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Drug & Alcohol Detox

Treating drug addiction can be difficult, and it often is for many people. As the first step in treating a substance abuse disorder, medical detoxification, more commonly known as detox, is essential in the recovery process. The primary purpose of detox is to remove all substance residue or toxins from past addictions and abuse before continuing treatment.

Carefully administered and monitored by medical experts, medical detox ensures that the patient’s withdrawal symptoms are in check as the substance is removed from the body. However, detox is much more than just “quitting.” 

What Is Detoxification?

Medical detoxification is a set of interventions that are aimed toward managing acute intoxication and withdrawal. The primary objective of supervised detox is to prevent potentially life-threatening complications that can appear if a client is left alone. 

On that same note, detox is a form of palliative care (reducing the intensity of the disorder) for those who desire drug abstinence or for those who must observe mandatory abstinence due to hospitalization or legal involvement. 

For some individuals, it is the first point of contact in the continuum of care. The continuum of care refers to a treatment system where a client enters treatment at the level that matches their current needs. The point is to find the right intensity of treatment, or move down to a less intensive approach as needed. 

The effective continuum of care features a successful transfer between the levels of care. For many, detox is going to be the first step in this journey. 

Some drugs require a much more intensive approach than others.

Why Detox?

Daily substance abuse easily leads to dependency and ultimately addiction, which can be very difficult to treat in some cases. When someone does get the motivation to quit, they will more than likely undergo uncomfortable physical and mental symptoms. This is called withdrawal.

Those struggling from withdrawal should enter a medical detoxification program. The severity depends on the length of the victim’s addiction. 

While all drugs are different, there are many withdrawal symptoms common between addictive substances. Those that are in the withdrawal phase commonly exhibit flu-like symptoms such as:

  • Agitation
  • Anxiety
  • Confusion
  • Depression
  • Sleep disorders (insomnia, excessive yawning, etc.)
  • Aching muscles
  • Watery eyes
  • Runny nose

More severe addictions such as those abusing opioids, benzodiazepines, and alcohol, can experience withdrawal symptoms, which include seizures, hallucinations, and delirium tremens that can prove to be fatal.

Many people will consider quitting drugs or alcohol cold turkey. The term “cold turkey” refers to the immediate cessation of a drug. Quitting cold turkey is strongly advised against and may lead to severe withdrawal symptoms

A medically-supervised detox program is the best course of action to curb withdrawal symptoms and ensure that relapse is prevented.

It is important to follow up after medical detox with a drug treatment program such as an inpatient or outpatient program. 

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As soon as the patient’s body is cleared of any residue and toxins, they can participate in therapy sessions to treat the psychological effects of addiction. Included in treatment are methods such as intensive behavioral therapy, counseling, and therapy sessions (both individual and group).

Three Essential Components in Detox

There is a consensus among addiction specialists that the existing definitions of detox are a full process with three components. These may take place concurrently, or with a series of different steps. These include:

At this point, the client is tested for the presence of drugs or alcohol in their bloodstream and measures the concentration. In addition, there is a screening for co-occurring mental and physical disorders.

The evaluation also includes a comprehensive assessment of the client’s medical and psychological conditions and social situation that will determine the appropriate level of treatment that follows detox. The evaluation stage is the initial substance abuse treatment plan.

During this stage, the medical and psychosocial process of assisting the client through acute intoxication and withdrawal to a medically stable, fully supported, and substance-free state. It is achieved through the use of medications. Some approaches, however, will not use medication. At this point, addiction specialists will ask for family or friends to assist in recovery.

The entry into the continuum of care will be stressed, and the importance of completing the program will be discussed.

For clients that have demonstrated a pattern of completing detox services and then failing to engage in treatment, a written treatment contract can encourage entrance in the continuum of substance abuse treatment and care. The agreement, which is not legally binding, is voluntarily signed by the client when they are stable enough to do so at the start of detox.

The client will agree to participate in a continuing care plan, with details and contacts established before detox concludes.

Medications Used In Detox

Medications are one of the best tools that treatment centers have to treat a patient during detox as medicines can ease symptoms or replace the substance of abuse.

Some medications approved by the U.S. Food and Drug Administration (FDA) are effective in treating specific withdrawal symptoms. Unfortunately, there are no FDA-approved drugs that fully treat benzodiazepine or stimulant withdrawal, but some medications can be used during detox to ease withdrawal symptoms and cravings.

Medications used for opioid addiction detox can include:

  • Methadone
  • Suboxone
  • Antidepressants
  • Anti-anxiety medications

Medications used for alcohol addiction detox can include:

  • Naltrexone
  • Benzodiazepines (such as diazepam)
  • Disulfiram
  • Anti-nausea medications
  • Antidepressants
  • Anti-anxiety medications
  • Anticonvulsants (used to treat the potentially fatal seizures and delirium tremens associated with alcohol withdrawal)

Medications used for stimulant addiction detox can include:

  • Antidepressants
  • Antipsychotics (used to deal with the psychosis associated with stimulant withdrawal)
  • Benzodiazepines (such as diazepam)
  • Benzodiazepines (such as diazepam, which can act as a short-term substitute for an abused, long-term substance)
  • Melatonin (as a sleep aid used to treat insomnia associated with sedative withdrawal)

Hospitalization

Hospitalization, or hospital detox, is commonly associated with an institutional approach to treatment. This is usually conducted in a detox center or hospital.

Similar to other forms of detox, hospitalization may consist of the medically-administered use of medications listed above. Medication in conjunction with the commonly used “12-Step Program” can be extremely effective in rehab settings, and even more so in hospital detox. To avoid any negative results, it is important to realize and understand the vast difference between hospitalization and other forms of detox.

The Safety of Detox at Rehab Centers

safety of detox

A client will best receive the treatment they need to endure the withdrawal symptoms if detoxing in a treatment center. In case of emergencies, doctors and nurses provide 24-7 medical support that you would not receive if self-detoxing at home. Treatment center detox provides the client with the proper resources they need to not only get sober but also to stay sober.

Although it may seem like a cheaper, more convenient way to go about drug detox, at-home kits and cold turkey methods are highly ineffective and do not take into consideration the patient’s safety and well-being.  

By participating in treatment at a medical detox facility, patients will be well-monitored by trained medical professionals.

Post-Acute Withdrawal Syndrome

A significant reason to remain in treatment once detox completes is due to a condition known as post-acute withdrawal syndrome (PAWS). While not everyone who goes through treatment might experience this, it can be crippling for those who have achieved prolonged periods of sobriety. 

According to the UCLA Dual Diagnosis program, PAWS refers to a set of impairments that can last for weeks or months after substance abuse abstinence. The condition is similar to symptoms found in mood or anxiety disorders. It consists of mood swings, increased levels of anxiety even without stimulus, and insomnia.

PAWS symptoms typically appear after a withdrawal period from alcohol, opioids, or benzodiazepines, but have been known to occur with the use of other psychoactive substances. 

Some signs and symptoms include:

  • Inability to accomplish cognitive tasks, such as learning, problem-solving, or memory recall
  • Irritability
  • Anxiety or panic attacks
  • Depression

Sources

Unknown Author. Choosing Private Detox or Hospital Detox. Retrieved (April, 2018) from http://www.soberforever.net/detox/choosing-private-detox-or-hospital-detox.cfm

U.S. Food & Drug Administration, (n,d).FDA Approved Drug Products. U.S. Food & Drug Administration. Retrieved April, 2018 from https://www.accessdata.fda.gov/scripts/cder/daf/index.cfm

Baxter. Louis E. Twelve Step Recovery and Medication Assisted Therapies. June 12, 2014 American Society of Addiction Medicine Retrieved from https://www.asam.org/resources/publications/magazine/read/article/2014/06/12/twelve-step-recovery-and-medication-assisted-therapies

Post-Acute Withdrawal Syndrome (PAWS). (n.d.). Retrieved from https://www.semel.ucla.edu/dual-diagnosis-program/News_and_Resources/PAWS

Substance Abuse and Mental Health Services Administration (US). (n.d.). EARLY INTERVENTION, TREATMENT, AND MANAGEMENT OF SUBSTANCE USE DISORDERS. Retrieved from https://www.ncbi.nlm.nih.gov/books/NBK424859/

Treatment, C. F. (1970, January 01). Chapter 3. Intensive Outpatient Treatment and the Continuum of Care. Retrieved from https://www.ncbi.nlm.nih.gov/books/NBK64088/

Treatment, C. F. (1970, January 01). 1 Overview, Essential Concepts, and Definitions in Detoxification. Retrieved from https://www.ncbi.nlm.nih.gov/books/NBK64119/

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