Detoxification

It’s the fear of detox that keeps a lot of people stuck on pills or heroin and it’s those shakes in the morning that hint at withdrawal and a detox to come that send us reaching for that first drink of the day.

Once we become dependent on our drug of choice, we are no longer free to stop using at our discretion – once we get addicted; we have withdrawal and detox to think about.

Through the chronic use of drugs or alcohol, we create enduring changes to our bodies and minds. The detoxification period is a period during which time the body returns to homeostasis – to a normal state of functioning.

During the detoxification period, as our body struggles to return to a normal state of functioning, we experience withdrawal symptoms. Withdrawal symptoms will vary depending on the drug we’re coming off, but they are almost always uncomfortable, sometimes even painful, and in some cases - can be dangerous.

Some people can endure a detoxification period on their own, but many people benefit from or require medical assistance, to make the period more humane and less dangerous. Medical detox interventions can include:

• Medications
• A dose tapering regimen
• Nursing care and observation
• Complete sedation and an accelerated withdrawal period
• Long term maintenance medications, such as methadone or Suboxone

Although withdrawal symptoms make the detox period difficult, enduring a detoxification is only a first tiny step down a road to lasting recovery. Detoxification is not a substitute for addiction treatment; detox simply readies a person to participate in addiction treatment. Some people chose to leave treatment after a detoxification, but sadly, these people are almost certain to relapse back to drug or alcohol abuse.

Withdrawal Symptoms

The brain always strives to return to its normal state of functioning.

If you continually take a substance (drugs or alcohol) that changes this state of functioning, the brain will in time adapt, in an attempt to retain normalcy.

It is this process that causes the development of a tolerance (the need to take more of a substance over time, to achieve the same intoxication) and it is this adaption that results in withdrawal symptoms upon sudden abstinence.

Different drugs cause different changes in the brain, and thus different withdrawal symptoms upon discontinuation of use.

Some common withdrawal symptoms for major drugs of abuse include:

• Alcohol  – anxiety, shakiness, nausea, insomnia, , seizures, others
• Opiates , codeine, Ultram or other opiate based analgesics) – nausea and vomiting, depression, aches and pains, insomnia, restless legs and others
• Stimulants (cocaine  or methamphetamine ) – anxiety, fatigue, hunger, depression and dysphoria, drug cravings and others
• Sedatives (benzodiazepines, Xanax  and others) – Anxiety, tremens, panic, insomnia, seizures and others
• Club Drugs (GHB , Ecstasy) - mood symptoms such as depression, anxiety and panic, as well as physical symptoms
• Marijuana – loss of appetite, insomnia, irritability, headache, cravings and others

The severity of drug and alcohol withdrawal symptoms can range from:

• Barely noticeable
• Moderately uncomfortable
• Very uncomfortable
• Dangerous/life threatening

People withdrawing from alcohol or certain sedative hypnotics should never quit cold turkey without medical supervision, to do so can lead to life threatening seizures, heart failure, coma and possible death.

Although an opiate detoxification can be exceedingly uncomfortable, the withdrawal symptoms of heroin, OxyContin, Vicodin and other opiate based analgesics are rarely dangerous.

Delirium Tremens (DT’s)

A small percentage of people in alcohol or benzodiazepine withdrawal will experience a syndrome of symptoms called the delirium tremens.

In addition to standard symptoms of alcohol withdrawal, people with the delirium tremens may experience symptoms such as:

• Hallucinations
• Fear and agitation
• Severe confusion and a lessening in cognitive capacities
  
• Bodily tremors
• Complete delirium (a loss of mental abilities)
• Increased sensitivity to stimuli
• Quick mood changes
• Seizures

You are more likely to get the delirium tremens if:

• You drink more than a pint of liquor per day for months in a row
• You have been alcohol dependent for more than a decade
• You have gone through alcohol withdrawal before

Left untreated, people with delirium tremens are in real danger of death - It is a medical emergency.¹

Marijuana Withdrawal – Is It Real?

Although many people will say that marijuana is a “non-addictive” drug, Harvard University researchers would disagree. In a study conducted in 2000, 60% of heavy marijuana users who quit smoking cannabis for 4 weeks experienced “significant symptoms of withdrawal” such as irritability, low mood, lack of appetite, anxiety and other symptoms. ²

Some options you have for the withdrawal period include:

• Cold Turkey – a white knuckle few days during which withdrawal pains are endured without assistance; not recommended for a detox from alcohol or sedatives, and generally very difficult for a detox from opiates

• Tapering – People physically dependent on medications can sometimes gradually reduce their daily dosage over a period of weeks, minimizing the shock to the body and thus reducing the experience of withdrawal symptoms. This can work well for people who are physically dependent on, but not abusing, medications such as opiates or sedatives, although people addicted to benzodiazepines will almost always need to slowly taper a dose down over time.

• Residential Medical Detox – People severely dependent on certain drugs and most people addicted to opiates, alcohol and sedatives will require a medical detoxification for a safe transition and a successful outcome. During a medical detox, patients benefit from around the clock nursing and care and the prescription of medications that can ease symptoms and increase safety.

• Outpatient Medical Detox – Some people may be able to detox medically on an outpatient basis, under the consultation and care of a doctor and with medications prescribed for symptoms as necessary.

• Rapid Opiate Detox - During a rapid opiate detox, opiate addicts are placed under anesthesia and given a cocktail of medications that accelerate the withdrawal period. Since this acceleration occurs while the patient is anesthetized, there is no discomfort. Rapid opiate detox sounds attractive, but remains very controversial; for its price tag, its efficacy and its potential risks

• Suboxone or Methadone - As an alternative to a detox, opiate addicts can substitute from a drug of abuse to a medication of stabilization, such as methadone or Suboxone.

The Medical Detox Center

The American Psychiatric Association’s recommended continuum of care is:

• Detoxification/stabilization
• Rehabilitation
• Continuing care

Although some residential treatment centers do have a detox clinic onsite - due to the specialized and clinical nature of the services offered during a detoxification period, people generally need to first go to a specialty detox clinic.

A medical detox center will have nursing staff available around the clock to administer doctor prescribed medications (such as benzodiazepines) and to ensure relative comfort.

Some detox clinics will offer initial addiction treatment programming, but the detox period is basically considered a readying/stabilizing period, so that people can begin addiction treatment once finished with detox.

Medications that are FDA approved for the treatment of acute withdrawal symptoms include:

• For alcohol – benzodiazepines or barbiturates
• For opiates – methadone, buprenorphine (Suboxone/Subutex), clonidine, naltrexone

There are no FDA approved medications for the treatment of cocaine, methamphetamine or marijuana withdrawal symptoms. ¹

Methadone or Suboxone

Both methadone and Suboxone are opiate medications that can be used as detoxification or addiction treatment medications.

These medications are used in one of 2 ways:

1. Very briefly, as medications to help reduce the severity of withdrawal symptoms during a medical detox
2. Over a longer period of time in a maintenance program of addiction treatment

Both methadone and Suboxone stimulate the opiate receptors in the brain and both can keep an opiate dependent person from feeling drug cravings or feelings of withdrawal – and at appropriate doses, neither medication produces any significant intoxication.

When methadone or Suboxone are used for maintenance treatment, drug withdrawal symptoms are delayed, sometimes indefinitely. People on maintenance treatment are clearheaded and sober and able to live and work without needing to get high. Maintenance treatment helps a person retake stability and health.

Eventually, most people decide to stop their maintenance treatment. To stop treatment, methadone or Suboxone doses are gradually reduced to minimize the eventual withdrawal symptoms, but at a certain dose, users must “jump off” and will still experience withdrawal symptoms.

• Methadone withdrawal symptoms are more severe and longer lasting than Suboxone’s withdrawal symptoms

Some people choose to stay on methadone or Suboxone indefinitely. These people have the lowest rates of relapse.

Neonatal Abstinence Syndrome (NAS)

Pregnant women who continue to abuse certain drugs can give birth to drug or alcohol addicted infants and these infants are at risk of NAS. Substances taken by pregnant women that can lead to NAS include:

• Opiates
• Alcohol
• Benzodiazepines
• Cocaine
• And others

NAS is a period of withdrawal symptoms endured by infants born to drug or alcohol addicted mothers, shortly after birth. The symptoms of NAS will depend on what drug the mother took, and how often/heavily she used it, amongst other factors.

Some possible symptoms of NAS can include:

• Fever
• Inconsolable crying
• Dehydration, diarrhea and vomiting
• Tremors
• Problems gaining weight
• Poor breast feeding ability
• Irritability
• Seizures
• Sweating
• Others

Babies going through NAS may need medication (like benzodiazepines or methadone) to reduce the severity of symptoms. Babies may also need help with feeding, to ensure adequate weight gain and may need IV fluids, in the case of severe dehydration.²

You very likely need a medical detox if you are physically dependent on:

• Alcohol
• Benzodiazepines
• Heroin
• Prescription opiates

Heroin and prescription opiates cause such severe and uncomfortable withdrawal symptoms that most people need assistance to avoid a return to opiate use. Alcohol and benzodiazepine withdrawal symptoms can be fatal in severe cases, and so medical attention (a medical assessment, at minimum) is always necessary.

You may need a medical detox if you are dependent on:

• Cocaine
• Methamphetamine
• Marijuana

Although these drugs do not cause dangerous withdrawal symptoms and although no medications are FDA approved for the treatment of cocaine, methamphetamine or marijuana withdrawal symptoms, these withdrawal symptoms can still be quite uncomfortable and some people require an observed detoxification for stabilization.

If you are experiencing withdrawal symptoms right now, you can gauge the severity of your symptoms with one of the following clinical scales tests:

• The Clinical Opiate Withdrawal Scale (COWS) Test

• The CIWA-Ar, an Alcohol Withdrawal Severity Test

These tests may help you to gain a better understanding of your situation but they should not substitute for a professional diagnosis. Withdrawal symptoms can be very dangerous and you need to speak to a medical professional about your best course of action.

Continuing Treatment after Detox

Too many people endure the discomforts of a detox period without committing to further participation in addiction treatment – and these people almost invariably relapse back to abuse.

According to the American Psychiatric Association, detoxification is a sometimes necessary phase of treatment for stabilization which readies a person to take part in the rehabilitation stage of care but which is not intended to produce “lasting sobriety”. ¹

Detox is not a cure; it simply readies a person to take part in a program of recovery. Research shows that the longer a person participates in addiction treatment, the better their chances of lasting recovery. Treatment options following a successful detoxification include:

• Residential addiction treatment (drug rehab)
• Intensive outpatient treatment
• Outpatient treatment and residency in a sober living house
• Continuing counseling
• Continuing participation in an AA or NA 12 steps group
• Others