Detoxification is the first part of the rehabilitation process for recovery from addiction. It is often followed by some kind of behavioral therapy, medication and continued support.
Detox can be defined as the process of clearing toxins from the body of a patient who is dependent on substances of abuse. It’s designed to manage the symptoms of withdrawal that follow cessation and to help patients overcome physical dependency.
In some situations, withdrawal from a substance of abuse can be life threatening. Detox centers and addiction rehabilitation centers are safe environments where health professionals use medications and other techniques to ease the withdrawal process and safely manage the side effects of withdrawal.
“Detox is part of addiction treatment,” said Dr. Glen Hanson, former interim director of NIDA and director of the Utah Addiction Center. You’ve got to get the drugs out of the body to figure out where you are. Not only in terms of the brain, but in terms of the rest of the body: the heart, the cardiovascular system, liver, everything is affected by these drugs.”
Withdrawal is different for everyone. The duration of the detox process and the types of medications used will vary based on the type of addiction a person is suffering from, their personal and family history, and the resources available at a facility.
It’s important to remember that detox does not treat the underlying behavioral, environmental or genetic causes of addiction. It is the first step in the treatment process and should be followed by education, therapy and other long-term support services.
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When a person uses alcohol or other drugs for an extended period of time, his or her body becomes dependent on the presence of the substance. The brain gets used to the way the drug affects it, and it adapts so it can function normally. Eventually, a person builds tolerance, meaning they have to consume higher doses of the drug to feel the same effects.
Tolerance usually leads to dependence, which means the body starts to require the drug to function normally. When the person doesn’t consume the drug, the body reacts negatively, causing headaches, fevers, vomiting and a number of other side effects called withdrawal symptoms. The body also starts to crave drugs when it doesn’t receive them.
Cravings and withdrawal symptoms make it difficult for people to abstain from alcohol or other drugs. Fortunately, medically supervised detox can get patients through withdrawal safely. Over time, the body relearns to function without the drug, and the cravings subside.
In less severe situations, patients can receive medication and supervision on an outpatient basis. When someone has a severe substance use disorder, he or she should receive 24-hour supervision and medical assistance at an inpatient detox center or drug rehab facility.
Examples of drugs that can cause addiction or dependency requiring supervised detox include:
Recovering from addiction can be difficult and dangerous without assistance. Supervised detox increases a patient’s chance for long-term recovery and provides a safe environment during the first phase of recovery. Detoxing at home or by using untested products is risky.
If you’ve been unable to stop using alcohol or other drugs the obvious way, by trying to abstain, it’s unlikely that detox kits will eliminate your withdrawals or cravings.
Medications designed to help you overcome addiction undergo clinical trials and require U.S. Food and Drug Administration approval. They’re prescribed by trained physicians. You can’t find proven cures on the counters of grocery or supplement stores.
The biggest demand for drug detox kits comes from individuals trying to pass drug tests for employment, probation or other requirements. They’re usually trying to beat a urine test, but there are also drug detox hair shampoos supposedly designed to beat hair tests.
The most common kits include drug detox drinks or pills that contain vitamin C, niacin, vinegar, lecithin, goldenseal and a variety of herbs. Research indicates that none of these ingredients increase the body’s ability to detox from drugs, according to the University of Columbia.
At best, detox drinks and kits might keep you hydrated and provide nutritious vitamins or minerals. But drinking water and eating a well-balanced diet is a cheaper and easier alternative for maintaining health.
DR. GLEN HANSON, FORMER INTERIM DIRECTOR OF NIDA, DIRECTOR OF THE UTAH ADDICTION CENTER
In general, detox is a three-step process: evaluation, stabilization and preparation for future treatment. Patients may also learn about addiction, attend therapy sessions or attend support group meetings during detox. However, those are complementary treatments and are not stages of detox.
Evaluation usually involves a questionnaire, a physical exam, blood tests and a screening for co-occurring mental health disorders or other medical conditions. Therapists will determine a person’s psychological state and the strength of a person’s support system during evaluation. A physician will then develop a treatment plan using that information.
Patients should be prepared for additional treatment following detox. The most uncomfortable physical side effects of recovery usually occur during detox, but detox does not prepare patients for the psychological challenges they will face afterward. Health professionals should educate patients about the importance of beginning therapy, entering a 12-step program or finding some form of long-term treatment to increase their chances of recovery.
The majority of health care professionals, public health officials and addiction experts support the medical model of detoxification. The Substance Abuse and Mental Health Service Administration’s principles of effective detox were built on the medical model, which incorporates a combination of care, including nursing staffs, medication and physician supervision during detox.
The social model of detox does not include medication or medical care. It relies on emotional care in a supportive environment to help individuals get through withdrawal. Examples include 12-step programs and support groups.
Many addiction treatment facilities use a combination of medical and social care. Patients at these facilities may attend support group meetings such as Alcoholics Anonymous or Narcotics Anonymous while receiving medically supervised treatment.
Regardless of the model being used, SAMHSA has developed overarching guidelines for effective detox. The guidelines are:
The social and medical models of detox are similar in that each emphasizes safety and wellness. Despite best intentions, other techniques can be dangerous.
Quitting cold turkey is probably the most common way people hooked on alcohol or other drugs try to achieve sobriety. The cold-turkey technique is hazardous when someone is dependent on a substance, though.
“When a person is addicted or dependent on drugs or alcohol, stopping cold turkey can be challenging,” said Dr. Kevin Wandler, chief medical officer of Advanced Recovery Systems. “For alcohol and some drugs, quickly stopping can be life threatening or cause the individual to have seizures.”
Compared to tapering or slowly decreasing consumption, the withdrawal symptoms are more agonizing when someone tries to quit cold turkey. If someone has a severe addiction to alcohol or benzodiazepines, quitting cold turkey can be deadly.
Ultra-rapid detox techniques were developed in the early 1990s to ease withdrawal symptoms for people dependent on heroin or other opioids. However, numerous studies have found that ultra-rapid detox doesn’t ease withdrawal and it can cause other risks to patients.
Ultra-rapid detox involves sedating patients while giving them a medication that causes rapid withdrawal. The belief was that patients would sleep through the worst parts of withdrawal.
However, studies found that when patients woke up they experienced withdrawal symptoms similar to those of patients who didn’t receive the treatment. The method did not accelerate the detox process, and patients with pre-existing medical conditions such as diabetes, heart disease, HIV/AIDS or co-occurring mental health disorders were at risk for complications.
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The goal of medication-assisted detox is to rid the body of dangerous substances and make the patient feel as comfortable as possible. A physician or a trained support staff comprising nurses and other behavioral health experts oversees the detox process.
Most medications treat side effects of withdrawal such as headaches, fevers, nausea, seizures or tremors. There are no medications that quicken the body’s ability to get rid of drugs, but some medications can reduce cravings.
Doctors prescribe benzodiazepines to treat anxiety, sleep problems and symptoms of alcohol withdrawal. Benzos are the drug of choice for patients detoxing from alcohol, but they’re more commonly used at inpatient facilities than outpatient centers because they have a high potential for abuse.
The drugs can prevent seizures and delirium, and they relieve tremors and anxiety. Benzodiazepines used during detox include:
Health professionals usually prescribe long-acting benzodiazepines such as Valium during alcohol detox, but short-acting drugs such as Ativan or Serax may be preferred for patients with liver problems.
The drugs may also be used to reduce anxiety during hallucinations caused by hallucinogens, such as LSD. After patients are stabilized, they’ll be tapered off the benzodiazepine over the course of several days. Quitting a high dosage of benzodiazepines abruptly can cause dangerous side effects.
Anticonvulsants are used to prevent seizures or lower the risk for seizure. They’re commonly used during detox from alcohol and benzodiazepines. Anticonvulsants can also stabilize mood in patients with bipolar disorder.
Anticonvulsants used during detox include
Pregnant women undergoing detox should be warned that anticonvulsants have been associated with malformations.
Addiction specialists use antipsychotics to treat agitation, delusions, hallucinations and delirium during detox. They’re also commonly used to treat symptoms of psychosis in patients affected by co-occurring mental health disorders, but they can increase the risk of seizure in some patients.
Antipsychotics are commonly used during detox from alcohol, and they’re rarely used to control psychotic symptoms caused by hallucinogens. Haldol (haloperidol) is one of the most common antipsychotics used during detox. Detox centers tend to stay away from older antipsychotics, such as Thorazine (chlorpromazine), because they’re more likely to reduce seizure threshold, making patients more vulnerable to seizures.
Antidepressants are commonly prescribed to patients with co-occurring mental health disorders, but they can cause unpleasant side effects, such as drowsiness, high blood pressure and loss of consciousness. A newer class of antidepressants, called selective serotonin-reuptake inhibitors, can cause anxiety, drowsiness and insomnia. Additionally, people who stop using the drugs abruptly can experience a range of withdrawal symptoms.
Still, the drugs can be beneficial for patients suffering from severe depression or experiencing suicidal thoughts. SSRIs are usually preferred because they have weaker side effects and fewer drug interactions.
Patients detoxing from amphetamines or hallucinogens often experience depression during withdrawal, so they’re more likely than those detoxing from other drugs to receive antidepressants.
Some sedating antidepressants, including Oleptro (trazodone) and Tofranil (imipramine), are occasionally used during detox to treat insomnia. However, they must be used cautiously because they can increase the risk of seizure in some patients.
Health professionals used to regularly administer barbiturates to treat withdrawal symptoms from alcohol or other sedatives, but the drugs are used sparingly today. Barbiturates can treat symptoms of withdrawal, but they are highly addictive, interact dangerously with alcohol and have the potential for fatal overdose.
Phenobarbital is the only barbiturate that SAMHSA experts recommend using during detox, but it should be used sparingly. It may be the drug of choice for patients detoxing from benzodiazepines or multiple substances when treatment with other benzodiazepines is inappropriate.
The blood pressure drug clonidine is occasionally prescribed to patients detoxing from multiple substances. In patients with heart problems or high blood pressure who are detoxing from alcohol , clonidine can weaken some withdrawal symptoms. It doesn’t reduce risk of seizure or delirium, though.
During opioid detox, clonidine can reduce some symptoms, but it’s commonly used with other medications because it isn’t as effective as methadone or buprenorphine. Clonidine is uncommonly used to treat minor symptoms of benzodiazepine withdrawal. The FDA has not approved the drug for treatment of withdrawal symptoms, but it’s often prescribed off-label.
Methadone, a prescription opioid, is the most commonly used medication for detox from other opioids. Only certified methadone clinics can prescribe methadone for opioid detox. The drug eases withdrawal symptoms and cravings. It’s also addictive, and when methadone is abused it can cause withdrawal symptoms, cravings and overdose. That’s why the use of methadone during detox is highly regulated.
Detox using methadone begins with a certified physician finding an appropriate dosage to curb withdrawal symptoms. The dose is then tapered for three to five days, with 5- or 10-milligram reductions each day. Patients with more severe addictions may require methadone maintenance therapy, a long-term treatment for addiction.
Buprenorphine is a newer drug that experts believe may replace methadone as the preferred medication for opioid detox. A buprenorphine injection called Buprenex is FDA approved for opioid detox. Other forms of buprenorphine, such as Subutex and Suboxone, are approved for addiction treatment, but they are not approved for use during detox.
Buprenorphine reduces withdrawal symptoms and is much safer than methadone. However, it does present a low risk of causing euphoria or respiratory depression. Certified doctors can prescribe the drug for outpatient detox.
Patients may experience a diverse array of withdrawal symptoms during detox. Health professionals often prescribe medications to treat withdrawal symptoms as they occur.
Common medications or supplements prescribed during detox include:
Doctors and nurses try to make patients as comfortable as possible while also considering potential drug interactions and side effects cause by additional medications.
The detox process begins with an assessment. Medical professionals will ask questions to learn about a patient’s medical history, history of substance abuse and the severity of the condition. They’ll screen patients for co-occurring mental health disorders, infectious diseases and nutritional deficiencies. Many facilities also screen patients for skin conditions, tuberculosis, oral health deficiencies and physical trauma.
After learning more about the patient, a physician or addiction specialist will develop a plan to make him or her as safe and comfortable as possible. At inpatient facilities, the patient will be assigned a room and monitored around the clock for about a week. At outpatient facilities, physicians or therapists will create a plan and schedule of appointments.
Despite the best efforts of health professionals, detox can be agonizing. But once it’s complete, patients are healthier and better able to focus on the next phase of treatment. The specific treatment approaches used during detox vary based on the substance or substances of abuse.
Detox from moderate or severe alcohol use disorders requires intense supervision and monitoring. Withdrawal from alcohol usually begins between six and 24 hours of the last drink, and it can begin when a person still has alcohol in their blood.
Symptoms of alcohol withdrawal include:
Without medical supervision, alcohol withdrawal can be deadly. It can cause life-threatening blood pressure, heartbeat or fever. Seizures and delirium tremens can also lead to death.
Patients detoxing from alcohol without medication will receive personal support, water and food in a safe environment. Nonmedical techniques may be applicable and cost-effective for individuals with mild alcohol use disorders and no previous experience with alcohol withdrawal.
However, individuals with moderate or severe alcohol use disorders, long histories of alcohol abuse or a history of experiencing withdrawal symptoms require medical treatment.
Medications used during alcohol detox include:
Other medication assisted treatments, such as naltrexone and acamprosate, can be introduced near the end of detox, but they do not treat withdrawal. They aim to decrease the chances of relapse and increase the chances of successful treatment.
Withdrawal from opioids causes extremely unpleasant side effects, but it’s rarely life threatening. Illicit opioids such as heroin and prescription opioids, such as oxycodone, fentanyl and codeine, cause similar withdrawal symptoms. However, the type of drug influences the severity and length of symptoms.
Heroin withdrawal usually starts between eight and 12 hours after the last dose, and detox from heroin addiction usually takes between three and five days. Methadone withdrawal occurs about two days after the last dose and gradually worsens. Detox from methadone dependence takes at least three weeks.
Symptoms of opioid withdrawal include:
During opioid detox, patients should receive medications to ease withdrawal symptoms. Abstaining from medically assisted detox causes unnecessary pain and suffering, according to SAMHSA.
Medications used during opioid detox include:
Opioid detox is often complicated by the presence of intravenous diseases, such as tuberculosis, HIV/AIDS and some sexually-transmitted diseases. Other medications may be prescribed to treat co-occurring medical conditions.
Detoxing from benzodiazepines is very serious. As with alcohol withdrawal, seizures and delirium are the most dangerous side effects of benzodiazepine withdrawal. Elderly patients are also at risk for falls and heart attacks.
Patients detoxing from benzodiazepines should always do so with medical supervision, according to SAMHSA. The best approach to detox is to taper off the drug because quitting cold turkey can cause severe side effects. Depending on the dosage, tapering from benzodiazepines can take weeks or months. The tapering schedule should be flexible. If withdrawal symptoms worsen, the patient’s dosage should be increase until he or she stabilizes.
Health professionals may prescribe a different benzodiazepine to taper off, or they may prescribe shorter-lasting benzos such as Librium or Klonopin (clonazepam). Other medications used to treat withdrawal symptoms during benzodiazepine detox include anticonvulsants and antidepressants.
Inpatient detox is preferable to outpatient detox because withdrawal symptoms are severe. If outpatient detox is the only option, patients should meet with therapists or physicians multiple times per week, especially during tapering periods.
The protocol for detoxing from illicit stimulants, such as cocaine and methamphetamine, is similar to detoxing from prescription stimulants, such as Adderall or Ritalin. In general, it’s seen as less dangerous than detoxing from alcohol, benzodiazepines or opioids.
However, stimulant withdrawal can cause intense depression, which can lead to suicidal thoughts. Symptoms of depression usually last longer during amphetamine withdrawal than during cocaine withdrawal. Withdrawal usually lasts three to five days, but some symptoms can persist for three to four weeks. Other medical complications, such as heart arrhythmias or heart attacks, can stem from recent binges.
Symptoms of stimulant withdrawal include:
Stays at inpatient detox centers are usually brief, and intensive outpatient detox can be effective for patients who can avoid cue-induced cravings. There are no medications currently approved for stimulant detox, but sedatives and SSRIs can be used to treat withdrawal symptoms.
Access to safe places to sleep, eat and hydrate are essential because many patients in recovery from stimulant abuse are sleep deprived, hungry and dehydrated.
There is some debate about the severity of withdrawal from heavy marijuana use. Some scholars discredit the existence of a THC withdrawal syndrome, but a 2001 study found evidence that withdrawal syndrome exists among heavy users.
THC withdrawal occurs about 24 hours after the last consumption. Frequent symptoms of marijuana or THC withdrawal include:
Less common symptoms include tremors, sweating, nausea, vomiting and elevated heart rate. Medications are rarely used during detox. Suicidal ideation is the most concerning medical issue associated with marijuana detox, but it usually stems from other mental health problems. Withdrawal symptoms decrease with time and usually vanish after one week.
The goal of medically supervised detox for marijuana is to provide a safe, comfortable environment free of triggers for cravings. It’s also an opportunity to educate patients about the addictive nature of marijuana and to refer them to counseling and therapy.
The length of detox differs for everyone. Several factors affect the length of detox, including:
Patients feel the most intense symptoms of withdrawal during the first days or week of detox. The early symptoms of withdrawal include physical side effects, such as diarrhea, vomiting, muscle pain, fever and tremors. Medication can ease many physical side effects.
When a person is addicted or dependent on drugs or alcohol, stopping cold turkey can be challenging. For alcohol and some drugs, quickly stopping can be life threatening or cause the individual to have seizures.DR. KEVIN WANDLER, CHIEF MEDICAL OFFICER, ADVANCED RECOVERY SYSTEMS
However, psychological side effects of withdrawal can last weeks or months. Psychological symptoms include insomnia, depression and anxiety. Health professionals usually use a combination of medication and therapy to help patients overcome psychological symptoms of withdrawal.
Detoxification centers are facilities that specialize in guiding patients through the first stage of the recovery process. The centers conduct evaluations, teach patients to overcome cravings, treat side effects of physical withdrawal and prepare patients for future therapy.
Detox centers provide patients with acute, or short-term, therapy. They do not provide the types of comprehensive treatment plans that drug rehab facilities provide. Some detox centers offer referral services for continuing treatment, but it is up to the patient to continue treatment after detox.
The treatment at detox facilities includes managing symptoms of withdrawal, offering guidance or advice and providing a safe environment in which patients can overcome cravings. Withdrawal from some drugs can be life threatening, so detox centers employ nurses and other certified staff members.
Common settings for detox include:
Detox centers have different specialties. Some centers offer only alcohol detox and others provide a wide range of addiction services. Detox centers may treat different genders or age groups, and they may have different religious affiliations. However, the highest-quality treatment centers possess common characteristics.
The best detox facilities perform extensive evaluations or assessments before beginning detox. Physicians, nurses or certified staff members screen for medical conditions, co-occurring mental health disorders and other health conditions. They determine the severity of a patient’s addiction and develop a detox plan specific to his or her needs.
Detox centers should provide medication to curb cravings and ease withdrawal when possible. They should also prepare patients for future therapy and offer referrals to therapists, support groups or other aftercare support organizations in the community.
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Before choosing a detox center, determine if you need inpatient or outpatient detox.
Outpatient detox includes regular appointments to check in with nurses or staff members and to receive medication. It offers more freedom for patients to attend work or school, but it is also riskier for individuals who might face temptations during daily life.
Inpatient detox provides a safe environment with around-the-clock supervision. It offers more structure and stability. A physician, therapist or counselor can help you determine whether inpatient or outpatient detox is best for you.
The best detox centers have high rates of success. Federal agencies judge success on how well a center prepares patients for future treatment and how often patients continue treatment after detox.
Read online reviews and ask for opinions from people who have attended the detox center. You can visit a local support group for peer advice or ask your family physician or current therapist for a recommendation.
Staff members should possess reputable certifications from colleges, universities or professional organizations such as the American Board of Addiction Medicine. Centers should also have a physician and licensed nurses on staff.
Make sure the detox center is in a location far from high-risk areas such as bars, clubs or neighborhoods known for drug trafficking. It might also be helpful if the center is close to supportive family members or friends.
Make sure that the detox center is the best one for you before beginning treatment. Ask the following questions to determine if the center is right for you.
Individuals recovering from addiction rarely maintain long-term sobriety if they decline to seek treatment after detox. Relapse rates are much lower for patients who attend therapy sessions, join support groups or access some other form of aftercare support.
Still, relapse is a common obstacle on the path to recovery. People in recovery needn’t be ashamed to return to a detox center or rehab facility if they relapse. Supervised detox is just as important after relapse as it is during a person’s initial treatment.
Usually, therapy can’t begin until a patient has rid his or her body of drugs and stabilized. Once they’re free of drugs or alcohol, behavioral therapy teaches patients to change behaviors that lead to addiction. That may mean avoiding things that cause certain stressors or avoiding people who are negative influences.
Some forms of therapy teach patients the underlying causes of addiction, such as genetics, environmental factors or mental health disorders. This allows them to recognize warning signs of relapse. Other therapeutic techniques help patients find motivation and rewards for maintaining sobriety.
Support groups are filled with real-life examples of people who have maintained long-term sobriety. Individuals in recovery often find inspiration from peers and gain access to a unique support system that can guide them through during difficult times.
Some support groups make sure every person has a sponsor — someone who can be called on at any time of day to offer support. The groups may also feature 12-step programs, which help many people begin and maintain sobriety.
If you’re trying to recover from addiction, develop a long-term treatment plan before attending a detox center. Find a therapist, counselor or rehabilitation center and schedule an appointment before you enter detox.
It might also be helpful to find a support group in your area to join after detox. Find the group’s meeting schedule, and determine how often you will be able to attend meetings every week.
It’s also important to be honest with family and friends. Ask them for their support after detox. Ask them to avoid pressuring you to use alcohol or other drugs or to avoid using them in your presence. If they’re unwilling to agree to those terms, plan on avoiding them and making new friends after your stay in detox.