treatment process

Detoxification, or detox, is the process by which the body rids itself of addictive substances like drugs and alcohol. In some cases, detox is undertaken in an outpatient setting with the support of friends and family. However, detox from certain substances can involve dangerous withdrawal symptoms and should only be undertaken with medical supervision. Detoxing from alcohol or CNS depressants should always take place in a controlled, medically supervised environment. In addition, medical detox is usually recommended for opiate withdrawal.

Medically supervised detox boasts higher completion rates than at-home detox, as the likelihood of relapse is substantially minimized with professional care. Medical detox also serves as a solid foundation for further treatment. Some level of medical supervision is generally recommended during the detox process regardless of the substance of abuse.

How Detox Works

SAMHSA supports a three-stage detox format, using the following steps:

Evaluation: This initial stage establishes that substances are in use and whether the individual is presently intoxicated. The concentration of substances within the bloodstream is measured, and co-occurring disorders are identified. This stage should include a full evaluation of the individual’s medical, psychological, and social state.

Stabilization: The stabilization phase of the detox process involves assisting the individual through the medical and psychological process of ridding the body of drugs or alcohol. This includes treatment for withdrawal symptoms.

Fostering entry into treatment: Medically assisted detox provides an opportunity for the individual suffering from substance abuse to receive support for additional treatment. Resources are available during the detox process to help the individual commit to a treatment plan. In many instances, detox can take place at the same center where the individual will be receiving addiction treatment.

Medically supervised detox can be an important first step toward additional treatment for substance use disorders. During this time, the client and the treatment team can build a healthy relationship, providing a foundation of trust on which a treatment plan can be built.

Alcohol Detox

According to Psychology Today, alcohol withdrawal can be accompanied by life-threatening symptoms, like cardiovascular collapse, hallucinations, and seizures. Medically supervised withdrawal provides the necessary supervision and medical intervention to minimize the associated risks and ease discomfort. Both inpatient and outpatient detox programs are available. Doctors monitor those in withdrawal for hallucinations, severe anxiety, and cardiovascular problems. Medications are often administered to treat the symptoms of alcohol withdrawal syndrome, including drugs to treat nausea and vomiting, anti-anxiety medications, and anticonvulsants.

Symptoms of alcohol withdrawal syndrome include:

  • Anxiety
  • Depression
  • Fatigue
  • Irritability
  • Shaking
  • Mood swings
  • Nightmares
  • Decreased cognizant thought

The most severe form of alcohol withdrawal is known as delirium tremens. The symptoms of delirium tremens include:

  • Severe agitation
  • Fever
  • Hallucinations
  • Seizures
  • Severe confusion

Delirium tremens can involve life-threatening symptoms. Medical detox is especially important for anyone who has had severe withdrawal symptoms in the past or is at an increased risk of delirium tremens due to co-occurring conditions.

CNS Depressant Detoxification

Medically supervised detox is important in cases of central nervous system depressant (CNS depressant) dependence. NIDA recommends that detox from this type of drug only take place under the supervision of a medical professional. Drugs like barbiturates and benzodiazepines often lead to a potentially life-threatening withdrawal syndrome.

Dosages of CNS depressants must be tapered gradually in order to avoid dangerous withdrawal symptoms. Individuals should not attempt this tapering process on their own; dosages should only be decreased under medical supervision. If complications arise, medical professionals can act quickly to intervene.

The National Library of Medicine lists the following symptoms of withdrawal from benzodiazepines:

  • Difficulty sleeping
  • Irritability
  • Increased tension or anxiety
  • Panic attacks
  • Hand tremors
  • Sweating
  • Difficulty concentrating
  • Nausea
  • Weight loss
  • Palpitations
  • Headache
  • Muscle pain and stiffness
  • Changes in perception, such as sight and hearing
  • Symptoms of barbiturate withdrawal can be similar, but they carry an increased risk of death. Common symptoms include:

    • Anxiety
    • Restlessness
    • Insomnia
    • Tremors
    • Dizziness
    • Seizures
    • Psychosis

    In severe and untreated cases, hyperthermia, heart failure, and death may occur. Withdrawal from barbiturates should always take place under medical supervision and may require inpatient care.

Opiates

While withdrawal from opiates, like heroin and prescription painkillers, is not usually life-threatening, it can be intense. As a result, medical detox is generally recommended for opioid withdrawal. Sometimes, medications are used to manage withdrawal symptoms. These maintenance medications may be slowly tapered over time to gradually wean clients off the substances. In addition, specific withdrawal symptoms can be managed as needed during detox, promoting client comfort and aiding completion of the detox process.