Not Just Physical: Why Addictions with Non-Observable Withdrawal Symptoms Still Need Treatment

The effects of some drugs make it impossible to deny their destructive nature. The sweating, vomiting, and muscle pain of heroin withdrawal or tremors and seizures that can result from sudden discontinuation of alcohol are clear indications that physical dependency has taken hold and is now being violently disrupted. Other drugs, however, do not infiltrate physical systems in the same way and, thus, discontinuation does not produce readily observable withdrawal symptoms. Too often, the absence of physical dependence and physically traumatic withdrawal is taken to indicate that the drug isn’t addictive. For many, this perceived lack of addictive potential is a central component of their drug choice and a part of their own justification for continued drug use; countless marijuana and MDMA/ecstasy users grab onto the myth of non-addictive drugs to deny their own addictions.

Physical dependence and addiction, however, are discrete phenomena that are sometimes, but not necessarily, related; being physically dependent on a substance doesn’t in and of itself indicate that you are addicted—and you can be addicted without being physically dependent. This is because addiction is not a physical illness, but a chronic brain disorder; it is not characterized by the presence or absence of physical phenomena, but by user behavior. As the National Institute on Drug Abuse states, “Addiction is defined as a chronic, relapsing brain disease that is characterized by compulsive drug seeking and use, despite harmful consequences.” As such, observable withdrawal symptoms, while extraordinarily meaningful for treatment, are entirely irrelevant when determining whether or not you are experiencing addiction. Hence, you can become addicted to any psychoactive substance, including those that will never leave you sweating, aching, vomiting, or shaking.

The fact that discontinuation of a substance doesn’t produce physical withdrawal symptoms also doesn’t mean there is no withdrawal at all. As your substance use has escalated, your brain has adapted to its chemically altered state by modulating neurotransmitter activity to account for the presence of drugs. Over time, your brain comes to depend on a constant supply of those drugs to maintain chemical equilibrium, and sudden discontinuation disrupts the delicate balance it has achieved. As a result, you may experience a host of non-observable withdrawal symptoms as your brain struggles to adapt to its new state. These symptoms may include:

• Anxiety and restlessness
• Irritability
• Depression
• Concentration and memory problems

While opiate addicts and alcoholics often fear the physical discomfort of detoxification, people who are addicted to drugs without observable withdrawal symptoms often underestimate the potential trauma of sudden discontinuation, and don’t seek the help they need to get through this difficult time. Too often, users who want to quit don’t have the supports necessary to cope with detox, and resume using to avoid the emotional and cognitive distress of withdrawal.