What is Detoxification?
Detoxification is the safe managing of withdrawal symptoms and the treatment of substance dependence in an individual. It is also a starting point of seeking help for many addicted individuals and for those who have become dependent on a substance. Depending on your situation, you may need detox if you are addicted to a drug or not. Most types of detox clinics provide medically assisted detox. According to the NIDA, “Medical detoxification safely manages the acute physical symptoms of withdrawal associated with stopping drug use.”
Why Would Someone Need Detox?
Someone could need detox if they are:
- Experiencing physical and/or psychological withdrawal symptoms from a drug
- Dependent on alcohol, drugs, or another substance
- Experiencing withdrawal symptoms that are so severe that it is unsafe for them to go through these symptoms without medical supervision
- Addicted to and currently still abusing a substance
IMPORTANT: You should remember that medical detox is not a cure for addiction. In fact, the NIDA states that “medically assisted detoxification is only the first stage of addiction treatment and by itself does little to change long-term drug abuse.” It can, however, be a good first step in helping an individual attend the treatment needed for drug addiction, but it will not change compulsive, drug-seeking and taking behavior on its own.
What Happens in Detox?
So far, the medical model of detox has been discussed. In general, there are actually two types of detox, according to SAMSHA.
- “The medical model of detoxification is characterized by the use of physicians and nursing staff and the administration of medication to assist people through withdrawal safely.”
- “The social model relies more on a supportive non-hospital environment than on medication to ease the passage through withdrawal.”
Some people do choose to go through withdrawal at home and not in a clinic. While there are outpatient detox clinics that allow patients to come and go freely every day from treatment, some patients need 24-hour care. Medications can also be very necessary as well.
For a medical model detoxification clinic, treatment begins with evaluation. The patient is evaluated by the medical staff, and it is decided which medications are needed at which dosages to help the patient through withdrawal from the substance. SAMHSA also states that this stage includes:
- “Testing for the presence of substances of abuse in the bloodstream”
- Screening for mental and physical disorders or conditions that the patient may have which co-occur with the addiction
- An assessment of the patients “medical, psychological, and social situation”
After the evaluation process is complete, the patient starts the stabilization process. This is, ideally, where the doctors and nurses “assist… the patient through acute intoxication and withdrawal to the attainment of a medically stable, fully supported, substance-free state.”
This stage is different for every individual, and although eventual abstinence from substances and a medication-free state are the goals of detox, it can take anywhere from a few weeks to a few months to several years for some patients to attain it. Depending on the drug and the treatment, every patient must be allowed to work through the stabilization process in their own time.
However, for most detox facilities, these are not the only types of treatment available. Patients are often encouraged to attend other types of behavioral treatments during detox in order to promote addiction treatment afterward. This prepares patients for addiction treatment and is very necessary to the process of their overall recoveries. Many detox facilities do provide other treatments to set up for addiction treatment once the patient is stable. These treatments could include:
- One-on-one therapy
- Group therapy
- Family therapy
- Vocational counseling
- Support groups
- Nutrition classes
- Socialization classes
Pros of Medical Detox
Medically assisted detox can be a beneficial treatment for addicts as well as drug-dependent individuals. Anyone who is experiencing withdrawal symptoms from substance use or abuse could consider detox; it is merely necessary to determine if it is right for you as an individual. Here are some of the pros of medical detox:
- Withdrawal will be milder and more easy to deal with so that you can focus on the other aspects of your dependence/addiction.
- There are many detox facilities all over the country, and you may attend whichever type works best for you.
- Inpatient detox clinics which provide 24-hour care for individuals going through extreme withdrawal symptoms
- Outpatient detox clinics where a patient can attend treatment, get their medication, etc. and still be able to go home every night
- Detox is usually very helpful in providing treatment that starts a patient on the right path to addiction treatment and recovery (therapy, etc.).
Cons of Medical Detox
While medical detox can be very beneficial for many patients, there are still some drawbacks to this treatment. Some of the cons are:
- Detox alone is not a treatment for addiction. Many patients sometimes believe it is and leave treatment after detox.
- Relapse is still possible after detox and, because the person’s tolerance for the drug will be very low at this point, overdose and death are even more likely. In fact, according to the NLM, “Most opiate overdose deaths occur in people who have just withdrawn or detoxed.”
- The philosophy of many detox clinics is still “complete drug abstinence as a goal” (ONDCP). We as a society have come to realize that this is not always the case.
While there are issues with medical detox, the treatment is not completely without merit. And, when done correctly, it can be a quick and effective way of getting patients from dependent states to being ready for addiction treatment. However, many patients will require long-term maintenance on a drug rather than detox programs. In any case, drug dependence treatment should always be specialized for the individual patient’s needs.
Is Medical Detox for Everyone?
No. Medical detox is not a necessary treatment for a person hoping to end their addiction to a substance. However, it can be a great starting point or tool for those who are working toward abstinence. While that possibility isn’t attainable or necessary for every individual, there are maintenance programs like methadone maintenance that are similar to detox in stabilizing the patient but do not necessarily have the eventual goal of complete abstinence.
Detox for Specific Substances of Abuse
There are a few overarching principles in any type of detoxification service, according to SAMHSA, such as:
- “Detoxification services do not offer a ‘cure’ for substance use disorders.”
- “Patients should be treated in a nonjudgemental and supportive manner.”
- “Patients should be treated with due consideration for individual background, culture, preferences, sexual orientation, disability, vulnerabilities, and strengths.”
The third of these informs specific detox clinics and programs which are specifically set up for certain groups, such as:
- Children and teens
- LGTBQA individuals
- People with co-occurring psychological disorders
However, every detox process is different, especially for those of different substances. Depending on the drug abused, the amount the person took, and the time they had been addicted/dependent, detox may take more or less time and require different amounts of medication. Every individual’s detox treatment regimen is different, but there are some similarities based on the drug abused.
According to SAMHSA, “Opioids are highly addicting, and their chronic use leads to withdrawal symptoms that, although not medically dangerous, can be highly unpleasant and produce intense discomfort.” Some of these withdrawal symptoms include:
- Flu-like symptoms (runny nose, chills, fever)
- Abdominal cramps
- Muscle and bone pain
- Vomiting and nausea
There are actually three types of medications that are used to manage these effects. They are:
Clonodine is often used in detox before a patient starts formal addiction treatment, although the other two options are viable and are used to treat opioid addiction itself as well.
Alcohol withdrawal can actually be very dangerous and, in “a severe form of alcohol withdrawal called delirium tremens,” can even cause death (NLM). Some of the symptoms of alcohol withdrawal and of delirium tremens are:
- Clammy skin
- Mood swings
According to the NLM, treatment for alcohol withdrawal includes:
- Watching the patient closely for signs of delirium tremens
- Blood tests
- “Testing and treatment for other medical problems linked to alcohol use”
- Sedating the patient using benzodiazepines until the withdrawal phase is over
It depends on how strong the individual’s withdrawal symptoms are whether or not they will need complete sedation throughout most of the withdrawal period.
SAMHSA states that “cocaine and amphetamines (such as methamphetamine) are the most frequently abused central nervous system stimulants.” However, many individuals also abuse prescription amphetamines that are commonly prescribed to treat ADHD and other disorders in order to get high and also to focus on work. This is common among college students, and many become addicted to them.
Withdrawal symptoms from stimulant abuse include:
- Cravings (often the strongest cravings of all drugs of abuse)
- Trouble concentrating
There are actually no medications proven to treat stimulant withdrawal at this time, but certain medications are being researched currently as a possible option. According to SAMHSA, “The most effective means of treating stimulant withdrawal involves establishing a period of abstinence from these agents.”