dopamine question to liesagain
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dopamine question to liesagain
I kinda highjacked meggymegos thread so thought i'd start a new one instead
okay liesagain what you put in that thread about dopamine makes a lot of sense to me and i've thought that dopamine is what my son was craving in all of his drug use and in fact the crazy behavior. It makes me wonder what ways an addict can find healthy avenues to increase dopamine or become more adjusted to normal levels. Is that just a matter of time?
Also do you or anyone else know the correlation between adrenaline and dopamine?
I'm sending him to stay with my brother for a couple of weeks after he gets out of rehab and that's a huge reason - my brother is very sports oriented and when younger did some extreme sports and i think its for the same rush but my brothers way is a lot more healthy. (no he wont do extreme sports with him but will do some thrilling things). I was hoping that my brother could show him that there are exciting things in life that we can get pleasure from.
okay liesagain what you put in that thread about dopamine makes a lot of sense to me and i've thought that dopamine is what my son was craving in all of his drug use and in fact the crazy behavior. It makes me wonder what ways an addict can find healthy avenues to increase dopamine or become more adjusted to normal levels. Is that just a matter of time?
Also do you or anyone else know the correlation between adrenaline and dopamine?
I'm sending him to stay with my brother for a couple of weeks after he gets out of rehab and that's a huge reason - my brother is very sports oriented and when younger did some extreme sports and i think its for the same rush but my brothers way is a lot more healthy. (no he wont do extreme sports with him but will do some thrilling things). I was hoping that my brother could show him that there are exciting things in life that we can get pleasure from.
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Hey Winnie, I moderate on a drug-specific forum (methamphetamines) and one of our other moderators there wrote an article on methamphetamine and dopamine. You might be interested in reading it:
Dopamine, Methamphetamines, and You
First things first -- What does dopamine do anyway?
1) Dopamine is critical to the way the brain controls our movements. Not enough dopamine -- can't move, or control our movements well. Too much dopamine? Uncontrollable/subconscious movements (like picking, tapping, repetitive moments, jerking, twitching). Remember that the heart is a muscle, too, and too much dopamine will result in increased pulse and blood pressure.
2) Dopamine controls the flow of information from other areas of the brain, especially memory, attention and problem-solving tasks. This becomes important when we talk about amphetamine-induced psychosis that is common in meth abusers.
3) When dopamine is released it provides feelings of enjoyment and reinforcement to motivate us to do, or continue doing, certain activities. Dopamine is released by naturally rewarding experiences such as food and sex. This pre-programmed reward system makes sure that people do eat, do desire to procreate, and basically survive. Without enough dopamine, people feel the opposite of enjoyment and motivation -- they feel fatigued and depressed, and experience a lack of drive and motivation.
How do brain chemicals like Dopamine work?
Brain chemicals, including Dopamine, are stored in cells, which you can think of like barrels full of that chemical. When something occurs like a good meal or great sex the brain pours out some dopamine from the dopamine barrels into an open space in the brain called a synapse. It floats around there. Think of the synapse like a street, and dopamine is like little cars driving around aimlessly on the street.
Across the street (not far) from the barrels of dopamine are Dopamine receptors. These receptors have little parking spaces on them that only fit Dopamine (or a substance VERY similar in chemical shape to Dopamine) into them, like a lock and key. As the Dopamine floats around in the synapse, it finds parking spaces at Dopamine receptors, and "plugs in" to the receptors. THIS is the point where we feel good, when the Dopamine is parked in a receptor's parking space. There are, however, a limited number of receptors with "Dopamine only parking" available, and each receptor has a limited number of parking spaces. So some of the dopamine may not be able to find a place to park.
When all the parking spaces are taken, the remaining dopamine that didn't find a place to park is normally recycled. There are "reuptake molecules" that do this -- think of them like tow trucks. They find the extra dopamine, and tow it back to the barrels of Dopamine so that it can be re-used the next time. After some time has passed, the receptors release the Dopamine that was parked in their parking spaces, and the tow trucks take those Dopamine molecules back to the barrel too.
The brain has a safety-check system that will destroy any excess Dopamine that isn't in a parking space, and didn't get picked up by the tow truck. There are special chemicals in our brains that will break down this extra dopamine. Think of this like the toxic waste crew coming in and sweeping up the street.
As a last resort, after repeated long-term over-stimulation, the brain will shut down Dopamine receptors so that nothing can park there ever again. Think of this like the demolition team coming in and permanently barricading off the driveways.
This is your brain on Meth!
So now that we have a basic understanding of how things work normally, I'll try to explain how things work when meth is ingested.
When someone eats, snorts, injects, or otherwise gets meth into their system, meth stimulates those barrels of Dopamine to pour out Dopamine. Meth continues to tell the cells to pour out dopamine until the body can break down the meth, which is typically 12 hours or so.
So Dopamine is poured out into the synapse (street) and finds parking spaces at dopamine receptors and makes the user feel high.
But meth is a tricky little chemical. It is shaped closely enough to Dopamine that the tow trucks get confused, and pick up meth thinking that it is dopamine. So the tow trucks are busy driving around hijacked by meth molecules leaving the extra Dopamine molecules floating around in the street (synapse). Well... that means the toxic waste crew comes in and destroys that dopamine that did not get recycled. So for the 12 hours or so it takes for the body to break down the meth, it is also spending that time destroying dopamine.
As long as the user keeps ingesting more meth, this process continues until there is not enough dopamine left to feel high from. When the user finally stops using, and the brain breaks down the meth molecules, the recycle trucks try to salvage what dopamine there is left, while the user crashes.
The end result of a "run" or "binge" on meth is a marked decrease in the amount of dopamine left in the brain. This leaves the user feeling exhausted, hungry, depressed, possibly suicidal and definitely unmotivated. They are literally suffering from a brain chemical imbalance. Self-inflicted mental illness.
How can the brain ever be normal again?
Well, luckily, the human body is pretty resilient. We do have the ability to make replacement dopamine. However, the body was not designed to need to do this in large quantities or in quick supplies. So we don't have a mass-production plant making dopamine. It's a 3 to 4 step process, too.
The process: Phenylalanine --> Tyrosine -->L-dopa --> Dopamine
Phenylalanine is the first "pre-cursor". It can be found in the following foods: soybean protein, frozen tofu, dried and salted cod, shellfish, lean meat, organ meat, skin-free chicken, cheese, milk, eggs, many seeds (watermelon, fenugreek, roasted soybean nuts), and chocolate. Equal artificial sweetener also contains Phenylalanine. The body can turn Phenylalanine into Tyrosine.
Tyrosine can also be found in food. This would eliminate the need for the body to synthesize it from Phenylalanine. One step closer to dopamine! Meat, dairy, eggs as well as almonds, avocados and bananas are good sources of Tyrosine.
From there, the body will convert Tyrosine into L-Dopa, and then on to Dopamine (and other neurotransmitters like norepinephrine).
So... to replace dopamine destroyed while high on meth, the recovering user must eat sources of Phenylalanine or Tyrosine.
To aid the body in making Dopamine, the person can use what dopamine they DO have left as often as possible. This tells the body that they need more of it. While you sleep, you use very little dopamine. Exercising, even just a walk around the block will use dopamine (remember, it controls movement). So setting a reasonable sleep schedule, and trying to get some exercise will help speed up recovery from Self-inflicted Dopamine Destruction (aka meth addiction)!
Be patient -- remember, we weren't designed to waste dopamine, we were supposed to be recycling it. The process of replenishing dopamine takes months. Studies show that recovering meth addicts who have abstained from meth use have about 80% of normal dopamine levels after 18 months of abstinence. This WILL be a long battle. It CAN be won.
What about the receptors that were destroyed?
Well, good news again. Even though those receptors can never heal or recover, the brain is able to use existing receptors and find new pathways to accomplish the same results. Some receptors will even get a home equity loan and build on extra parking spaces!
Are there any medicines that can help?
A doctor should always be consulted and included on any medication treatment for a recovering user. Many recovering addicts have found Wellbutrin (Bupropion) to be helpful after a few months of clean time. What Wellbutrin does is block some (not all) of the tow trucks for a little while so that the dopamine the person has left can be more effective. It does not, however, stimulate the barrels to pour out dopamine. The person has to have enough dopamine in their brain before Wellbutrin can help.
Health stores do carry supplements of Phenylalanine and Tyrosine. A recovering addict who finds it difficult to eat enough protein may benefit from a supplement. Again -- consult your doctor first.
Lori Pate
B.A Psychology
University of Texas at Austin
Dopamine, Methamphetamines, and You
First things first -- What does dopamine do anyway?
1) Dopamine is critical to the way the brain controls our movements. Not enough dopamine -- can't move, or control our movements well. Too much dopamine? Uncontrollable/subconscious movements (like picking, tapping, repetitive moments, jerking, twitching). Remember that the heart is a muscle, too, and too much dopamine will result in increased pulse and blood pressure.
2) Dopamine controls the flow of information from other areas of the brain, especially memory, attention and problem-solving tasks. This becomes important when we talk about amphetamine-induced psychosis that is common in meth abusers.
3) When dopamine is released it provides feelings of enjoyment and reinforcement to motivate us to do, or continue doing, certain activities. Dopamine is released by naturally rewarding experiences such as food and sex. This pre-programmed reward system makes sure that people do eat, do desire to procreate, and basically survive. Without enough dopamine, people feel the opposite of enjoyment and motivation -- they feel fatigued and depressed, and experience a lack of drive and motivation.
How do brain chemicals like Dopamine work?
Brain chemicals, including Dopamine, are stored in cells, which you can think of like barrels full of that chemical. When something occurs like a good meal or great sex the brain pours out some dopamine from the dopamine barrels into an open space in the brain called a synapse. It floats around there. Think of the synapse like a street, and dopamine is like little cars driving around aimlessly on the street.
Across the street (not far) from the barrels of dopamine are Dopamine receptors. These receptors have little parking spaces on them that only fit Dopamine (or a substance VERY similar in chemical shape to Dopamine) into them, like a lock and key. As the Dopamine floats around in the synapse, it finds parking spaces at Dopamine receptors, and "plugs in" to the receptors. THIS is the point where we feel good, when the Dopamine is parked in a receptor's parking space. There are, however, a limited number of receptors with "Dopamine only parking" available, and each receptor has a limited number of parking spaces. So some of the dopamine may not be able to find a place to park.
When all the parking spaces are taken, the remaining dopamine that didn't find a place to park is normally recycled. There are "reuptake molecules" that do this -- think of them like tow trucks. They find the extra dopamine, and tow it back to the barrels of Dopamine so that it can be re-used the next time. After some time has passed, the receptors release the Dopamine that was parked in their parking spaces, and the tow trucks take those Dopamine molecules back to the barrel too.
The brain has a safety-check system that will destroy any excess Dopamine that isn't in a parking space, and didn't get picked up by the tow truck. There are special chemicals in our brains that will break down this extra dopamine. Think of this like the toxic waste crew coming in and sweeping up the street.
As a last resort, after repeated long-term over-stimulation, the brain will shut down Dopamine receptors so that nothing can park there ever again. Think of this like the demolition team coming in and permanently barricading off the driveways.
This is your brain on Meth!
So now that we have a basic understanding of how things work normally, I'll try to explain how things work when meth is ingested.
When someone eats, snorts, injects, or otherwise gets meth into their system, meth stimulates those barrels of Dopamine to pour out Dopamine. Meth continues to tell the cells to pour out dopamine until the body can break down the meth, which is typically 12 hours or so.
So Dopamine is poured out into the synapse (street) and finds parking spaces at dopamine receptors and makes the user feel high.
But meth is a tricky little chemical. It is shaped closely enough to Dopamine that the tow trucks get confused, and pick up meth thinking that it is dopamine. So the tow trucks are busy driving around hijacked by meth molecules leaving the extra Dopamine molecules floating around in the street (synapse). Well... that means the toxic waste crew comes in and destroys that dopamine that did not get recycled. So for the 12 hours or so it takes for the body to break down the meth, it is also spending that time destroying dopamine.
As long as the user keeps ingesting more meth, this process continues until there is not enough dopamine left to feel high from. When the user finally stops using, and the brain breaks down the meth molecules, the recycle trucks try to salvage what dopamine there is left, while the user crashes.
The end result of a "run" or "binge" on meth is a marked decrease in the amount of dopamine left in the brain. This leaves the user feeling exhausted, hungry, depressed, possibly suicidal and definitely unmotivated. They are literally suffering from a brain chemical imbalance. Self-inflicted mental illness.
How can the brain ever be normal again?
Well, luckily, the human body is pretty resilient. We do have the ability to make replacement dopamine. However, the body was not designed to need to do this in large quantities or in quick supplies. So we don't have a mass-production plant making dopamine. It's a 3 to 4 step process, too.
The process: Phenylalanine --> Tyrosine -->L-dopa --> Dopamine
Phenylalanine is the first "pre-cursor". It can be found in the following foods: soybean protein, frozen tofu, dried and salted cod, shellfish, lean meat, organ meat, skin-free chicken, cheese, milk, eggs, many seeds (watermelon, fenugreek, roasted soybean nuts), and chocolate. Equal artificial sweetener also contains Phenylalanine. The body can turn Phenylalanine into Tyrosine.
Tyrosine can also be found in food. This would eliminate the need for the body to synthesize it from Phenylalanine. One step closer to dopamine! Meat, dairy, eggs as well as almonds, avocados and bananas are good sources of Tyrosine.
From there, the body will convert Tyrosine into L-Dopa, and then on to Dopamine (and other neurotransmitters like norepinephrine).
So... to replace dopamine destroyed while high on meth, the recovering user must eat sources of Phenylalanine or Tyrosine.
To aid the body in making Dopamine, the person can use what dopamine they DO have left as often as possible. This tells the body that they need more of it. While you sleep, you use very little dopamine. Exercising, even just a walk around the block will use dopamine (remember, it controls movement). So setting a reasonable sleep schedule, and trying to get some exercise will help speed up recovery from Self-inflicted Dopamine Destruction (aka meth addiction)!
Be patient -- remember, we weren't designed to waste dopamine, we were supposed to be recycling it. The process of replenishing dopamine takes months. Studies show that recovering meth addicts who have abstained from meth use have about 80% of normal dopamine levels after 18 months of abstinence. This WILL be a long battle. It CAN be won.
What about the receptors that were destroyed?
Well, good news again. Even though those receptors can never heal or recover, the brain is able to use existing receptors and find new pathways to accomplish the same results. Some receptors will even get a home equity loan and build on extra parking spaces!
Are there any medicines that can help?
A doctor should always be consulted and included on any medication treatment for a recovering user. Many recovering addicts have found Wellbutrin (Bupropion) to be helpful after a few months of clean time. What Wellbutrin does is block some (not all) of the tow trucks for a little while so that the dopamine the person has left can be more effective. It does not, however, stimulate the barrels to pour out dopamine. The person has to have enough dopamine in their brain before Wellbutrin can help.
Health stores do carry supplements of Phenylalanine and Tyrosine. A recovering addict who finds it difficult to eat enough protein may benefit from a supplement. Again -- consult your doctor first.
Lori Pate
B.A Psychology
University of Texas at Austin
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Freedom....................thank you for sharing that info.
I was recently trying to explain this to my daughter whos 20..........and cant grasp the addiction and thinks its a matter of will.
Shes a really bright girl so I figured I could explain it from a scientific viewpoint .........I did at least I tried......not at all as clearly and easy to understand as Lori Pate did.
but it helped her alot to be able to view her stepfathers addiction in a scientific manner rather than from the emotional and personal perspective
For me, its important for the children to understand addiction isnt about love, how much we love the addict or how much they love us. Its Never my intention to EXCUSE them but there truely is a mental/physical/chemical and psychological reason for addiction
It is my personal belief that it is important to grasp the disease concept of addiction in order to help elievate or minimize feelings of guilt for the family
Thanks again
I was recently trying to explain this to my daughter whos 20..........and cant grasp the addiction and thinks its a matter of will.
Shes a really bright girl so I figured I could explain it from a scientific viewpoint .........I did at least I tried......not at all as clearly and easy to understand as Lori Pate did.
but it helped her alot to be able to view her stepfathers addiction in a scientific manner rather than from the emotional and personal perspective
For me, its important for the children to understand addiction isnt about love, how much we love the addict or how much they love us. Its Never my intention to EXCUSE them but there truely is a mental/physical/chemical and psychological reason for addiction
It is my personal belief that it is important to grasp the disease concept of addiction in order to help elievate or minimize feelings of guilt for the family
Thanks again
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Freedom great article - i really like that it shows foods that can help. i'm a strong believer in diet and holistic healing.
Cynical - thank you for that too - i'm a huge science nut so that's very interesting what the different drugs do.
I am a bit hopeful that if he stops while he's still young that his brain can recover. I know there was a mom in drug court who said that her brain is no longer able to make dopamine on its own because of the years of crack use and she has to take meds for it. She was clean but did not seem like a very happy woman. She said it was hell to go through life like that.
Cynical - thank you for that too - i'm a huge science nut so that's very interesting what the different drugs do.
I am a bit hopeful that if he stops while he's still young that his brain can recover. I know there was a mom in drug court who said that her brain is no longer able to make dopamine on its own because of the years of crack use and she has to take meds for it. She was clean but did not seem like a very happy woman. She said it was hell to go through life like that.
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Excellant points Anvil - besides in the end its up to him to decide what he wants to do. I do still think its a good idea for him to see there is fun in the world that doesnt include drugs so i still want him to stay with my brother a little while. he is a teenage boy and even healthy ones love excitement. besides my brother is the best man I've ever known so the influence will be good for him.
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My brother will do the fishing thing too but he'll probably take him out somewhere in a canoe on the ocean to do it. he's a funny man. I visited them over the 4th when his families wife was all there. the other adults all sat around drinking the whole weekend but he and his wife (and me) were out playing on the beach, swimming, canoeing - just having fun. i found it interesting how the next day he was up bright and early going on a bike ride while they were all taking asprin and nursing their hangovers. He just smiles at them and says i'm off for more fun.
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Originally Posted by winnie12 
Excellant points Anvil - besides in the end its up to him to decide what he wants to do. I do still think its a good idea for him to see there is fun in the world that doesnt include drugs so i still want him to stay with my brother a little while. he is a teenage boy and even healthy ones love excitement. besides my brother is the best man I've ever known so the influence will be good for him.
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Winnie I am sure your son can come back and his brain will heal and become healthy.
After 24 years of drinking and drugging 22 of it in addiction phase mine did. I have a neurologist that I see regularly because of my neuropathy problems. Every time he does a brain scan he comments on and shows me how there are many areas of my brain that are working that really should not be and that there are parts of my brain not working where it should be. He tells me he is seeing this more and more in recovered addicts.
He is very well known in the field of MS and is now working more with those addicted. I literally grew 'new pathways' and as far as he is concerned my brain looks pretty darn good, lol today.
I think it is an EXCELLENT idea that your brother is going to work with your son when he gets out ................................... give him some new outlets to pursue.
Freedom thank you for posting that. I copied it, pasted it, and have printed out a copy. That is something I definitely want to pass on.
Winnie keeping you and your family in my prayers. It will be rough for your son, learning new things, becoming more involved in his diabetes, etc Exercise and sports will also affect his blood sugar levels. I know as I started walking more and working with my dogs more my bs levels went all over the place for a while but have it back in control again by eating small, very small meals 6 times a day and each meal is equal carbs and proteins.
Sounds like you have some semblance of a plan in place, however, don't forget it is still up to him, and I know that is hard.
Love and hugs,
After 24 years of drinking and drugging 22 of it in addiction phase mine did. I have a neurologist that I see regularly because of my neuropathy problems. Every time he does a brain scan he comments on and shows me how there are many areas of my brain that are working that really should not be and that there are parts of my brain not working where it should be. He tells me he is seeing this more and more in recovered addicts.
He is very well known in the field of MS and is now working more with those addicted. I literally grew 'new pathways' and as far as he is concerned my brain looks pretty darn good, lol today.
I think it is an EXCELLENT idea that your brother is going to work with your son when he gets out ................................... give him some new outlets to pursue.
Freedom thank you for posting that. I copied it, pasted it, and have printed out a copy. That is something I definitely want to pass on.
Winnie keeping you and your family in my prayers. It will be rough for your son, learning new things, becoming more involved in his diabetes, etc Exercise and sports will also affect his blood sugar levels. I know as I started walking more and working with my dogs more my bs levels went all over the place for a while but have it back in control again by eating small, very small meals 6 times a day and each meal is equal carbs and proteins.
Sounds like you have some semblance of a plan in place, however, don't forget it is still up to him, and I know that is hard.
Love and hugs,
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Originally Posted by winnie12
Freedom, I would have LOVED to send my son to one of those but they dont take diabetics.
You know, he has one terrific mother, and I'm willing to bet that if he really grabs hold of recovery with both hands, he's inherited his mother's tenacity and strength, and will use that to his advantage.
:ghug :ghug
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Originally Posted by laurie6781
Exercise and sports will also affect his blood sugar levels.
I remember when he was first diagnosed and started on insulin - that kid ate 10 times a day - I never left the kitchen just went from one meal to the next. He gained 30 lbs in two weeks and grew two inches. i've never seen anything like it but basically his body had been starving for so long that once it could absorb the blood sugar he went into an eating frenzy and grew right before my eyes. I can always tell when something is up with his control or using because he'll immediately start loosing weight.
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(((Winnie)))
I was an "adrenaline junkie". When I was a nurse, I thrived in the areas where I got a "rush"...ER/ICU...the sicker the patients, the better I was. I guess it's no surprise I got hooked on crack, but didn't get "hooked" to the opiates when I was abusing them.
I NEVER thought I'd be happy not having that "rush" in my life, but I am. Sure, I still get a thrill when something happens and I'm pushed into overdrive...I just don't LOOK for it. Great if it comes along, but I'm pretty darned happy with my calm life, these days.
As far as how long, well, I spent 12 years as a nurse, and um, quite a few using drugs, only 2-3 with the crack, but more with the other stuff. Yes, at first my life seemed "boring", but it didn't really take long, at all, to where I enjoyed the calm in my life.
Hugs and prayers!
Amy
I was an "adrenaline junkie". When I was a nurse, I thrived in the areas where I got a "rush"...ER/ICU...the sicker the patients, the better I was. I guess it's no surprise I got hooked on crack, but didn't get "hooked" to the opiates when I was abusing them.
I NEVER thought I'd be happy not having that "rush" in my life, but I am. Sure, I still get a thrill when something happens and I'm pushed into overdrive...I just don't LOOK for it. Great if it comes along, but I'm pretty darned happy with my calm life, these days.
As far as how long, well, I spent 12 years as a nurse, and um, quite a few using drugs, only 2-3 with the crack, but more with the other stuff. Yes, at first my life seemed "boring", but it didn't really take long, at all, to where I enjoyed the calm in my life.
Hugs and prayers!
Amy
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oh yeah - anvil i know what you mean. high bs my son will just go into a rage and i actually cannot tell the difference between my son with a low bs or my son drunk because he acts the same exact way. i always hold opinion till i test him (of course if he's drunk usually getting close enough to test his bs will mean his oh so lovely breath will give it all away). its like living with someone who is bi-polar - much more work dealing with the emotions then i ever imagined. we do have one rule that i strongly enforce and that is that we never argue unless he tests his bs - if his bs is high he has to take some insulin and wait 30 minutes before we continue - usually by that time he comes and says sorry dont know why i was so upset. i dont hold this against him since it is medical but do explain that not everyone is going to forgive him for this behavior so he has to learn to take care of himself. he doesnt remember all of it - blacks out when its too high or too low. he'll just snap to after we've given him insulin or food and wonder why is everyone staring at him.
lordy he just had to throw addiction on top of all of this craziness we already had didnt he - little smuck.
lordy he just had to throw addiction on top of all of this craziness we already had didnt he - little smuck.
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the thing with a diabetic drinking isnt so much the sugar - that just makes them go high temporarily. what the danger is is that the liver stops processing anything but the alcohol. when your blood sugar goes low the liver is supposed to release some sugar but it cant because its so busy with the alcohol. A healthy person would be okay with this because their body naturally releases the proper amount of insulin but the diabetic has injected insulin and so they have too much in their system and no sugar for it to attach to. This means you just keep going lower and lower and will eventually end up in a coma. Ever noticed the next day after you drink how you'll crave sweets? that's why.
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Originally Posted by Freedom1990
When someone eats, snorts, injects, or otherwise gets meth into their system, meth stimulates those barrels of Dopamine to pour out Dopamine. Meth continues to tell the cells to pour out dopamine until the body can break down the meth, which is typically 12 hours or so.
So Dopamine is poured out into the synapse (street) and finds parking spaces at dopamine receptors and makes the user feel high.
So Dopamine is poured out into the synapse (street) and finds parking spaces at dopamine receptors and makes the user feel high.
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Wellbutrin (Zyban, bupropion) is a weak dopamine effector. That's why it's prescribed for nicotine withdrawal. They're doing clinical studies now to see if it will help with other types of drug withdrawal.
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