A History and Guide to Medical Detox for Addiction
Why we Use Medical Detox
When a person is addicted to drugs and alcohol, their brain and body become accustomed to the substance. If they are not exposed to the substance within a certain amount of time, they will start to experience withdrawal symptoms. Any substance that a person takes that affects the chemicals in their brain can cause withdrawal symptoms if a person takes enough of the drug (or alcohol) for a significant amount of time. Even medications that don’t give off a high will result in withdrawal symptoms, but they may not be as profound or potentially life-threatening as withdrawal from drugs and alcohol can be.
Drug Dependence vs Drug Addiction
There is a difference between drug dependence and drug addiction. For example, a person with a severe disorder that causes pain – such as cancer – may take large amounts of pain-relieving medications to manage their pain.
They would experience withdrawal symptoms if they stopped taking the medication because their bodies are dependent on the drug. However, drug addiction is a loss of control over how much or how often a person uses a particular substance.
Also, use of illegal drugs like methamphetamine and heroin have no known medical purpose in the quantities people abuse them in. They are highly addictive, and can lead to withdrawal symptoms when a person uses them regularly. If taken in excessive quantities, they can lead to overdose and death.
The Fear of Withdrawal
Sometimes a person wants to stop using drugs and alcohol, but fears that symptoms that come with the detox process. In addition to physical symptoms, strong cravings can take over and cause a person to relapse. Also, a person may not understand what symptoms are normal and when they are almost to the end of or peak of their detox, they relapse not knowing how close they were to feeling better. For this reason, drug rehabilitation programs offer medical detox services. The history, concept, and practice of medical detox will be discussed in this article.
The Symptoms of Withdrawal
When a person abuses substances like alcohol, opiates or heroin, the substances work on specific parts of the brain to create a certain effect. For example, alcohol works on GABA receptors in the brain to slow down certain processes in the body and depress the central nervous system. Therefore, when a person withdraws from drugs or alcohol, they often experience effects that are the direct opposite of what using the drug does.
Withdrawal from alcohol can be a life-threatening occurrence. For this reason, most rehabilitation experts will recommend a person undergo the detoxification process in a medical treatment facility, such as a hospital or medical rehabilitation location.
According to the U. S. National Library of Medicine, a person will typically start to experience alcohol withdrawal symptoms within eight hours of stopping drinking. Their most acute symptoms will last about 24 to 72 hours. However, a person may notice they experience continued symptoms associated with alcohol withdrawals for several weeks.
Examples of alcohol withdrawal symptoms may include:
- Appetite loss
- Difficulty sleeping
- Hand tremors
- Mood swings
- Trouble thinking clearly
However, some people going through alcohol withdrawals experience a severe form of withdrawals known as the delirium tremens or DTs (2). This can cause symptoms such as high body temperatures, seizures, hallucinations, severe confusion and agitation. These symptoms can be life-threatening if a person does not receive treatments as quickly as possible.
Heroin is an opioid drug that is produced from poppy plants. When a person uses heroin, it elicits a highly euphoric effect that can make a person’s limbs feel heavy and give a warm, flushed feeling to the skin. Although the withdrawal effects from heroin are not as life-threatening as alcohol withdrawals can be, some of the symptoms may include:
- Cold flashes and goosebumps
- Difficulty sleeping
- Severe muscle pain
- Uncontrolled leg movements
A person will also experience strong cravings for heroin that can be difficult to control if they do not have medication or psychiatric support to get through the most acute cravings.
Withdrawal from Opiates
Opiates are pain-relieving medications. These include morphine, fentanyl, Dilaudid, Demerol, and more. They work on opiate receptors in the brain, which can cause not only pain relief, but also slowed breathing rate and feelings of euphoria when taking the medication. While the medications have a medical purpose, they are subject to addiction and abuse. A person may take an excessive amount of these pills or use them in ways unintended, including snorting or crushing and injecting the medications.
While a person rarely dies from opiate withdrawal, the withdrawal effects can be unpleasant and difficult to withstand. Examples of these symptoms include:
- Difficulty sleeping
- Muscle aches
Some doctors may describe opiate withdrawals as being a flu-like illness. However, the withdrawal from opiates can be dangerous if a person experiences severe nausea symptoms, such as prolonged diarrhea or vomiting and becomes dehydrated.
The Types of Detox
Medical detox is an umbrella term for many different medical-assisted options that help a person detox from different drugs. Some people may prefer a fast approach to detox while others may prefer (or require) a slower one.
For example, people who are addicted to benzodiazepines (such as Klonopin, Valium or Ativan) are at risk for seizures if they attempt to detox too quickly. As a result, their detox process must be slower and controlled.
Inpatient vs Outpatient Drug Detox
Sometimes, drug detox programs may divide their services by inpatient and outpatient options. Inpatient detox is when a person will stay at a rehabilitation facility to receive medical care, medications, and mental health support while they detox. This approach is by far the most common detox type. The next approach is outpatient detox, where a person may visit a rehabilitation facility on a daily basis.
Other detox programs may be specific to a particular substance abused. For example, there are programs geared specifically toward detox for the following symptoms:
Other detox programs may be divided by time. For example, drug rehabilitation facilities may offer short-term detox services. These services may be anywhere from a few days to a week so a person can get through the most acute symptoms of their withdrawal. There are also long-term detox services where a person will take medications on a regular basis – sometimes months or longer – to promote long-term sobriety.
It’s okay if a person isn’t sure what type of detox they need. A person can discuss with the experts at a drug rehabilitation facility what approach may be best, given a person’s history of abuse as well as their personal medical history, such as any chronic conditions.
What Is Medical Detox and How Does It Work?
Medical detox is the use of medications and medical support to bring a drug- or alcohol-dependent person to a non-dependent state.
According to the National Institute on Drug Abuse, medical detox is often the first (but not the last) step in addition treatment.
This involves receiving medication management and support while a person is undergoing detoxification from drugs and/or alcohol.
By administering these medications, a person is less likely to experience severe withdrawal side effects. Ideally, medical detox will help a person complete their treatment program and emerge as a sober individual. Also, medical detox may help reduce a person’s fear toward quitting drugs and alcohol.
The First Step
The first step to medical detox is the intake process. A person will meet with a facility’s medical professionals to discuss their drug abuse history and other medical conditions. Other considerations will include if a person has gone through drug detox before and how long a person can stay in treatment. A rehabilitation expert will use this information to create a medical detox plan. While this plan can be changed at any time during a patient’s stay, it can serve as a basis for starting the program.
Begin the Program
Next, a person will begin the program. They will stop taking drugs or drinking alcohol, or they will taper the dosages they are currently taking. They may take drugs intended to reduce withdrawal symptoms or take medications that can treat symptoms, such as nausea.
Detox is Different for Everyone
How long it takes a person to detox can depend upon the type of drug or drugs abused. For example, heroin is a very short-acting drug, so it will not stay in a person’s system for very long. However, some medications are longer-acting and may take more time to withdraw from.
Even if a person completes a medical detox program and becomes fully sober, they still have many aspects of their addiction to learn about and contend with. They also have a mental addiction as well as physical cravings. For this reason, medical detox is only the first step in treatment for a person who has struggled with addiction.
The History of Medical Detox
The history of medical detox has involved many experimental therapies that were quickly discarded. According to the American Medical Association, early medical detox treatments involved placing patients in an unconscious state, allowing them to withdraw from drugs without being awake.
Examples of early medical detox programs include “bromide sleep treatment,” “insulin-induced hypoglycemia,” or “hibernation therapy.” Not only did these approaches prove ineffective in helping a person stay sober, they were also dangerous and difficult to control.
However, doctors and researchers continued to make strides toward safer medications and approaches for medical detox. Examples include the FDA approval of medications such as methadone and clonidine, which can be used to enhance opiate withdrawal over the course of several days. Clonidine is a medication that helps to suppress the signs and symptoms of opioid withdrawals. While these medications are effective in the short-term, they
In 2002, the FDA approved the medication buprenorphine to treat opioid dependence. This medication allows a person to lessen the symptoms and cravings of opioid withdrawal without requiring frequent blood testing as methadone can. Those who take buprenorphine are also less likely to overdose as those who take methadone.haven’t proven a long-term relapse prevention strategy for some people struggling with drug and alcohol abuse.
Today, researchers are testing additional medical detox approaches for potential effectiveness. One example is an “ultra-rapid” detox where a patient is heavily sedated or under general anesthesia. An anesthesia provider administers medications that will cause a person addicted to opiates to rapidly withdraw from opioids. After the medications are administered, a patient is awakened and has already undergone the withdrawal process. However, there are concerns about the safety of this approach as well as the long-term effectiveness.
As long as substance addiction and abuse is a concern, researchers will continue to seek out new ways to help a person enhance the recovery process and stay sober long-term.
When Is Medical Detox Typically Used?
Medical detox is appropriate for any person struggling with addiction. While the FDA may not have approved detox medications for every substance abused (such as methamphetamines or cocaine), a person may still experience nausea symptoms associated with these withdrawals. As a result, they can benefit from medication administration of anti-nausea medications as well as the psychological support that medical detox can provide.
Treatments are typically individualized based on the type of substance abused. For example, heroin abuse is often treated through prescription medications that can reduce opioid withdrawals. One example is the medication lofexidine, which is FDA-approved to reduce opioid withdrawal symptoms. Other medications a doctor may prescribe to treat heroin addiction include methadone and buprenorphine. These medications can block the same opioid receptors as heroin, but they do not elicit the same euphoric effect as using heroin does. This can reduce withdrawal symptoms and cravings without a person continuing to abuse heroin.
Evidence of Effectiveness
Limited data exists on the effectiveness of medical detox programs. This is often because there are many different approaches to detoxification and patients must be followed on a long-term basis to determine if medical detox can play a key role in assuring lasting sobriety.
Additionally, drug and alcohol relapse rates are high regardless of if a person participates in a medical detox program or not. Therefore, researchers must work to establish a working definition of effectiveness as it relates to the substance abuse treatment world.
One such effectiveness study is found in the Journal of the American Medical Association. The journal article assigned heroin-dependent patients to one of three treatment approaches. The first was an anesthesia-assisted rapid detoxification process; the second was buprenorphine-assisted detoxification, and the third was clonidine-assisted detoxification.
The researchers measured outcomes after several days in treatment, including withdrawal severity, and also 12-week sobriety rates . After the study, the researchers found that anesthesia-assisted withdrawals were no more effective than using buprenorphine or clonidine.
The authors also found that retention in a drug treatment program did not differ among the three approaches. After three weeks, the dropout rate was 50 percent and at the 12-week point, the dropout rate was 82 percent. The study’s authors found what many other rehabilitation experts know about drug treatment: When a person does not engage in continued rehabilitation after medical detox, they are highly likely to relapse.
The study cited another article that found if a patient remained on a buprenorphine maintenance program, the retention rate was 75 percent, but patients who participated in a 6-day buprenorphine treatment program only had a 0 percent sobriety rate one year later .
This is not to say that medical detox programs are not effective. They are effective at helping a person detox from substance abuse by minimizing withdrawal effects. However, they are truly only the first steps in maintaining long-term sobriety. A person should continue their journey by engaging in therapy, 12-step programs, or other medication management strategies.
Where Can I Find Medical Detox?
Medical detox programs are widely available across the United States at drug and alcohol rehabilitation facilities. If a person is unsure of where to start, or you have a loved one that struggles with drug and alcohol addiction and are hoping to help them seek treatment, calling us can be the start of a new, sober lifestyle.