Understanding Withdrawal Symptoms vs COVID-19 Symptoms and the Best Path to Treatment

During this time of nationwide social distancing and quarantine at home, many of us are hypervigilant about watching for signs of the coronavirus infection. Though some questions remain about the transmission and communicability of this novel viral illness, we have been warned to watch for signs or symptoms that may indicate we have been infected with it. Since the medical community is learning in realtime about crucial details as this emerging crisis threatens to sicken the world’s population, there are still many unknowns.

But if you are quarantined with a family member with a history of drug or alcohol abuse, you may have an additional concern. With access to substances of abuse potentially limited due to current restrictions, the possibility that your loved one will experience substance withdrawal may be increased. When signs of illness appear, you may be wondering whether they should be attributed to withdrawal symptoms vs COVID-19 symptoms, and you may need some help distinguishing between the two. Understanding the most common symptoms of both conditions may be helpful in determining if medical attention is needed.

Understanding Withdrawal Symptoms

When someone abuses drugs or alcohol on a regular basis, they may become both physically and psychologically dependent. Our bodies, seeking homeostasis, incorporate the substance and, over time, grow to depend on its presence for balance. When substance use is abruptly discontinued, a somewhat predictable set of symptoms can be expected within hours or days. Breaking the physical dependency means allowing the substance to be withdrawn from the body and managing the resulting symptoms as the body creates a new normal without it.

The type and intensity of symptoms an individual will experience during drug or alcohol withdrawal depend on several factors. The type of substance or substances used and the amount used each day will affect the nature of the symptoms. In addition, the duration of a person’s substance abuse helps to determine the severity of withdrawal symptoms. Another key factor that may affect substance withdrawal is the mode of administration: intravenous, smoking, snorting, or oral consumption. A person’s medical and mental health profile, as well as their family history and genetics, might also influence the type and severity of withdrawal they will experience.

Examining Withdrawal Symptoms vs COVID-19 Symptoms

As of the spring of 2020, much emphasis has been placed on the primarily respiratory nature of the novel coronavirus. But as we learn more about this unfolding pandemic, our understanding of its symptom presentation is evolving. At the same time, it is important to remember that withdrawal symptoms vary widely from person to person due to many of the aforementioned factors. Let’s look at the most common symptoms and see where overlaps might occur:

Fatigue, Lethargy, or Generalized Lack of Energy

Probably one of the least specific but most pervasive symptoms, fatigue, lethargy, or a lack of energy may occur when the body is busy fighting a battle; this leaves little energy left over for other activities. Generally, this applies to a body fighting off an infection as well as a body detoxifying from substance abuse. Thus fatigue or lethargy is not a good symptom to use to differentiate between substance withdrawal and COVID-19 infection.

Gastrointestinal Upset

GI symptoms including vomiting, diarrhea, and loss of appetite are quite common with substance abuse withdrawal. Until recently, these may have served as a valid differentiating symptom. But a soon-to-be-published journal article discloses that, in a small study of Chinese COVID-19 patients, more than 50% reported digestive symptoms along with the other more commonly reported symptoms of fever, coughing, and breathing difficulties. In this study, 23% of the patients experienced GI symptoms only. Therefore, the presence of GI symptoms cannot be used reliably to decide if a person is experiencing withdrawal or to rule out a COVID-19 infection.

Respiratory Symptoms

A COVID-19 infection is normally characterized by respiratory symptoms, including sore throat, dry cough, and, in some cases, dyspnea or shortness of breath. Within this category, there is tremendous variability and even changes over time. As a symptomatic COVID-19 infection progresses, some degree of respiratory symptomology can likely be expected. The most serious cases may progress to pneumonia and acute respiratory distress that may require intubation and mechanical breathing assistance. It is also true that severe withdrawal symptoms could cause respiratory depression in extreme cases. Respiratory distress is always serious and requires medical intervention regardless of the cause.

Fever

One sign that might help to differentiate the symptoms of substance withdrawal from those of a COVID-19 infection is fever as it is generally associated with infection. Since people experiencing drug or alcohol withdrawal may perceive that they are feverish and may experience sweating and chills, it is important to identify true fever with a thermometer. In some cases, particularly with alcohol withdrawal, fever is possible. By recording the body temperature as measured with a thermometer, you can note and track elevations above the average normal temperature of 98.6°F.  Adults with a fever of 103°F or higher or whose fever lasts more than three days should contact their doctor.

Cravings and Mood Disturbances

Along with the physical symptoms of drug or alcohol withdrawal, people often experience strong cravings. This signal of substance withdrawal would distinguish it from a possible coronavirus infection. Likewise, withdrawal may bring serious mood disturbances or even hallucinations. These red flags should be your cue to consult a medical professional.

It is important to remember that our understanding of the symptoms of COVID-19 infection is steadily evolving as it is a new viral infection. There has been tremendous variability of symptomology documented with a large number of individuals remaining asymptomatic despite testing positive for the virus. As more people around the world experience the infection and more research studies are published, our understanding of how to interpret symptoms will continue to expand.

Unfortunately, people with substance abuse issues may be predisposed to develop COVID-19 since these toxins can weaken the body and damage the immune system. Whenever there is doubt or at the first sign of serious symptoms, getting the input of a medical professional is essential.

Best Treatment Practices in Addiction Medicine

Regardless of whether emerging symptoms lead you to suspect a loved one is experiencing withdrawal symptoms vs COVID-19, or vice versa, you should seek medical advice. What may start out with mild symptoms could intensify to a dangerous situation for your family member. A phone call to their primary care physician or to an addiction recovery specialist can provide information and advise you regarding the next steps. Telemedicine offers an effective alternative to in-person appointments, especially during this period of widespread social distancing and self-quarantine.

It is difficult to predict how withdrawal symptoms will progress. In the worst cases, people may experience seizures, delirium tremens, or even death. Medical management of the detoxification process can be the difference between a potentially dangerous situation and a relatively comfortable, much safer process. Substance abuse treatment centers use evidence-based treatment protocols to help patients safely detoxify and achieve physiologic stabilization. Under the supervision of a specially trained physician, this may include slowly tapering off of a drug or medically assisted withdrawal that helps the body more comfortably experience the clearing of the substance. In both cases, the goal is to achieve stability as the body adjusts to the cessation of substance use.

Though our medical systems may be challenged at this time, it’s also a time when expert medical advice is critical. If you suspect a loved one may be displaying symptoms of substance withdrawal or COVID-19, a phone call is warranted. Rather than attempting to manage these serious events on your own, there are options—such as telemedicine—that can put your mind at ease and give you the answers you need. In spite of quarantines and shutdowns, essential health care providers and addiction recovery centers are there to offer support.