Detox

Detoxification

If you choose to enter a traditional drug or alcohol treatment center for help with a substance abuse problem, you can expect the process to start with medical detoxification. Medical detoxification (detox for short) is administered and monitored by health care professionals who understand addiction care.

Detox serves two main purposes. The first is to ensure that addictive and harmful substances and other toxins are safely removed from the body. The second is to ensure that clients’ withdrawal symptoms are also safely managed as the substances are removed.

The purpose of detox is to safely manage the acute physical symptoms of withdrawal that comes when someone stops using drugs, according to the National Institute on Drug Abuse (NIDA). 

Why Is Detox Needed?

Many people do not think about the long-term effects that chronic drug and/or alcohol use will take on their bodies, minds, or spirits. Once substance dependence and addiction are underway, it is difficult to stop using. When people do decide to stop using drugs or alcohol, they often find the decision to do so is not without physical or mental consequences.

A medical detox program is strongly recommended for people who are experiencing changes as a result of not using. This is known as withdrawal, and this period, which is unpleasant for many, will unfold according to the substance or substances that were abused and the length of time they were abused.

While withdrawal affects people differently, many people experience changes in mood and flu-like symptoms. Some common withdrawal symptoms are:

• Agitation
• Anxiety
• Confusion
• Depression
• Excessive yawning
• Insomnia (or other sleep disorders)
• Irritability
• Muscle aches
• Runny nose
• Watery eyes

Withdrawal symptoms can vary according to the substance used. Substance users who are in withdrawal from opioids, benzodiazepines, and alcohol should seek professional help immediately as any of these can be life-threatening.

The Dangers of Cold Turkey Withdrawal

Quitting any substance cold turkey, or abruptly, after using it for some time is not recommended, even for people who have mild cases of substance dependence or those who may be in the early stages of addiction.

Attempting to use this method with highly addictive drugs and after severe alcohol dependence can lead to serious consequences, even death.

This is especially the case with substances like benzodiazepines and alcohol. Heavy alcohol use and benzodiazepines can produce grand mal seizures, which can be life-threatening. Grand mal seizures can result in a loss of consciousness and violent muscle contractions, according to the Mayo Clinic.

With highly addictive drugs like opioids, the symptoms of withdrawal are not life-threatening, but they are enough to drive someone to relapse, which can make them prone to overdose, which can be fatal. 

Alcohol, Benzodiazepines, and Opioid Withdrawal Symptoms

Severe Alcohol Withdrawal Symptoms

Stopping abruptly after heavy, long-term alcohol use can produce a cluster of severe symptoms known as delirium tremens (DTs), according to MedlinePus.gov:

• Seizures
• Hallucinations
• Severe confusion
• Agitation
• Fever

Benzodiazepine Withdrawal Symptoms

According to Verywell Mind, popular benzodiazepine drugs like Xanax, Valium, and Klonopin can produce a litany of severe symptoms, such as:

• Hallucinations (auditory, tactile, or visual)
• Feelings of unreality
• Delirium
• Racing pulse
• Hyperventilation
• Restlessness
• Hand tremors
• Muscle spasms
• Headache
• Sweating
• Irritability
• Aches and pains
• Problems with concentration and memory
• Visual disturbances (flashes of light or blurred vision)
• Nausea or vomiting
• Anxiety
• Insomnia
• Panic attacks
• Hypersensitivity to stimuli like light and touch
• Abnormal bodily sensations (skin-crawling, goosebumps)
• Depression
• Grand mal seizures

A sudden interruption in use can lead to a serious injury, relapse, or an overdose that can turn deadly, especially when withdrawal symptoms are severe.

Opioid Withdrawal Symptoms 

Opioids and opiates like OxyContin, Vicodin, and heroin produce withdrawal symptoms that are often described as flu-like symptoms. According to MedlinePlus.gov, those symptoms come in early and late stages. 

The early symptoms of opioid withdrawal are:

• Sweating
• Insomnia
• Runny nose
• Muscle aches
• Agitation
• Anxiety
• Increased tearing
• Yawning

Late symptoms include:

• Nausea
• Vomiting
• Diarrhea
• Dilated pupils
• Abdominal cramping
• Goosebumps

A medical care professional can help best determine what’s severe and what’s not and ensure a client in withdrawal is getting the proper care needed for the person’s particular situation.

Why Is an Alcohol or Drug Detox Recommended?

People who use drugs and alcohol for a long time have high tolerances to addictive substances that don’t just go away when they make a decision to quit.

A professionally-administered detox addresses the physiological ramifications of withdrawal, as well as the medical consequences.

However, detox is just the initial treatment process. It is the first step rather than the final or only step.

Detox does little to change long-term drug use, according to NIDA.

Recovering drug and alcohol users are encouraged to enroll in rehab treatment services at a licensed residential facility for long-term recovery.

When the body has been cleared of traces of substance use, then the work can begin on treating the psychological effects of addiction. This involves intensive behavioral therapy and counseling.

How Safe Is a Detox at a Rehab Center?

Medical detox at a rehab center or hospital can ensure clients:

Detox at a rehab center is considered much safer than trying to quit drugs or alcohol outside of a medical setting.

Some people will try to detox from drugs and alcohol with homemade remedies or drug detox kits that can be used at home.

While those options are less expensive and more convenient, any methods or options pursued outside of medical detox may be ineffective and put the client’s safety and well-being at further risk.

Undergoing a medical detox at a licensed facility that is monitored by trained, knowledgeable addiction care and health care professionals is recommended over other options.

Detox and Tapering

During a medically monitored detox, a tapering schedule may be set up to wean clients off addictive substances.

Tapering means fewer doses of the drug will be given during the course of the detox process to help clients come off of it safely.

Clients may be given tranquilizers, or sedative medications to relax the client or they may be given intravenous, or IV fluids support.

Vitals, such as their heart rate and blood pressure, are regularly reviewed as well.

For opioid withdrawal, clients may receive methadone and buprenorphine.

The U.S. Food and Drug Administration (FDA) has approved both drugs for opioid addiction treatment.

People who are in benzodiazepine withdrawal may receive decreasing amounts of benzos. They also may be given a benzo medication that is different from the one they have been taking or a phenobarbital substitution.

For alcohol withdrawal, clients may also receive benzodiazepine medications to reduce agitation and anxiety to prevent tremors and seizures.

Stimulant withdrawal detox for drugs such as methamphetamine and cocaine also may involve benzodiazepine treatment to help calm clients who have taken these drugs.

To date, the FDA has not approved medications for stimulant withdrawal.

How Long Does Detox Take?

There is no set timeline for drug and alcohol detox due to the fact that the effects of these substances impact people differently and complications can be difficult to predict.

Other factors include what kinds of substances were abused, the manner in which they were abused, and how much of the substances were abused. Generally, a detox can take three to seven days to complete. They also can take a week or longer. A physician can give a better idea once a client’s personal situation is reviewed.

Drug Detoxification Is a Three-Step Process

According to the Substance Abuse and Mental Health Services Administration (SAMHSA), drug detoxification consists of three important steps.

They are evaluation, stabilization, and fostering entry into drug treatment. The process ends when the clients are advised to enter a drug or alcohol treatment program that best fits their needs.

Step 1 – Evaluation.

This the information-gathering stage. Tests are conducted to:

• Check for substances that are present in the bloodstream and measure the concentration and assess the level of use

• Screen for co-occurring mental and physical conditions

• Evaluate clients’ medical and psychological conditions and their social situation to determine the proper level of treatment after detoxification. The initial substance abuse treatment plan for the client is based on this evaluation.

Step 2 – Stabilization.

Clients receive assistance with their acute intoxication and withdrawal with the goal being to attain a medically stable, fully supported, and substance-free state.

Medications may or may not be administered during this stage. Also, in this step, clients are introduced to what to expect in treatment and what role they play in their treatment and recovery.

The involvement of their friends, family, employer, and others might be sought as well.

Step 3 – Fostering entry into treatment.

In this step, clients are prepared to start a substance abuse treatment program. Supportive staff emphasizes the importance of staying the course to complete the substance abuse treatment continuum of care.

The detoxification process is considered successful by whether the substance-dependent client enters, remains in, and completes a treatment/rehabilitation program.

It is important to note that any drug or alcohol detoxification process that does not include all three steps listed and explained above is considered incomplete and inadequate by the consensus panel.

Inpatient Detox Programs

Detox programs can be customized to the needs and preferences of clients.

Traditional programs are available as well as those that treat clients with nontraditional treatment approaches.

If there’s time, do your research to find a program that best suits what you need and what you are looking for.

Detox is usually given in an inpatient setting. If you are experiencing severe withdrawal symptoms, an inpatient program is likely the better arrangement for you.

Such a program offers 24-hour medical care and monitoring of vital signs. Inpatient detox can take place at residential rehab treatment centers, hospitals, dual-diagnosis treatment facilities, and medical detox centers.

It also can be carried out at treatment centers that offer holistic and alternative treatments. After detox ends, a therapeutic follow-up program may be recommended.

What Is Rapid Detox and Does It Work?

The traditional drug or alcohol detox can take anywhere from days to weeks to complete.

However, there is another method some clients use to speed up this process, and it is known as rapid detox.

The word “rapid” is key to understanding how rapid detox works. In this process, clients are put under a general anesthetic and given medications intravenously to speed up the withdrawal process.

This fast detox, which usually takes place in a clinical setting, completes the substance elimination process in four to six hours while clients are under medical supervision.

Clients then remain for another day or two as they recover. They also may be given naltrexone, a drug that blocks the effects of opiates/opioids and alcohol.

They also may continue to receive this drug months after the procedure takes place. Some claim rapid detox effectively treats addiction to alcohol, opiates/opioids, and heroin, an illegal opioid.

There are claims that rapid detox helps clients avoid uncomfortable and life-threatening withdrawal symptoms, which could encourage more people to get addiction help.

Clients are able to start their recovery sooner as the process goes quickly. Whether one wishes to undergo rapid detox is a personal decision.

However, there appears to be disagreement over whether rapid detox is more effective than traditional detox procedures. There is also debate over whether it is safe.

Heart attacks, infections, choking, nausea, vomiting, and death are also possible.

There’s also the possibility of relapse if the treated person believes they can just get a rapid detox to clean them up after a post-treatment return to using.

Before choosing rapid detox, it is strongly advised that clients do their research. At Pathway to Hope, we support traditional detox methods for people wishing to recover from substance addiction.

What Happens After Detox?

After detox is finished, recovery from substance addiction is just beginning. As mentioned above, it is the first step. If a person decides to enter a reputable rehabilitation center, they have a wide variety of programs and services to choose from.

They can enter an inpatient or residential treatment program that offers a safe space to focus on their addiction that is highly structured and monitored by medical professionals 24 hours a day.

In centers such as these, clients also can participate in individual or group counseling and a variety of therapies that help the client understand the psychological side of their addiction.

They can also join a 12-step fellowship program, such as Alcoholics Anonymous or Narcotics Anonymous, or an alumni program to help them stay connected to like-minded people who share their sobriety goals and avoid relapse.

Sources

Mayo Clinic. (2018, December 07). Grand mal seizure. Retrieved from https://www.mayoclinic.org/diseases-conditions/grand-mal-seizure/symptoms-causes/syc-20363458

MedlinePlus.gov. (n.d.). Opiate and opioid withdrawal: MedlinePlus Medical Encyclopedia. Retrieved from https://medlineplus.gov/ency/article/000949.htm

MedlinePlus.gov. (n.d.). Alcohol withdrawal: MedlinePlus Medical Encyclopedia. Retrieved from https://medlineplus.gov/ency/article/000764.htm

National Institute on Drug Abuse. (n.d.). What Are Therapeutic Communities? Retrieved from https://www.drugabuse.gov/publications/research-reports/therapeutic-communities/what-are-therapeutic-communities

National Institute on Drug Abuse. (n.d.). 8: Medical Detoxification. Retrieved from https://www.drugabuse.gov/publications/teaching-packets/understanding-drug-abuse-addiction/section-iii/7-medical-detoxification

O, C., & Osborn, K. (2019, June 07). How Long Does Withdrawal From Benzodiazepines Last? Retrieved from https://www.verywellmind.com/benzodiazepine-withdrawal-4588452

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