Substance Withdrawal vs. Mental Health Crisis: How to Tell the Difference
- Bradley Pulliam
- Jun 15
- 1 min read
Withdrawal symptoms can mirror mental health disorders so closely that they’re often misdiagnosed, delaying proper treatment and risking relapse.
Biology Breakdown:
Substance withdrawal causes abrupt shifts in neurotransmitters. For example:
Alcohol withdrawal drops GABA activity and surges glutamate → causing anxiety, tremors, and hallucinations.
Opioid withdrawal slams the dopamine system into reverse → leading to deep depression and dysphoria.
Stimulant withdrawal (Adderall, cocaine) depletes dopamine → often presenting like clinical depression or suicidal ideation.
Mental health crises, in contrast, typically develop more gradually or are triggered by stress, trauma, or underlying neurochemical imbalances independent of substance removal.
Common Myths:
“If they’re clean, the depression must be their real issue.”→ Not always. Post-acute withdrawal syndrome (PAWS) can last for months, mimicking depression or anxiety disorders.
“Just push through it, it’s just detox.”→ Without addressing co-occurring mental health needs, many relapses during withdrawal are misidentified as a psychiatric crisis.
Risk vs. Reward:
Risk (Mislabeling the cause): Inappropriate meds, worsening symptoms, relapse, hospitalization.
Reward (Accurate diagnosis): Faster recovery, targeted treatment, improved long-term outcomes.
Peer-Reviewed Sources:
Kosten, T. R., & O'Connor, P. G. (2003). Management of drug and alcohol withdrawal. The New England Journal of Medicine
Koob, G. F., & Volkow, N. D. (2016). Neurobiology of addiction: a neurocircuitry analysis. The Lancet Psychiatry
Gossop, M., et al. (2002). Substance misuse and psychiatric comorbidity. European Addiction Research
Withdrawal can look exactly like a breakdown, but it requires a completely different treatment path. Mislabeling leads to mistreatment.
If you're unsure whether you're in withdrawal or having a mental health crisis, don’t guess; reach out. Our team offers no-cost assessments and referrals tailored to your situation.
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