As the National Institute on Drug Abuse points out, detox alone is never considered to be sufficient to treat addiction.
Medical detox should always be immediately followed with extensive addiction treatment services. Addiction is a complex disease, and treatment must be research-based, expertly layered, dynamic, and tailored to the individual’s needs. Detox is a necessary starting point, but it is only the beginning of a process that can positively change a person’s entire body, mind, spirit, and personal life.
Withdrawal is part of a larger biological process known as physical dependence. Certain drugs are addiction-forming, including some prescription medications as well as all drugs of abuse. When a person continuously takes an addiction-forming drug, the body will naturally develop a physical dependence on it. There are two main hallmarks of physical dependence: tolerance and withdrawal. These two natural processes are interrelated.
As a person continues to a take an addiction-forming drug, the body will require more of the drug in order for the person to get the desired effects. In the case of drugs, the desired effect is usually the high or euphoria that the drug induces. Tolerance can, for clear reasons, be dangerous, yet it is inevitable. As a person takes more of a drug, to get above the rising threshold of tolerance, the body is exposed to harmful side effects, including the potential for overdose. Tolerance is a main side effect of drug abuse and a main contributor to unhealthy side effects and even tragic outcomes.
When a person stops taking a drug, or significantly reduces the familiar amount, the body goes into the natural process of withdrawal. Since the body has habituated to the drug, and a certain volume of the drug at that, a host of symptoms will emerge due to the drug’s absence. Drug cravings are common. In essence, the body is seeking to restore the status quo. By sending out signals to resume drug use, however illogical to survival that seems, the body is trying to get back to what’s familiar. Withdrawal symptoms are limited in time; a person can typically overcome them and safely navigate out of drug abuse.
Certain drugs can have a particularly dangerous withdrawal profile. Speaking generally, those drugs are opioids, opiates, benzodiazepines, and alcohol. However, a person can face a dangerous, even potentially life-threatening withdrawal process for many reasons. There are a host of factors that are involved in the severity level of the withdrawal process, including:
- The type of drug abused
- Physiological factors specific to the individual in withdrawal
- The length of abuse
- The volume of drug abuse/severity of the abuse
- Social factors, including whether the person has adequate support from family and friends
As will be discussed, medical detox (or medicated detox) can help to prevent the onset of severe withdrawal symptoms.
There is no surefire way for individuals to accurately gauge whether their withdrawal will present mild, moderate, or severe symptoms. For this reason, it is always best to consult with specialists who are qualified to make a recommendation or provide detox services.
The Relevance of a Drug of Abuse to the Medicated Detox Process
At this juncture, it is useful to point out a way to think about drug recovery treatment in general, so as to clear up any possible confusion. On the one hand, many individuals who have been experiencing substance abuse have a preference for a certain drug or drug type. On the other hand, a main key to addiction treatment is treating the addiction itself rather than a specific drug of abuse. However, for some purposes, the drug of abuse is relevant, such as in the medicated detox process.
Take, for example, a person who has a history of prescription opioid abuse (e.g., pain relievers such as Vicodin or heroin). From an addiction treatment standpoint, the opioid abuse is significant to the medicated detox phase of treatment because there are certain research-based therapies available for withdrawal from this drug type (known as medication-assisted treatment, or MAT). This targeted treatment approach will be discussed below.
What Is Medicated Detox?
There are least two kinds of detoxification approaches: natural detox and medical detox (also called medicated detox). Stated most simply, detox is the process by which drugs are eliminated from a person’s system. The natural detox approach is often referred to as going cold-turkey. However, a cold-turkey detox is seldom, if ever, advisable for certain drugs of abuse. Rather, the prevailing wisdom is that individuals should undergo medicated detox if they are abusing certain types of drugs, such as opioids, benzodiazepines, and alcohol. Medicated detox can occur in different settings, including but not limited to:
- A rehab center that is equipped with a detoxification facility
- A hospital with a detoxification facility
- A standalone detoxification facility
- A clinic or other community service setting that offers this service
When talking about medicated detox, the topic of MAT must be addressed. Again, MAT involves the use of targeted prescription medications. These medications may be introduced during the detox phase but can also be used on a long-term basis to support ongoing recovery. The following is a list of medications that can be used during the medical detox phase of recovery from opioid abuse:
- Buprenorphine (in the form of Subutex or Suboxone)
- Naloxone (Note: This is not used during the detox phase but rather in the event of an opioid overdose.)
The following is a list of MAT medications that are approved for use during medical detox from an alcohol use disorder:
The following is a list of MAT medications (all of which are benzodiazepines) that may be used during detox from a sedative use disorder (i.e., benzodiazepine addiction):
- Valium (the generic is diazepam)
- Klonopin (the generic is clonazepam)
- Xanax (the generic is alprazolam)
- Ativan (the generic is lorazepam)
There are numerous benefits associated with undergoing medicated detox, if a doctor or addiction specialist recommends one. First, research shows that MAT can relieve the symptoms of withdrawal, including cravings for the drug. This is a particularly significant benefit because it means that medical detox can help to prevent relapse. As the National Institute on Drug Abuse notes, there is a 40-60 percent drug abuse relapse rate. There is a significant risk of relapse during the withdrawal process, but there are numerous safeguards in place during medical detox that can prevent one from happening. In addition to the use of medications, there are medical supervision and efforts to keep the recovering person comfortable, safe, and motivated.
Second, medical detox can prevent the onset of severe withdrawal symptoms. Withdrawal from opioids, alcohol, and benzodiazepines can be particularly dangerous. In some instances, especially when a person withdraws suddenly, severe symptoms, such as seizures, comas, or depressed respiration, can occur and possibly lead to a fatality. The use of medications can prevent severe symptoms from emerging or help to effectively manage them if they do.
Third, medical detox is not detoxification in the strict sense of the word. Since MAT involves medications, it is more accurately referred to as substitution therapy in some cases. A person is safely transitioned onto a safer drug, such as Suboxone in the case of opioid substitution therapy. Some individuals will, over time, undergo a full detoxification (i.e., no more of the drug or the MAT drug is in the system). In other instances, a person may remain on an MAT drug for weeks, months, or a longer period.
Fourth, there is a strong recommendation in the field of addiction treatment services that individuals commit to the recovery process from the very start. At the same, however, it is well observed that individuals, as a side effect of the addiction, may lack the motivation to fully engage in the initial process. During medical detox, addiction treatment staff can psychologically support a person going through this process. With each day of abstinence that passes, the benefits of treatment have a stronger ability to take root. In this way, a person who was not initially enthusiastic about detoxification and recovery may transition into a much more accepting mindset and develop the desire to actively engage.