Detox and Withdrawal Management
The American Society of Addiction Medicine and other organizations, such as the World Health Organization, have replaced the familiar term detoxification (or detox) with the term withdrawal management in many of their stated policies and in their clinical literature.
This change might be confusing to some. For many people, it appears to infer that a new approach has taken place in treatment policies. This article will briefly discuss how these terms relate to one another and how and why they are used.
The Strict Definition of Withdrawal and Detox
- The withdrawal process occurs when an individual is not used to having their regular dosage of a particular drug, and their system is thrown out of balance after learning to adjust itself to the presence of the drug in the tissues. This state results in a number of negative symptoms occurring. Withdrawal symptoms are often a barrier to individuals attempting to recover from substance use disorders, as they trigger strong cravings to use one’s drug of choice. Once the person uses again, the symptoms of withdrawal will quickly abate.
- Detox is the physical process where the body is cleansed of toxins, such as drugs. Detox occurs regularly, mainly via the liver as the person’s system eliminates various substances, waste products, etc. Detox occurs in the presence or absence of a withdrawal syndrome. The detoxification process occurs continuously. If an individual has stopped taking drugs altogether, withdrawal symptoms may appear, depending on the types of drug that they have used regularly. The detoxification process is a mandatory step in recovery from a substance use disorder.
- For many individuals who are involved in the treatment of substance use disorders, the terms detox and withdrawal have become synonymous, even though the withdrawal syndrome occurs as a part of a broader detoxification process.
Withdrawal management refers to the medical and psychological treatment of individuals who are experiencing a withdrawal syndrome due to either reducing their use of a particular drug or totally ceasing their use. This definition was used by the World Health Organization (WHO) in 2009 and was most likely used prior to that by other organizations.
WHO began using the term withdrawal management in place of the term detoxification because it was noted that the term detoxification had many different definitions and did not translate well outside of the English language. The American Society of Addiction Medicine (ASAM) also replaced the term detoxification with the term withdrawal management. ASAM explains in the glossary of the ASAM Criteria: “The liver detoxifies, clinicians manage withdrawal.”
In the last year, it appears that ASAM has also replaced the term detoxification with the term withdrawal management in all their supplementary guidelines for the management of withdrawal symptoms from different types of substances. It appears as if ASAM finds this term more descriptive of their policies for practice; however, the use of the two terms merely appears to represent a semantic difference. There appears to be no real major policy changes or shifts in treatment practices simply associated with the practice of medically assisted detox as a result of the switch in terms.
Subsequently, other sources have also used the term withdrawal management to describe the medical management of withdrawal symptoms that result from the development of physical dependence on specific drugs. The terms detoxification, detox, and withdrawal management remain synonymous to many, and the choice to use any particular term appears to be associated with one’s affiliation.
ASAM’s Approach to Treatment and Withdrawal Management
The current standard of care for the treatment of substance use disorders by ASAM involves a multistep approach that consists of six phases:
- Comprehensive Assessment and Diagnosis: Individuals are subject to a comprehensive medical history, physical examination, and appropriate diagnostic testing to determine all issues associated with their complaints.
- Withdrawal Management: If the person has developed a physical dependence on a drug, they are placed in a withdrawal management program. The ASAM withdrawal management program follows a medical model of treatment that utilizes physicians and nurses.
- Treatment Planning: Comprehensive treatment plans are developed to assist the individual in recovery.
- Treatment Management: Treatment is implemented and supervised in order to make sure that the program runs in accordance with the goals for treatment derived in the planning phase.
- Care Transitions and Care Coordination: Compliance with rules and regulations and privacy concerns are of extreme importance to ensure the safety of the individual in treatment and that the quality of care is maintained.
- Continuing Care Management: Following acute treatment, efforts are made to ensure that the individual continues to engage in a proactive treatment program and receive support.
The withdrawal management portion of the treatment outlined by ASAM consists of three standards of care:
- Determining the person’s withdrawal management needs: The need for withdrawal management is assessed in the first phase of the treatment process, and the level of withdrawal management services and appropriate treatment environment for the client is determined.
- Providing medical interventions: Physicians use empirically validated measures for both intoxication and withdrawal symptoms, if present, to determine the appropriate medical intervention. Typically, medical interventions include medications, a tapering schedule, and other medically based approaches.
- Determining appropriate psychosocial interventions: In addition, the withdrawal management approach uses empirically validated psychosocial interventions, such as therapy, stress reduction, approaches to manage individuals who are intoxicated, etc.
ASAM views the withdrawal management process as an important step in the complete care of an individual with a substance use disorder. Even though it has changed its terminology, it still recognizes the need for long-term aftercare following withdrawal management or detox. The change in terms from detox to withdrawal management is not associated with any significant changes in the approach or the treatment policy of the organization, although treatment approaches are always evolving.