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.
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How long do these programs 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.
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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.
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What medications are provided?
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:
- Treating symptoms:
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.
- Decreasing cravings:
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.
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What accreditations do facilities require?
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.
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What staff is on hand?
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.
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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.