Experience Of Withdrawal Research Articles

What stops people on long-term opioid substitution from completing treatment?

Purpose Opioid substitution treatment is effective in reducing harm for the person and society. However, the introduction of the recovery agenda has changed treatment philosophy. Associated targets such as successful treatment completions have introduced new expectations from treatment providers and service users. The purpose of this paper is to provide a service user-centred evaluation of underlying reasons that might prevent them from considering completion of treatment. Design/methodology/approach Ten service users who were stable on opioid substitution treatment for more than five years were interviewed face-to-face using a semi-structured format. Detailed inductive coding and thematic analysis of all transcripts was conducted. Findings Most participants expressed fear of change to their treatment and in particular reduction of the prescribed medication, due to past traumatic withdrawal experience, fear of relapse, fear of negative impact on their mental and physical health. Nevertheless all were optimistic about their future lives and were hoping to be able to complete their treatment at some point. A three-month follow-up revealed little change, with most participants not considering changing their medication dose in the future. Practical implications It could be argued that treatment providers, instead of focussing their efforts on stable service users in promoting treatment exit, should focus on new service users, avoiding coercion to treatment aims and rushed detoxifications. Originality/value This small qualitative study confirms results of other recent studies on the same theme and argues for the importance of the quality of the treatment experience of new people accessing treatment.

Binge Eating Disorder and Substance Use Disorder: A Case for Food Addiction

We review literature regarding the symptomatic and neurological similarities between Binge Eating Disorder (BED) and Substance Use Disorder (SUD) in order to make a case for the inclusion of “Food Addiction” (FA) in future versions of the Diagnostic and Statistical Manual of Mental Disorders (DSM). FA is defined by a markedly harmful and addictive cycle of compulsive eating, which requires professional intervention and treatment strategies. We argue that FA is a scientifically sound diagnosis due to the addictive-like compulsive overeating behavior that has major similarities with SUDs. Similarities occur among the symptoms of the disorders, the chemical components within the disorders, and the neurological details related to each of the disorders. Some symptom similarities include the descriptor of consuming “large amounts” of the substance (i.e., food), experience of dependence and withdrawal, and “self-medicating” behavior. We conclude that the compulsive overeating that defines BED is distinctively similar to substance addictions and that this consistent overlap provides reason for FA to be accepted as a diagnosis in the DSM.

Stories of Hell and Healing: Internet Users' Construction of Benzodiazepine Distress and Withdrawal.

Benzodiazepines are a group of drugs used mainly as sedatives, hypnotics, antiepileptics, and muscle relaxants. Consumption is recommended for 2 to 4 weeks only, due to fast onset of dependency and potentially distressing withdrawal symptoms. Few peer-review studies have drawn on the user experiences and language to appreciate firsthand experiences of benzodiazepine withdrawal or discontinuation syndrome. We looked extensively at patient stories of benzodiazepine withdrawal and recovery on Internet support sites and YouTube. Our analysis indicated that users employ rich metaphors to portray the psychologically disturbing and protracted nature of their suffering. We identified seven major themes: hell and isolation, anxiety and depression, alienation, physical distress, anger and remorse, waves and windows, and healing and renewal. By posting success stories, ex-users make known that "healing" can be a long, unpredictable process, but distress does lessen, and recovery can happen.

Behavioral and neural responses to infant and adult tears: The impact of maternal love withdrawal.

The current study examined behavioral and neural responses to infant and adult tears, taking into account childhood experiences with parental love-withdrawal. With functional MRI (fMRI), we measured neural reactivity to pictures of infants and adults with and without tears on their faces in nulliparous women with varying childhood experiences of maternal use of love withdrawal. Behavioral responses to infant and adult tears were measured with an approach-avoidance task. We found that individuals with experiences of love withdrawal showed less amygdala and insula reactivity to adult tears, but love withdrawal did not affect amygdala and insula reactivity to infant tears. During the approach-avoidance task, individuals responded faster to adult tears in the approach condition compared with the avoidance condition, indicating that adult tears facilitate approach behavior. Individuals responded faster to infant tears than to adult tears, regardless of approach or avoidance condition. Our findings suggest that infant tears are highly salient and may, therefore, overrule the effects of contextual and personal characteristics that influence the perception of adult crying. (PsycINFO Database Record

Testosterone reactivity to infant crying and caregiving in women: The role of oral contraceptives and basal cortisol

Several studies have shown that mothers and fathers have significant lower levels of testosterone (T) than non-mothers and non-fathers, and that in men caregiving is related to a decrease in T. To date, only a few studies have examined T in women. We examined T reactivity to a crying infant simulator in 160 women. Use of oral contraceptives (OC), basal cortisol (CORT) levels and childhood experiences of maternal love withdrawal were taken into account. T levels were consistently significantly higher in women not using OC. In women not using OC, high basal CORT was related to higher initial T levels and larger decreases of T during caregiving. No effect of basal CORT was found in women with OC use. Childhood experiences of maternal love withdrawal did not affect T levels. This is the first study to show support for a decrease of T in women while taking care of a crying infant, supporting the Challenge hypothesis and the Steroid/Peptide Theory of Social Bonds.

Withdrawal of Life-Sustaining Treatment from Children: Experiences of Nurses Caring for the Children

Purpose: The purpose of this study was to describe feelings and actions of nurses following withdrawal of life-sustaining treatment from children being cared for by the nurses. Methods: Data were collected by in-depth interviews with 7 nurses from different hospitals where children receiving nursing care had life-sustaining treatment withdrawn. The interviews were conducted from August 2016 to February 2017 when all data were saturated. Interviews lasted 30~90 minutes and were conducted 2~3 times per participant. Data were analyzed using Giorgi’s phenomenological research methodology. Results: The following factors constituted experiences of nurses working in pediatric wards when life-sustaining treatment was withdrawn from children: “agony and conflict in the aspects of care”, “heavy mind and regret for exhausting care”, “intentionally avoiding parents’ sadness”, “comforting sadness in the heart” and “orientation in the role of caring for children undergoing withdrawal of life-sustaining treatment.” Conclusion: Findings indicate that support systems and intervention programs need to be developed so that nurses can understand and wisely deal with experiences of withdrawal of life-sustaining treatment from children who receive care from nurses.

Nicotine Withdrawal Induces Neural Deficits in Reward Processing.

Nicotine withdrawal reduces neurobiological responses to nonsmoking rewards. Insight into these reward deficits could inform the development of targeted interventions. This study examined the effect of withdrawal on neural and behavioral responses during a reward prediction task. Smokers (N = 48) attended two laboratory sessions following overnight abstinence. Withdrawal was manipulated by having participants smoke three regular nicotine (0.6 mg yield; satiation) or very low nicotine (0.05 mg yield; withdrawal) cigarettes. Electrophysiological recordings of neural activity were obtained while participants completed a reward prediction task that involved viewing four combinations of predictive and reward-determining stimuli: (1) Unexpected Reward; (2) Predicted Reward; (3) Predicted Punishment; (4) Unexpected Punishment. The task evokes a medial frontal negativity that mimics the phasic pattern of dopaminergic firing in ventral tegmental regions associated with reward prediction errors. Nicotine withdrawal decreased the amplitude of the medial frontal negativity equally across all trial types (p < .001). Exploratory analyses indicated withdrawal increased time to initiate the next trial following unexpected punishment trials (p < .001) and response time on reward trials during withdrawal was positively related to nicotine dependence (p < .001). Nicotine withdrawal had equivocal impact across trial types, suggesting reward processing deficits are unlikely to stem from changes in phasic dopaminergic activity during prediction errors. Effects on tonic activity may be more pronounced. Pharmacological interventions directly targeting the dopamine system and behavioral interventions designed to increase reward motivation and responsiveness (eg, behavioral activation) may aid in mitigating withdrawal symptoms and potentially improving smoking cessation outcomes. Findings from this study indicate nicotine withdrawal impacts reward processing signals that are observable in smokers' neural activity. This may play a role in the subjective aversive experience of nicotine withdrawal and potentially contribute to smoking relapse. Interventions that address abnormal responding to both pleasant and unpleasant stimuli may be particularly effective for alleviating nicotine withdrawal.

Suicide risk in refugees and asylum seekers

Increasing numbers of individuals forced to leave their home countries in areas of war, conflict, human rights violations and persecution pose a challenge for host countries to meet the mental-health care needs of these individuals. Refugees and asylum-seekers may face unique risk factors for mental disorder before, during, and after their migration leading to suicidality. Experiences of family withdrawal, integration difficulties, and perceived lack of care may contribute to suicide within the refugee populations. Identifying effective treatments and support to minimize the risk especially once the individuals arrive in their new country is key to providing appropriate care. Barriers to mental-health care including lack of knowledge about available resources, communication or language barriers, cultural beliefs about origins and treatment of mental disease, as well as a lack of trust in authority, pose a challenge for health care providers and policy makers.Research has been inconsistent in the findings for the prevalence of mental disorders, suicidal behaviours, and suicide ideation among refugees and asylum seekers. Thus far, research has been limited to small scale, non-randomised, often qualitative analysis. Several studies have found higher rates of mental disorder, whereas others have found a similar prevalence as in the general population, although, Post-Traumatic Stress Disorder has more consistently been found to have a higher prevalence among migrants. The lack of early and thorough exploration of suicidal intent in this population requires large-scale quantitative studies to evaluate the effectiveness and feasibility of current practices in mental-health care and suicide prevention.Disclosure of interestThe author has not supplied his declaration of competing interest.

Marijuana Use Predicts Cannabis Withdrawal in Adolescents: A Model of Psychological Dysregulation

Trait dysregulation further complicates the experience of withdrawal in high frequency marijuana use. Understanding the role of affective, behavioral, and cognitive dysregulation in the perpetuation of substance use can better inform relapse prevention efforts.

Withdrawal experience and possible way-outs from withdrawal behavior in young people

The term NEET (not in employment, education, or training) has been increasingly applied to young people in Europe not engaged in the three systems mentioned. Young people who seclude themselves at home and progress to social withdrawal can be considered a NEET subgroup—the “disengaged.” This phenomenon was first identified in Japan, where such reclusive individuals are referred to as hikikomori, but youth social withdrawal has also been reported in other countries, including South Korea and Hong Kong. Research on youth social withdrawal has mainly focused on describing and identifying contributing factors to this withdrawal behavior. Very few studies have examined the transitional processes from the initial self-seclusion to later help-seeking. Examining the mechanisms behind the engagement process for helping professionals is important to guide social work services for this unique group of young people. We conducted a qualitative study involving semi-structured interviews with 30 socially withdrawn young people in Hong Kong. Thematic analysis conceptualized their social withdrawal processes into three subthemes: private status, de-friending spiral, and suspension of experiences. Three reasons for changing their withdrawal behavior were also identified: rebalancing one’s ideal self with reality, reconnecting with tuned-in people, and regaining momentum in life. This study provides practical implications for social workers to develop approaches to engage withdrawn young people.

The Story of Withdrawals During an Ultra-Trail Running Race: A Qualitative Investigation of Runners’ Courses of Experience

We analyzed the courses of experience of 10 runners who volunteered to describe their experiences of withdrawal during an ultra-trail race. Data collected contained traces of past activities elicited in self-confrontation interviews. Data were coded and compared with identify structures in common sequences. Seven representative sequences were identified: feeling pain; putting meaning to those feelings; adjusting one’s running style; attempting to overcome the problem; other runners’ influences; assessing the situation; and deciding to withdraw. Results showed that disruptive events could cause progressive, cumulative, and varied transformations in runners’ courses of experience that led inevitably to withdrawal. Practical implications for mental preparation and race management are proposed.

Gambaran Self Stigma Penderita HIV/AIDS di Poli Cendana Rumah Sakit Ngudi Waluyo Wlingi

The spread of HIV and AIDS in Indonesia over the last five years is quite high. United Nations AIDS (UNAIDS) even dub Indonesia as an Asia’s country with most spread of HIV/AIDS. However the fear of stigma and discrimination against PLWHA (people living with HIV/AIDS) remains a major obstacle. The purpose of this research was to describe self stigma of HIV/AIDS in poly Cendana Ngudi Waluyo Hospital Wlingi based questionnaire ISMI (Internalized Stigma of Mental Illness) that included a portrait of alienation, acceptance of stereotypes, experience of discrimination, social withdrawal, and rejection of stigma. The samples were 27 people with HIV/AIDS. The results showed that generally self stigma of HIV/AIDS were low 44.4% (12 patients). This result, indicated that the motivation of people living with HIV/AIDS as well as their moral support was instrumental in lowering self-stigma. Recommendations from this study were expected for health care to prevent and overcome self stigma of HIV/AIDS.

Understanding Early Decisions to Withdraw Life-Sustaining Therapy in Cardiac Arrest Survivors. A Qualitative Investigation.

Early withdrawal of life-sustaining therapy contributes to the majority of deaths following out-of-hospital cardiac arrest (OHCA), despite current recommendations for delayed neurological prognostication (≥72 h) after treatment with targeted temperature management. Little is known about clinicians' experiences of early withdrawal of life support decisions in patients with OHCA. To explore clinicians' experiences and perceptions of early withdrawal of life support decisions and barriers to guideline-concordant neurological prognostication in comatose survivors of OHCA treated with targeted temperature management. We conducted qualitative interviews with intensive care unit (ICU) physicians and nurses following withdrawal of life support in comatose patients with OHCA treated with targeted temperature management. The study was carried out across 18 academic and community hospitals participating in a multicenter, stepped-wedge, cluster-randomized controlled trial designed to improve quality-of-care processes for patients after OHCA in Ontario, Canada. We used a focused thematic analysis to capture barriers to guideline-concordant neurological prognostication and used these barriers to identify potentially modifiable issues. The core thematic finding was a high emotional burden of ICU family-team communication in which strong feelings inhibited information transfer and delayed decision making following OHCA. Four subthemes describing sources of communication strain were identified: (1) requests from family members to provide early outcome predictions, (2) incomplete family comprehension of critical care, (3) family requests for early withdrawal of life support based on their understanding of patients' preferences and values, and (4) family-team communication gaps related to prognostic uncertainty. Participants worried that gaps in timely and clear prognostic information contributed to surrogates' perceptions of a poor outcome and to inappropriately early decisions to withdraw life support. Family-team communication difficulties may be an underestimated factor leading to early withdrawal of life support in ICUs for individuals who initially survive OHCA.

Emplotting Hikikomori: Japanese Parents' Narratives of Social Withdrawal.

Hikikomori, often glossed as "social withdrawal," emerged as a sociomedical condition among Japanese youth at the end of the twentieth century, and it continues to fascinate and concern the public. Explanatory frameworks for hikikomori abound, with different stakeholders attributing it to individual psychopathology, poor parenting, and/or a lack of social support structures. This article takes an interpretive approach to hikikomori by exploring parents' narrative constructions of hikikomori children in support group meetings and in-depth interviews. I argue that some parents were able to find hope in hikikomori by 'emplotting' their children's experiences into a larger narrative about onset, withdrawal, and recovery, which helped them remain invested in the present by maintaining a sense of possibility about the future. Contrary to literature that examines hikikomori as an epidemic of isolated individuals, I demonstrate how parents play a key role in hikikomori through meaning-making activities that have the potential to shape their children's experiences of withdrawal.

The adenosinergic system is involved in sensitization to morphine withdrawal signs in rats-neurochemical and molecular basis in dopaminergic system.

RationaleExperimental data informs that not only do the dose and time duration of dependent drugs affect the severity of withdrawal episodes. Previous withdrawal experiences may intensify this process, which is referred as sensitization to withdrawal signs. Adenosine and dopamine (DA) receptors may be involved in this sensitization.ObjectivesRats were continuously and sporadically treated with increasing doses of morphine for 8 days. In rats, sporadically treated with morphine, morphine administration was modified by adding three morphine-free periods. Adenosine agonists were given during each of the morphine-free periods (six injections in total). On the 9th day, morphine was injected. One hour later, naloxone was administered to induce morphine withdrawal signs. Then, the animals were placed into cylinders and the number of jumpings was recorded. Next, the rats were decapitated and brain and brain structures (striatum, hippocampus, and prefrontal cortex) were dissected for neurochemical, molecular, and immunohistochemical experiments within DAergic pathways.ResultsWe demonstrated that previous experiences of opioid withdrawal intensified subsequent withdrawal signs. Adenosine ligands attenuated the sensitization to withdrawal signs. In a neurochemical study, the release of DA and its metabolites was impaired in all structures. Significant alterations were also observed in mRNA and protein expression of DA receptors.ConclusionsResults demonstrate that intermittent treatment with morphine induces alterations in the DAergic system which may be responsible for sensitization to morphine withdrawal signs. Although adenosine ligands attenuate this type of sensitization, they are not able to fully restore the physiological brain status.

Predictors of nicotine withdrawal symptoms: findings from the first randomized smoking cessation trial in a low-income country setting.

To identify predictors of nicotine withdrawal symptoms among smokers who participated in a randomized cessation trial in a low-income country. We analyzed data from 269 smokers who participated in a randomized, placebo-controlled smoking cessation trial conducted in primary healthcare in Aleppo, Syria. All participants received behavioral counseling and were randomized to receive either 6weeks of nicotine or placebo patch and were followed for one year. Throughout the study, lower total withdrawal score was associated with greater education (p=0.044), older age of smoking initiation (p=0.017), lower nicotine dependence (p=0.024), higher confidence in ability to quit (p=0.020), lower reported depression (p<0.001), higher adherence to patch (p=0.026), belief of receiving nicotine patches rather than placebo (p=0.011), and waterpipe use (p=0.047). Lower nicotine dependence, greater educational attainment, higher confidence in ability to quit and waterpipe use predict lower withdrawal severity. Waterpipe smoking may serve as a barrier to smoking cessation efforts in countries where its use is highly prevalent. Further, expectancies about the effects of pharmacotherapy appear to mediate the experience of nicotine withdrawal.

Experience of withdrawal of elosulfase alpha (VIMIZIM) from patients at an LD centre in North West England

Experience of withdrawal of elosulfase alpha (VIMIZIM) from patients at an LD centre in North West England

An Investigation into Suicides Among Bhutanese Refugees Resettled in the United States Between 2008 and 2011.

An increase of Bhutanese refugee suicides were reported in the US between 2009 and 2012. This investigation examined these reported suicides in depth to gain a better understanding of factors associated with suicide within this population. The study employed 14 psychological autopsies to elicit underlying motivations and circumstances for self-inflicted death and to identify potential future avenues for prevention and intervention among refugee communities. Disappointment with current (un)employment, lack of resettlement services and social support, and frustrations with separation from family were believed to contribute to suicidal acts. Suicide within refugee populations may be connected with experiences of family withdrawal, integration difficulties, and perceived lack of care. It is important to assess the effectiveness of improving refugee services on the mental health of migrants. More research is needed in order to better understand, and respond to, suicide in resettled populations.

“Stressing out”: defining severity of cannabis withdrawal symptoms in Australian indigenous inmates

Background: No previous studies have investigated cannabis withdrawal severity in indigenous or incarcerated populations. Aims: We sought to quantify life-time cannabis use, report cannabis withdrawal symptoms and severity, and define the holistic experience of cannabis withdrawal. Methods: Seventy consenting males (18–40 years) from an Australian correctional center were interviewed about lifetime cannabis use and experience of withdrawal upon incarceration. Results: Findings indicate that participants smoked on average 12.3 cones or joints/day (95%CI: 9.5–15.2) for 9.4 years (95%CI: 7.6–11.1). Cannabis withdrawal symptoms most frequently reported were; physical symptoms (52.9%), insomnia (52.9%) and depressed mood (47.1%). The most severe symptoms were insomnia (22.9%), nervousness/anxiety (17.1%) and aggression (14.3%). Analysis further revealed the construct of “stressing out”, defined as a highly anxious state with increased aggression. Conclusions: Insomnia and physical symptoms were the most commonly reported symptoms with insomnia and nervousness/anxiety the most severe. Psychological symptoms were also voiced by this population sample; however, they were less frequent than the combined aggregated physical symptoms of “stressing out”. Implications: The identification of severe withdrawal symptoms, especially aggression, will facilitate identification and treatment to new inmates upon incarceration. The recognition of “stressing out” will enable safety measures and treatments to be prescribed in this setting.

Withdrawal: Expanding a Key Addiction Construct.

Withdrawal is an essential component of classical addiction theory; it is a vital manifestation of dependence and motivates relapse. However, the traditional conceptualization of withdrawal as a cohesive collection of symptoms that emerge during drug deprivation and decline with either the passage of time or reinstatement of drug use, may be inadequate to explain scientific findings or fit with modern theories of addiction. This article expands the current understanding of tobacco withdrawal by examining: (1) withdrawal variability; (2) underlying causes of withdrawal variability, including biological and person factors, environmental influences, and the influence of highly routinized behavioral patterns; (3) new withdrawal symptoms that allow for enhanced characterization of the withdrawal experience; and (4) withdrawal-related cognitive processes. These topics provide guidance regarding the optimal assessment of withdrawal and illustrate the potential impact modern withdrawal conceptualization and assessment could have on identifying treatment targets.