolerance is a
factor in the development of DEPENDENCE, in which
body biochemistry changes in response to the
drug’s presence so that the body depends on the
drug for a particular way of functioning, and in
ADDICTION, in which the drive to use the drug (irre-
spective of dependence) is all-consuming so that
most efforts in daily life focus on obtaining and
using the drug. Dependence and addiction may
have physiologic or psychologic components, or
both; tolerance is physiologic and may occur with-
out dependence or addiction.
Tolerance develops at an unpredictable rate
with psychoactive drugs (drugs that affect the
mind, mood, and emotions) and NARCOTICS. It may
be necessary to wean from, or gradually taper the
DOSAGEof, these drugs so a person may stop taking
them without adverse effects.
See also DETOXIFICATION; ILLICIT DRUG USE; PRE-
SCRIPTION DRUG ABUSE; SUBSTANCE ABUSE TREATMENT;
WITHDRAWAL SYNDROME.
withdrawal syndrome The physical and psycho-
logic symptoms that may occur with DETOXIFICATION
from substance abuse, DEPENDENCE, or ADDICTION.
The symptoms of withdrawal vary, depending on
the substances of dependence and addiction.
Because substance abuse often involves multiple
drugs, there is wide variation in the specific symp-
toms individuals experience during detoxification.
Among the more common symptoms are
- NAUSEAand VOMITING
- shivering or trembling (“the shakes”)
- abdominal cramping or PAIN
- intense cravings for the drugs of abuse
- HALLUCINATION
ALCOHOLwithdrawal, especially from long-term
alcohol abuse, may result in DELIRIUM TREMENS, a
severe and potentially fatal complex of symptoms
that requires medical treatment and monitoring
until the body completely detoxifies from alcohol.
Withdrawal from BARBITURATESalso requires close
medical supervision and usually medications to
relieve withdrawal symptoms; suddenly stopping
barbiturates can result in lethal complications,
resulting from NEUROTRANSMITTERimbalances in the
BRAIN. Withdrawal from STIMULANTS typically
causes profusely runny NOSEbecause stimulants
have a decongestant action through constricting
the BLOODvessels in the nose. Withdrawal from
OPIATES results in sometimes severe coughing
because opiates suppress the COUGH REFLEX; remov-
ing this suppression causes rebound coughing
until opiate receptors re-acclimate.
Doctors typically use medications such as BEN-
ZODIAZEPINESto ease withdrawal symptoms until
detoxification is complete. Subsequent treatment
to maintain SOBRIETY may include medications
such as disulfiram and NALTREXONE for alcohol
addiction and METHADONE, NALTREXONE, or LEVO-
ALPHA ACETYLMETHADOL(LAAM) for narcotic addic-
tion. Many people trying to stop smoking benefit
from NICOTINE REPLACEMENTproducts to wean from
NICOTINEaddiction. When PRESCRIPTION DRUG ABUSE
of NARCOTICS for CHRONIC PAIN relief results in
dependence or addiction, subsequent treatment
incorporates alternative methods of pain relief.
Though withdrawal symptoms end when the sub-
stances of abuse are no longer present in the body,
continued treatment for addiction remains key for
preventing relapse.
See alsoALCOHOLISM; ILLICIT DRUG USE; SMOKING
CESSATION; SUBSTANCE ABUSE PREVENTION; SUBSTANCE
ABUSE TREATMENT.354 Substance Abuse