How does tramadol affect sleep patterns. What are the short-term and long-term effects of tramadol on sleep quality. Can tramadol cause insomnia or other sleep disturbances. What dosages of tramadol are most likely to impact sleep.

The Relationship Between Tramadol and Sleep Disturbances

Tramadol, a widely prescribed opioid analgesic, has been the subject of numerous studies investigating its effects on sleep patterns. While primarily used for pain management, researchers have observed that tramadol can significantly impact sleep architecture, leading to various sleep disturbances.

What are the primary effects of tramadol on sleep? Studies have shown that tramadol can:

• Increase the duration of stage 2 sleep
• Decrease slow-wave sleep (stage 4)
• Reduce rapid eye movement (REM) sleep at higher doses
• Potentially cause lingering effects on sleep patterns even after discontinuation

Dosage-Dependent Effects of Tramadol on Sleep Structure

How does the dosage of tramadol influence its impact on sleep? A randomized, cross-over trial conducted on healthy volunteers revealed distinct differences between 50 mg and 100 mg doses of tramadol:

Tramadol 50 mg Effects:

• Increased stage 2 sleep duration
• Decreased slow-wave sleep (stage 4) duration
• No significant impact on REM sleep

Tramadol 100 mg Effects:

• Increased stage 2 sleep duration
• Decreased slow-wave sleep (stage 4) duration
• Significantly decreased REM sleep duration
• Lingering effects on sleep structure in the subsequent night

These findings suggest that higher doses of tramadol may have more pronounced and prolonged effects on sleep architecture.

Short-Term vs. Long-Term Effects of Tramadol on Sleep

What are the differences between short-term and long-term effects of tramadol on sleep? The study provides insights into both immediate and subsequent night effects:

Short-Term Effects (Night of Drug Application):

• Altered sleep structure with both 50 mg and 100 mg doses
• Increased stage 2 sleep
• Decreased slow-wave sleep
• Potential reduction in REM sleep with higher doses

Long-Term Effects (Subsequent Night):

• No significant changes observed with 50 mg dose
• Lingering effects noted with 100 mg dose:
  • Shorter duration of stage 2 sleep
  • Longer duration of stage 4 sleep compared to pre-drug baseline

These findings highlight the potential for tramadol to cause sleep disturbances beyond the immediate night of use, particularly at higher doses.

Implications for Pain Management and Sleep Quality

How do tramadol’s effects on sleep impact its use in pain management? The alteration of sleep architecture by tramadol presents a complex challenge for healthcare providers and patients:

• Pain relief benefits may be offset by sleep disturbances
• Disturbed sleep can potentially exacerbate pain perception
• Long-term use may lead to chronic sleep issues
• Balancing pain management with sleep quality becomes crucial

Healthcare providers must carefully consider these factors when prescribing tramadol, especially for patients with pre-existing sleep disorders or those requiring long-term pain management.

Comparing Tramadol to Other Sleep-Affecting Medications

How does tramadol’s impact on sleep compare to other medications? While the study focused specifically on tramadol, it’s valuable to consider its effects in the context of other commonly prescribed medications known to affect sleep:

Antidepressants:

• Paroxetine: Can suppress REM sleep and increase REM latency
• Mirtazapine: May increase total sleep time and efficiency

Anxiolytics:

• Alprazolam: Can decrease sleep latency but may reduce slow-wave sleep

Antipsychotics:

• Ziprasidone: Shown to improve sleep continuity and increase slow-wave sleep

These comparisons underscore the complex relationship between various medications and sleep architecture, highlighting the need for personalized treatment approaches.

Strategies for Mitigating Tramadol-Induced Sleep Disturbances

What can be done to minimize the impact of tramadol on sleep quality? While further research is needed, several strategies may help mitigate sleep disturbances associated with tramadol use:

1. Dose optimization: Use the lowest effective dose to manage pain while minimizing sleep disruption
2. Timing of administration: Consider adjusting the timing of tramadol doses to potentially reduce nighttime sleep disturbances
3. Sleep hygiene practices: Encourage patients to maintain good sleep habits, such as consistent sleep schedules and relaxation techniques
4. Combination therapy: Explore the potential of combining tramadol with sleep-promoting medications under medical supervision
5. Alternative pain management strategies: Consider non-pharmacological approaches or alternative medications with less impact on sleep
6. Regular monitoring: Assess sleep quality and adjust treatment plans as needed

Implementing these strategies may help balance the pain-relieving benefits of tramadol with the preservation of healthy sleep patterns.

Future Research Directions in Tramadol and Sleep Studies

What areas require further investigation regarding tramadol’s effects on sleep? The current study provides valuable insights, but several questions remain unanswered:

• Long-term effects of chronic tramadol use on sleep architecture
• Impact of tramadol on sleep in patients with chronic pain conditions
• Potential differences in sleep effects between immediate-release and extended-release tramadol formulations
• Interactions between tramadol and other medications commonly used in pain management
• Genetic factors influencing individual susceptibility to tramadol-induced sleep disturbances
• Development of strategies to counteract tramadol’s negative effects on sleep while maintaining its analgesic properties

Addressing these research gaps could lead to more informed prescribing practices and improved patient outcomes.

The Role of Sleep Architecture in Pain Perception and Management

How does sleep architecture influence pain perception and management? Understanding the bidirectional relationship between sleep and pain is crucial for optimizing treatment strategies:

Impact of Sleep on Pain:

• Disrupted sleep can lower pain thresholds
• Sleep deprivation may increase inflammatory markers
• Poor sleep quality can amplify pain sensitivity

Impact of Pain on Sleep:

• Chronic pain can lead to difficulty initiating and maintaining sleep
• Pain-related sleep disturbances may alter sleep architecture
• Sleep fragmentation due to pain can reduce overall sleep quality

Given this intricate relationship, medications like tramadol that affect both pain and sleep require careful consideration in treatment planning.

Patient Education and Informed Decision-Making

How can healthcare providers better inform patients about tramadol’s potential sleep effects? Effective communication and patient education are essential for promoting informed decision-making:

1. Discuss potential sleep disturbances as a side effect of tramadol treatment
2. Explain the importance of sleep in pain management and overall health
3. Provide guidance on recognizing and reporting sleep-related issues
4. Offer strategies for maintaining good sleep hygiene while using tramadol
5. Encourage open dialogue about sleep quality throughout the treatment process
6. Explore patient preferences and concerns regarding sleep and pain management

By fostering informed discussions, healthcare providers can help patients make balanced decisions about their pain management and sleep health.

Integrating Sleep Monitoring in Pain Management Protocols

How can sleep monitoring be incorporated into pain management protocols involving tramadol? Implementing systematic sleep assessment can enhance treatment outcomes:

• Baseline sleep evaluation: Assess sleep patterns before initiating tramadol treatment
• Regular sleep quality check-ins: Incorporate sleep-related questions in follow-up appointments
• Use of sleep diaries: Encourage patients to maintain sleep logs to track changes over time
• Actigraphy monitoring: Consider using wearable devices to objectively measure sleep patterns
• Polysomnography: Utilize sleep studies when necessary to evaluate complex cases
• Interdisciplinary collaboration: Involve sleep specialists in pain management teams

By integrating sleep monitoring into pain management protocols, healthcare providers can more effectively balance pain relief with sleep quality preservation.

Pharmacological Alternatives and Adjuncts to Tramadol

What alternatives or adjunctive treatments can be considered to minimize sleep disturbances while managing pain? Exploring other options may help optimize treatment for patients experiencing sleep issues with tramadol:

Alternative Analgesics:

• Non-opioid pain relievers (e.g., NSAIDs, acetaminophen)
• Other opioids with potentially different sleep effects
• Topical analgesics for localized pain

Adjunctive Medications:

• Sleep-promoting agents (with caution and under medical supervision)
• Medications targeting specific pain mechanisms (e.g., gabapentinoids for neuropathic pain)
• Antidepressants with dual pain and sleep benefits

Non-Pharmacological Approaches:

• Cognitive-behavioral therapy for insomnia (CBT-I)
• Physical therapy and exercise programs
• Mindfulness and relaxation techniques
• Acupuncture or other complementary therapies

By considering a range of treatment options, healthcare providers can develop personalized strategies that address both pain management and sleep quality.

The Economic and Quality of Life Impact of Tramadol-Induced Sleep Disturbances

What are the broader implications of sleep disturbances caused by tramadol use? The effects extend beyond individual health outcomes:

Economic Impacts:

• Increased healthcare utilization due to sleep-related complications
• Potential loss of productivity in the workplace
• Higher costs associated with managing both pain and sleep disorders

Quality of Life Impacts:

• Reduced daytime functioning and cognitive performance
• Increased risk of accidents due to daytime sleepiness
• Potential strain on personal relationships due to sleep disturbances
• Compromised emotional well-being and mental health

Understanding these broader impacts underscores the importance of addressing tramadol-induced sleep disturbances as part of comprehensive patient care.

Genetic Factors Influencing Tramadol Metabolism and Sleep Effects

How do genetic variations affect individual responses to tramadol and its impact on sleep? Emerging research suggests that genetic factors play a role in tramadol metabolism and efficacy:

• CYP2D6 enzyme variations: Affect tramadol metabolism and analgesic efficacy
• Opioid receptor gene polymorphisms: May influence sensitivity to tramadol’s effects
• Genetic variations in sleep-regulating pathways: Could modulate tramadol’s impact on sleep architecture

Future pharmacogenomic studies may lead to more personalized approaches in prescribing tramadol and managing its sleep-related side effects.

Tramadol Use in Special Populations: Considerations for Sleep Management

How should tramadol’s effects on sleep be approached in special patient populations? Different groups may require tailored strategies:

Elderly Patients:

• Increased sensitivity to medication effects
• Higher risk of falls due to sleep disturbances
• Potential interactions with other medications

Patients with Chronic Pain Conditions:

• Pre-existing sleep disturbances may be exacerbated
• Complex interplay between pain, sleep, and medication effects

Individuals with Sleep Disorders:

• Heightened vulnerability to tramadol’s sleep-altering effects
• Need for close monitoring and potential sleep specialist involvement

Patients with Substance Use Disorders:

• Increased risk of developing dependence
• Potential for exacerbating sleep issues related to substance use

Tailoring tramadol use and sleep management strategies to these special populations can help optimize treatment outcomes and minimize risks.

Technological Innovations in Monitoring Tramadol’s Sleep Effects

What emerging technologies can aid in assessing and managing tramadol’s impact on sleep? Advancements in sleep monitoring technology offer new possibilities:

• Smart wearables: Provide continuous sleep tracking and pattern analysis
• Mobile applications: Facilitate easy logging of sleep quality and medication effects
• Home-based sleep monitoring devices: Offer more detailed sleep architecture data
• Artificial intelligence algorithms: Analyze complex sleep data to identify patterns and trends
• Telemedicine platforms: Enable remote monitoring and adjustment of treatment plans

Integrating these technologies into clinical practice could enhance the management of tramadol-related sleep disturbances and improve patient outcomes.

As research continues to evolve, our understanding of tramadol’s effects on sleep will deepen, potentially leading to more refined treatment strategies and improved patient care. Healthcare providers must stay informed about these developments to provide the best possible care for patients using tramadol for pain management.

The effects of two single doses of tramadol on sleep: a randomized, cross-over trial in healthy volunteers

Clinical Trial

. 2001 Jan;18(1):36-42.

doi: 10.1046/j.1365-2346.2001.00772.x.

B Walder 
¹
, M R Tramèr, R Blois

Affiliations

Affiliation

• ¹ Division of Surgical Intensive Care, Geneva University Hospitals, 1211 Geneva 14, Switzerland.

• PMID:

  11270008

• DOI:

  10.1046/j.1365-2346.2001.00772.x

Clinical Trial

B Walder et al.

Eur J Anaesthesiol.

2001 Jan.

. 2001 Jan;18(1):36-42.

doi: 10.1046/j.1365-2346.2001.00772.x.

Authors

B Walder 
¹
, M R Tramèr, R Blois

Affiliation

• ¹ Division of Surgical Intensive Care, Geneva University Hospitals, 1211 Geneva 14, Switzerland.

• PMID:

  11270008

• DOI:

  10.1046/j.1365-2346.2001.00772.x

Abstract

Background and aim:

The effects of analgesic drugs on sleep are poorly understood. We investigated short- and medium-term effects of tramadol on sleep structure.

Methods:

Eight healthy volunteers received a placebo (predrug placebo-night), then, in a randomized, double-blind, cross-over fashion a single oral dose of tramadol 50 mg or 100 mg (drug-night), and finally, again a placebo (postdrug placebo-night). Standardized polysomnography (electroencephalogram, electro-oculogram, submental electromyogram) was continuously recorded during placebo- and drug-nights.

Results:

During drug-nights both doses of tramadol significantly increased the duration of stage 2 sleep, and significantly decreased the duration of slow-wave sleep (stage 4). Tramadol 100 mg but not 50 mg significantly decreased the duration of paradoxical (rapid eye movement) sleep. In the placebo-night after tramadol 100 mg (but not after 50 mg) duration of stage 2 sleep was significantly shorter, and duration of stage 4 sleep was significantly longer compared with the predrug placebo-night.

Conclusion:

In healthy volunteers, a single dose of tramadol 50 mg disturbs sleep in the night of drug application. With 100 mg, sleep is disturbed in both the night of drug application and in the subsequent night.

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Does Tramadol Cause Insomnia? | Absolute Awakenings

Table of Contents

Does Tramadol Cause Insomnia?

Even when taken as prescribed, Tramadol has been known to cause side effects, including insomnia.

If you’re abusing Tramadol, the side effects become stronger.

Even when taken as prescribed, Tramadol has been known to cause side effects. One of the most common side effects of Tramadol is insomnia. How can a potent painkiller lead to disrupted sleep? Most painkillers cause severe fatigue and sedation. Tramadol disrupts normal sleep cycles when taken as prescribed – the individual taking the drug is more liable to fall asleep during the day and stay awake at night. However, insomnia is far more commonly a side effect of Tramadol withdrawal. Those abusing this medication for any length of time will experience a host of unpleasant symptoms upon ceased use, including sleep-related issues like restlessness, fatigue, and an inability to fall asleep.

Tramadol and Insomnia

The National Library of Medicine recently published a study that focused on the effects of Tramadol on sleep patterns. The study was randomized, and researchers gave healthy subjects between one and two doses of Tramadol before they went to bed in hopes of better understanding the relationship between the two. Eight volunteers received a placebo one night and a 50mg or 100mg dose of Tramadol the second night. It was discovered that 100mg of Tramadol significantly reduced rapid eye movement sleep (REM sleep) for two full nights, the kind of deep sleep humans need to recharge and feel well-rested. The study confirmed that when an individual was given a 50mg dose of Tramadol, sleep was interrupted during the night they were given medication. When an individual was given 100mg of the medication, sleep was harshly interrupted for two full nights. Although this is only one example, it has been proven that Tramadol interrupts sleep. With continued use, it is likely to cause insomnia eventually.

Tramadol detox is another story entirely. It is widely known that insomnia is one of the predominant symptoms of Tramadol withdrawal, along with nausea, vomiting, diarrhea, cold sweats, muscle aches, and stomach cramping.

Absolute Awakenings and Tramadol Addiction

At Absolute Awakenings, we have extensive experience treating Tramadol withdrawal symptoms and the side effects of Tramadol abuse and addiction. Our team of experienced professionals knows how disruptive and aggravating attempting to deal with a lack of sleep can be, especially in early recovery. Our prescribing physicians will work with each client and prescribe a non-narcotic sleeping aid to help with insomnia whenever necessary.

Of course, medication is not the only solution – we also work to instill healthy coping mechanisms – ways to calm the body and the mind so that achieving a good night’s sleep is more likely. Some holistic approaches to treating insomnia include yoga, meditation, and breathing exercises. If you have been struggling with Tramadol abuse or addiction and you are ready to stop experiencing the painful and disruptive side effects due to painkiller dependence, give us a call today. We are standing by to help you in any way we can and get you started on your journey of Tramadol addiction recovery.

References

1. Dhesi M, Maldonado KA, Maani CV. Tramadol. In: StatPearls. StatPearls Publishing; 2022. Accessed January 17, 2023. http://www.ncbi.nlm.nih.gov/books/NBK537060/
2. Walder B, Tramèr MR, Blois R. The effects of two single doses of tramadol on sleep: a randomized, cross-over trial in healthy volunteers. Eur J Anaesthesiol. 2001;18(1):36-42. doi:10.1046/j.1365-2346.2001.00772.x
3. Basics on Sleep. WebMD. Published November 16, 2022. Accessed January 17, 2023. https://www.webmd.com/sleep-disorders/sleep-101

Last medically reviewed January 17, 2023

Tramadol is a psychotropic drug belonging to the group of opioid analgesics. This drug is distinguished by the presence of pronounced analgesic properties. Due to the effect of Tramadol on the central nervous system and active stimulation of opioid receptors, the drug is also used to achieve a state of drug intoxication.

Action of Tramadol

When the active ingredients of Tramadol penetrate into the bloodstream, they cause a state of pleasant euphoria, the person becomes emotionally receptive, feels a surge of strength and energy, feels free and liberated. However, tolerance to the drug develops quite quickly and soon the euphoria after taking it is reduced from 36 hours to 5 minutes. A person is forced to constantly increase the dosage. The state of “tramadol withdrawal” is accompanied by severe pain, sleep disturbances, panic states, leading to the development of paranoia.

Effects of Tramadol on the body

Addiction to Tramadol develops rapidly. After a few months of drug use, the patient shows signs of physical and psychological exhaustion. A person becomes depressed, irritable, begins to lose weight dramatically, suffers from a permanent lack of appetite, insomnia.

The following effects from Tramadol :

• tearfulness;
• headaches;
• changes in blood pressure;
• fainting spells;
• memory impairment, reduced ability to concentrate.

After a year of using Tramadol, the patient’s appearance changes, hair begins to fall out, teeth decay. In addition, there is a weakening of bone tissue structures, which causes frequent fractures. As a rule, in the absence of timely provision of qualified assistance, a person dies from an overdose within 3-4 years. The insidiousness of Tramadol lies in the fact that this drug causes a strong psychological dependence, the manifestations of which have to be fought for 10-15 years after stopping the use of Tramadol.

Treatments for Tramadol

Tramadol treatment should be carried out in a hospitalized patient, with complete isolation from the usual environment. The therapeutic course begins with a comprehensive detoxification and the use of restorative techniques. The duration of detox is about 3-4 weeks. Often, patients are prescribed antipsychotic and nootropic drugs, symptomatic treatment, a course of vitamin therapy.

Drug treatment in Medicon is carried out by qualified specialists, according to licensed methods, which significantly increases the chances of achieving successful results.

Therapeutic course includes psychological correction, work on the program “12 steps” in groups of codependents, methods of Genstald therapy. Particular attention is paid to the rehabilitation of patients and the prevention of a possible breakdown in the Medicon Narcological Center. Psychological consultations, classes with a family psychologist and in groups of co-dependents help a person overcome psychological dependence on Tramadol, fully returning to a normal, sober life.

Author: Ivashchenko Yuliana Borisovna

Addiction specialist

About the specialist

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Tramadol addiction – MedLux

Tramadol (tramadol hydrochloride) is a pharmaceutical drug analgesic, refers to potent painkillers of the opioid series , began to be used in European countries in 1962. It is used to combat acute pain syndromes caused by fractures and severe soft tissue injuries. Its important feature is the rapid formation of stable tramadol addiction.

Available in various forms: tablets, capsules, drops, and injectable solutions, so drug addicts can use the drug in various ways. Sale is allowed in pharmacy chains of Ukraine strictly by prescription. In drug addict slang, tramadol is called: tram, tramalgin, tramal, tram, wheels.

Narcotic effect of tramadol

Tramadol has a characteristic intoxicating effect on the human body almost immediately after injection, and also 20-30 minutes after oral administration of tablets, capsules or drops. The intensity of the effect depends on the dose of the substance used and the characteristics of the body of a particular person.

Psychotropic substance causes a short-term feeling of euphoria, pain is eliminated, an imaginary feeling of calmness appears, actions become inhibited, breathing and heartbeat slow down, coordination of movements is disturbed, a feeling of prostration appears, the addict becomes friendly to others without visible signs of aggression.

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How tramadol addiction manifests itself – signs

When used for therapeutic purposes in compliance with the dosage, dependence on tramadol does not occur. But with increasing doses, the drug causes stable changes in the mental and physical nature. After taking 7-8 capsules, a pronounced narcotic effect occurs, the patient feels an imaginary euphoria, a feeling of carelessness and an increase in mood appear – this effect can persist for a short time, after which mental problems form: insomnia, hallucinations, nightmares, increased anxiety, a sense of fear.

To restore calmness and a feeling of euphoria, the patient takes another dose, and then another and another. After several weeks or months of taking, a stable dependence is formed on the mental and physical level. Dependence is accompanied by such signs as: hand tremor, rapid weight loss, aggression during withdrawal, inadequate mental reactions.

How tramadol affects the body

Recognizing the signs of tramadol use is more difficult than most other addicts because tramadol has less of an effect on opioid receptors than heroin or opium. Because of this, a person “sitting” on tramadol may not cause suspicion among others, including close people and relatives.

The mechanism of the effect of tramadol on the body is to block opioid receptors responsible for the transmission of nerve pain impulses. Due to these properties, the drug has an excellent analgesic effect, tranquilizing and antidepressant effect.

It is almost impossible to get rid of the problem on your own, so the patient needs a consultation with a psychotherapist and subsequent specialized treatment in a narcological hospital.

Consequences of use

Tramadol has a lot of side effects, so it is not intended for long-term use. But drug addicts use tramadol systematically for years, which leads to severe consequences for physical and mental health. When using tramadol with alcohol, instant severe intoxication occurs even from small doses, it is manifested by a high load on the liver, as a result – jaundice, disruption of the internal organs and systems, up to their complete failure.

The influence of tramadol on the human psyche is also great. The only goal and desire in the life of an addict is to find and use the next dose. A drug addict may experience epileptic seizures, dementia, disorientation, and a disturbed perception of reality. In the absence of the drug in the blood, unbearable suffering begins – you can remove the withdrawal symptoms by using another dose or by detoxifying from drugs.

How to get rid of tramadol addiction

The vast majority of drug addicts are unable to cope with their problem on their own, so they need treatment for tramadol addiction with the involvement of professional narcologists. Drug addiction treatment should always be comprehensive, including four main stages of getting rid of:

• Detoxification from drugs and their breakdown products from the body;
• Restorative drug treatment;
• Work with a psychiatrist and psychotherapist aimed at creating a stable motivation for a complete cure;
• Rehabilitation and resocialization of the patient.

To finally get rid of tramadol addiction, the patient must abruptly stop using the drug and strictly adhere to the recommendations of doctors.

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Tramadol overdose – symptoms and first aid

Tramadol overdose poses a serious threat to the life of the addict, it is accompanied by the following symptomatic manifestations: vomiting, white foam from the mouth, loss of consciousness or deep sleep, difficulty swallowing, rapid shallow breathing, slow heartbeat, impaired vision and taste, convulsive phenomena, lack of response to sounds and pain.

First aid for an overdose of tramadol provides for the following sequence of actions:

1. Call for an ambulance, emergency or specialized drug treatment;
2. Explain the situation to the dispatcher, say what drug the addict was poisoned with;
3. Do not let the drug addict fall asleep, disturb and talk to him;
4. Provide fresh air to the room;
5. In case of severe overdose, lay the addict on his side so that he does not choke on vomit;
6. In case of cardiac or respiratory arrest, perform chest compressions and artificial respiration until the team or narcologist arrives.

Tramadol addiction treatment at the MEDLUKS Clinic

MEDLUKS clinic specialists provide comprehensive professional services for the treatment and rehabilitation of drug addicts. The clinic has all the conditions for a comfortable stay of patients and effective treatment of tramadol addiction. Our doctors have a specialized education, and also have many years of successful experience working with patients of any complexity.

In the treatment of tramadol addiction, only treatment regimens that have proven to be highly effective in practice are used. To find out more details and get drug treatment help, contact our administrator in any convenient way.

Frequently Asked Questions

• How long does Tramadol withdrawal last?

Break times are always individual. The term depends on the experience of the addict and the physiological characteristics of his body. The average withdrawal period varies within 5-28 days after the use of the drug. Withdrawal is accompanied by unbearable torment.

• How long does tramadol leave the body?

The timing of the elimination of tramadol from the blood of an addict varies from person to person. It depends on body weight and the dose of the substance taken. Often, complete elimination takes 3 days after consumption. But for long-term drug addicts, this process can take up to 6-10 days.

• Can you die from tramadol?

If tramadol is used for short periods in small doses in therapeutic treatment, it is safe. But with tramadol addiction, the dose increases significantly. In this case, the drug has a strong toxic effect on the body, which can lead to death. Death from an overdose of tramadol is very common.

• Is it possible to get rid of tramadol addiction at home?

Cases of self-treatment are known, especially in the initial stages of use. But the vast majority of addicts are not able to quit on their own.