One of the biggest concerns about entering rehab for substance abuse is detox.
Giving up drugs or alcohol after a long period of heavy use can lead to uncomfortable symptoms, and without knowing what those symptoms are or how to handle them, the whole idea can be intimidating.
For some people, it may seem easier to simply stop using drugs or alcohol and get it over with, riding out whatever symptoms may follow. Others may try to taper off the substance to make the symptoms milder; however, these methods aren’t as easy as they sound. Symptoms of drug or alcohol withdrawal can be more uncomfortable than expected, leading to renewed cravings and resulting in relapse into use. The person may not know how to taper the drug properly, leading to longer periods of withdrawal. In some cases, these symptoms can even be dangerous, putting a person’s life at risk.
To minimize these issues, there is medical detox, in which the person is supported by doctors and nurses who provide medications in response to the symptoms of withdrawal while also, when necessary, managing a taper that is shown by research to make the detox process easier. Medical detox can make the more uncomfortable symptoms milder, hold cravings at bay, and give the person a better chance of avoiding relapse.
What Is Medical Detox?
Detox and withdrawal from substance abuse or addiction can be physically and psychologically difficult, as noted by the National Institute on Drug Abuse. When the brain and body become dependent on a substance, the abrupt removal of the substance can be a shock to the system, which can result in a number of challenging reactions, including physical and emotional withdrawal symptoms.
Medical detox is a way of counteracting or alleviating these symptoms to make the withdrawal process easier on the brain and body, in turn making it easier for the person to complete detox without relapsing to using the substance.
By providing medications that manage some of the symptoms of withdrawal, medically trained addiction treatment specialists can make it more likely that the person will complete the detox process and move into treatment and recovery.
Medical detox does not completely eliminate the symptoms of withdrawal. However, it can make the process far more bearable and easier to follow until detox and withdrawal are complete, rather than resulting in relapse to substance abuse. In some cases, medical detox can be lifesaving.
Signs and Symptoms of Withdrawal
Signs and symptoms of withdrawal from drugs or alcohol can include the following, according to the National Council on Alcoholism and Drug Dependence:
- Shakiness and loss of coordination
- Digestive upset or loss of appetite
- Headaches or body aches
- Sweating, runny nose, and watery or red eyes
- Insomnia and fatigue
- Anxiety, depression, and irritability
There can be additional symptoms that are specific to the type of drug being used. For example, according to the Substance Abuse and Mental Health Services Administration (SAMHSA), the early period of withdrawal from stimulants like cocaine and methamphetamines can include periods of extreme anxiety and agitation, or even aggressive behaviors.
Most troublesome are the withdrawal symptoms from long-term or heavy alcohol use or long-term use of benzodiazepine drugs (benzos) used to treat anxiety or sometimes used illicitly as club drugs. The withdrawal syndromes for these substances can include life-threatening symptoms in certain circumstances. Withdrawal from benzos can result in grand mal seizures, while alcohol withdrawal can cause a condition called delirium tremens (DTs) that results in symptoms such as hallucinations, weakness, delirium, stupor, and high fever, and can also cause seizures. Without medical intervention, these symptoms can result in death. For this reason, abrupt detox from alcohol or benzos should never be attempted without help from a doctor experienced in detox care.
When Medically Supported Detox Is Necessary
Medically supported detox may be required under a variety of circumstances, including:
- Long-term addictions to certain substances that can result in dangerous withdrawal symptoms
- Polydrug abuse, such as for a person who uses opioids and benzos together
- Multiple cycles of detox/withdrawal and relapse; those with high relapse risk
- Co-occurrence of complicating mental or physical disorders with substance abuse
In these cases, complications could lead to dangerous physical or psychological reactions to detox, resulting in death, self-harm, or other problems with recovery. At a minimum, not providing the proper medical support to people with these conditions could result in a higher risk of relapse to substance use.
Types of Addiction That Require Medical Assistance
As described above, medical support is necessary for alcohol or benzo detox to minimize or prevent life-threatening symptoms of withdrawal. However, these are not the only cases in which medical detox may be needed. According to SAMHSA’s Treatment Improvement Protocols for detox, medical support of detox can be helpful for the symptoms of withdrawal for a wide range of substances, including:
- Prescription or illicit opioids
- Cocaine and amphetamines (including meth)
- Inhaled psychoactive substances
- Some club drugs, such as GHB
While the withdrawal symptoms from these substances are generally not dangerous, medical detox can help decrease the severity of withdrawal and help avoid relapse to substance use.
Medically supported detox is also recommended in the case of people who are using more than one substance at the same time, which can cause complications during withdrawal because of the various symptoms caused by the different drugs. It is also recommended in the case of co-occurring mental or physical disorders to prevent psychological complications.
As reported in a study from Drug and Alcohol Review, people with co-occurring severe depression and methamphetamine use may need to be observed during withdrawal, because the depression may be worsened during withdrawal, resulting in the person considering or attempting suicide.
When Medical Support Is Not Necessary for Detox
Several drugs either have no true withdrawal syndrome or withdrawal symptoms that do not respond to medical treatment. Generally, medical detox is not required for these substances of abuse:
- Marijuana or hashish
- Anabolic steroids
- Some club drugs, such as ecstasy or hallucinogens
For these substances, medical support is not considered to be necessary for detox because the symptoms do not warrant it or do not respond to it.
Even in these cases, however, it can be helpful to work with addiction treatment professionals from the moment that the decision is made to quit using. Addictive substances can still have a strong pull through cravings or because of the psychological and social reasons that use was started in the first place. Dealing with these issues as soon as possible can help a person manage the situations that may result in starting to use again.
Those who opt for medical detox from these substances do generally have higher rates of detox success since the likelihood of relapse is lessened in a supervised environment.
Medical Detox: Statistics and Facts
According to the National Survey of Substance Abuse Treatment Services for 2014, fewer than 20 percent of substance abuse treatment centers offered medications to support alcohol or other drug detox. Also, fewer than 20 percent provided medications to treat prescription or illicit opioid abuse.
A study in the journal Addiction noted that people who receive help with the various stages of addiction treatment are more likely to remain abstinent over the long-term. After three years, 62.4 percent of those who received treatment were still in recovery from their addiction compared with 43.4 percent of those who tried to recover on their own. After 16 years, 60.5 percent of those who tried to recover on their own relapsed to substance use, while only 42.9 percent of those who received help for recovery relapsed.
In 2010, a study in Alcohol and Alcoholism reported that 6.6 percent of patients who were admitted to hospitals with alcohol withdrawal syndrome died because of their symptoms. Medical detox can prevent fatalities since medical professionals are able to intervene quickly if complications occur.
Is medically supported detox really necessary?
Medical detox is an important part of the recovery process for many types of addiction. Specifically for alcohol and benzo withdrawal after heavy or long-term use, medical detox can be lifesaving. For other substances like opioids, stimulants, or inhalants, medical detox can make withdrawal symptoms more manageable and reduce cravings and other triggers that cause relapse into substance use.
Some of the statistics above also demonstrate that getting help with detox, as part of a full range of treatment, can make it more likely that the person will continue to maintain abstinence in the long run. However, this is not true if the person does not continue treatment following detox, as emphasized by the National Institute on Drug Abuse.
How long does medical detox last?
The amount of time that a person spends in medical detox depends mostly on how long it takes for the substance to be cleared from the body. This amount of time is based on the drug’s half-life, or how long it takes to excrete or eliminate half of the substance, as well as on the metabolism of the drug in the body. Some substances, like short-acting benzos, clear very quickly over a day or so. Others, like prescription painkillers, may take many days.
This time can also be affected by the level of addiction or substance use, the person’s individual constitution (such as weight, fitness, and health), and whether or not the person has tried to quit before and relapsed. When a substance needs to be tapered off slowly, this also adds time to the detox process.
In addition, physical and psychological symptoms can last beyond the amount of time it takes to clear the substance from the body. As the body and brain adjust to the absence of the substance, different withdrawal symptoms arise and peak. For this reason, medical detox treatment generally lasts 5-14 weeks. Because some withdrawal symptoms can last a month or more, or even up to a year after detox, medical support can be continued throughout rehab or even after returning to daily living outside of rehab.
Is the process safe?
Medical detox performed by doctors and nurses with specific experience in managing the withdrawal process is safer than trying to detox without help; this is true for several reasons.
First, the medical professionals who oversee the process are trained to manage the specific challenges that arise during detox for those who struggle with substance abuse or addiction, as described by the American Board of Addiction Medicine. They use research-based methods to minimize withdrawal symptoms and provide medical treatment for the physical, psychological, and social issues that arise during addiction treatment.
Also, detox and withdrawal are safer with support than without it. People who try to detox on their own are often surprised by the level of discomfort they feel. While withdrawal symptoms from most substances are not dangerous, people who detox from alcohol or benzos can be at risk of dangerous symptoms like seizures or even death. Even for substances that do not carry this risk, it is much more likely that attempts to detox without help can lead to severe cravings, a return to substance use, and risk of overdose. Medically supported detox can mitigate these risks.
That said, there are some types of detox that have been performed that can be dangerous. One of these is anesthesia-supported rapid detox from opiates, a method where the person is placed under anesthesia and given high doses of medicines that block the opiates from the brain so withdrawal happens faster. Not only has this method been shown to be dangerous in certain circumstances, as demonstrated by an article in the Journal of the American Medical Society, but the same research shows that it may not actually accelerate the symptoms of withdrawal more than any other treatment method, making it a waste of the time and money.
What medications are provided during detox?
The medications provided depend on the type of drug involved and, in some cases, the specific symptoms that occur, the degree of abuse, and whether or not the person has previously tried to stop using and relapsed one or more times. These medications can be divided into several types, based on what they do:
Some of the medications offered during detox are intended to decrease the discomfort of some symptoms, such as nausea, insomnia, or body aches and pains. Sometimes, the symptoms are mild enough that these can be over-the-counter painkillers, anti-nausea medications, or antidiarrheal medications. However, in some cases, prescription drugs may be used.
Sometimes, prescribed substances similar to the drug of abuse are used in a tapering process and to decrease cravings. For example, as recommended by research from Current Psychiatry, a short-acting benzo may be replaced with a long-acting benzo that is then tapered more slowly, making it possible to minimize the withdrawal syndrome and decrease the chance of relapse. In other cases, less addictive forms of a drug may be introduced, such as buprenorphine for opiate withdrawal, to help manage cravings during detox. These substances may be tapered off later during rehab or even after the person has been clean for a certain period of time.
Blocking the effects of the drug or alcohol
Naloxone is an example of this type of substance, and it is used specifically to interrupt the action of an opiate drug. Naloxone is often used to reverse overdose, as described by the National Library of Medicine’s Medline Plus website; sometimes, in the case of severe substance abuse or addiction, this type of medicine is necessary to avoid more serious withdrawal or overdose risks.
Managing other conditions
If a person who is in detox presents with symptoms of a co-occurring disorder, such as anorexia or depression, it may be necessary to begin stabilization of that condition during the detox process. A medical professional is required for this type of medication because of the risk that the medicine provided may also be addictive or may react badly with the substance of abuse.
What accreditations are needed for medical detox?
Only medical personnel with valid licenses and accreditation by the state in which they practice should provide medical detox. In addition, these personnel should have training specific to detox services and withdrawal treatment for substance abuse. This type of certification is granted by organizations like the American Society of Addiction Medicine and requires a certain amount of training in addiction treatment to receive.
Some states require the doctors and nurses who prescribe certain treatment medications – like buprenorphine and naloxone – are registered or complete additional training or requirements prior to distributing the prescriptions. This is because these substances are classified as illicit drugs or narcotics unless prescribed for medical use. In many cases, the recipients of the prescriptions are likewise required to be registered, trained, or otherwise tracked.
Who will be present during medical detox?
The main participants in medical detox are the doctors and nurses who provide the medications and monitoring of the process. These are the only personnel who are qualified to assist in the most serious cases of medical detox, such as from heavy use of alcohol or benzodiazepines.
There is also residential detox, which can be undertaken once the client has reached a stable enough state to require a lower level of medical care. This type of detox is still managed by licensed medical personnel, but it can be supervised by biomedical technicians who supervise the person while self-administering medication.
In the case of other needs, such as co-occurring mental health disorders, a psychiatrist may also be available to help with factors that may complicate the detox process.
What happens after detox?
Detox is the first step in the process to help a person achieve recovery from substance abuse. According to research, people who go through detox but do not continue with other methods of substance abuse rehab or treatment are most likely to begin using again.
Relapse to substance use is a great risk because, once detox is complete, the body’s tolerance for the drug is lowered, meaning that the person becomes more sensitive to the amount of the drug taken. Nevertheless, when the person returns to using the same amount as before detox, this has become too much for the body to handle, and the person can end up overdosing on an amount that might not have been a problem before detox.
This issue has become an increasing problem. For example, between 2000 and 2013, the rate of heroin overdose almost quadrupled, according to a report by the Centers for Disease Control and Prevention. Much of this problem can be attributed to repeated withdrawal and relapse to heroin use.
On the other hand, inpatient rehab provides an opportunity to learn more ways of resisting relapse, increasing the chance that the person will continue abstinence and avoid overdose. Because of this, inpatient treatment is an important step to take after detox.