A Complete Overview of Medical Detox for Drug and Alcohol Addiction
What is Medical Detox?
Detoxification, or detox, is the process of withholding drugs or alcohol to allow all traces of the substance to leave your body. Medical detox is a medically supervised detox program for people who are dependent on drugs or alcohol.
Prevent and Treat Withdrawal Symptoms and Complications
Medical detox involves medications that help reduce the severity of withdrawal symptoms, prevent or treat complications and improve comfort and well-being during detox. But Medical Detox serves a bigger purpose as well: Without treatment after detox, the chances of staying sober for the long-term are low. Medical Detox helps motivate clients to enter treatment following the detox process.
How Dependence Develops
Addiction and dependence are not the same. Addiction is characterized by compulsive drug use despite the negative consequences it causes. It’s the result of changes in the brain’s physical structures and chemical functions.
Chronic drug abuse can cause the brain’s memory, learning and motivation centers to communicate in a way that causes intense cravings and compulsive drug-seeking behaviors. These brain changes lead to dysfunctional thought and behavior patterns that further perpetuate the addiction.
Dependence is characterized by withdrawal symptoms that set in when you stop using substances. Drugs and alcohol are psychoactive substances, which means that they act on the brain’s chemical messengers, known as neurotransmitters.
Different substances have different effects on different neurotransmitters, including dopamine, GABA, serotonin, glutamate, and norepinephrine.
With heavy drug or alcohol abuse, the brain tries to compensate for the effects of these substances on neurotransmitters by increasing or reducing neurotransmitter activity.
For example, alcohol, a depressant, increases the activity of GABA, which is responsible for feelings of well-being and calmness. It reduces the activity of glutamate, which is responsible for feelings of excitability. Chronic alcohol abuse leads the brain to compensate by reducing the activity of GABA and increasing the activity of glutamate. The result of this is tolerance.
Tolerance means that it takes increasingly larger amounts of alcohol to get the desired effects. But as you drink more, the brain continues to compensate by increasing glutamate activity and decreasing the activity of GABA. At some point, brain function may shift so that the brain begins to operate more comfortably when alcohol is present.
When you suddenly stop drinking, normal neurotransmitter function rebounds. Glutamate (excitability), which was suppressed by alcohol, now floods the brain. GABA (calmness), which was increased by alcohol, is reduced.
This rebounding of chemical activity causes physical withdrawal symptoms. The withdrawal symptoms produced by a certain drug depends on what neurotransmitters the drug effects and how it affects them.
Withdrawal Symptoms Associated with Common Drugs
Withdrawal symptoms can range from mild to severe, and they can last anywhere from a few days to several weeks or longer. Not everyone will experience all of the possible symptoms of withdrawal from a particular drug. During medical detox, medications can help reduce the severity of symptoms and shorten the duration of detox. The severity of withdrawal symptoms and the time it takes to detox depend on a number of factors:
- Your age
- How much of the drug is in your system at the time of detox
- Your general state of physical and mental health
- Your unique biological and genetic makeup
Different drugs produce different withdrawal symptoms, although one symptom all psychoactive drugs have in common is cravings. These often persist long after detox is complete. The four most common types of drugs for which people undergo detox are alcohol, stimulants, sedatives, and opioids.
Central Nervous System Sedatives
Prescription sedatives include benzodiazepines like Klonopin, Xanax, and Valium. Sedative withdrawal symptoms typically set in within 24 hours after the last dose. Some symptoms associated with sedative withdrawal can be dangerous, and in some cases, they can be fatal.
Symptoms of sedative withdrawal include:
- Heart palpitations
- Nausea and vomiting
- Muscle aches
- Dizziness and confusion
- Anxiety and panic attacks
- Tingling in the arms or legs
- Dangerous increases in blood pressure and heart rate
- Suicidal thoughts
Because there are no medications that can treat the dangerous symptoms of sedative withdrawal, detox from these drugs is a tapering-off process that involves reducing doses over time to prevent withdrawal from occurring altogether.
Central Nervous System Stimulants
Stimulants include illegal drugs like cocaine and methamphetamine and prescription medications like Adderall and Ritalin.
These drugs cause withdrawal symptoms that typically set in up to 24 hours after using.
Symptoms of stimulant withdrawal include:
- Deep depression
- Fever and chills
- Heart palpitations
No medications have been approved to treat symptoms of stimulant withdrawal, but antidepressants may be prescribed to reduce the intense depression that may occur.
Detox from stimulants typically takes one to two weeks, but depression and cravings can persist for much longer. Most people begin to experience an improved mood, better sleep and more energy around a month after quitting.
Alcohol withdrawal typically begins between two and 12 hours after the last drink.
Early symptoms of alcohol withdrawal include:
- Nausea and vomiting
- Profuse sweating
Mild hallucinations may occur between 12 and 24 hours after the last drink, but people who experience them know that they’re hallucinating. These usually end after 48 hours. Between 24 and 48 hours after the last drink, withdrawal seizures may occur. People who are at risk for seizures include those who have been through alcohol withdrawal before.
Severe alcohol withdrawal may occur between 48 and 72 hours after the last drink. Severe withdrawal is characterized by a condition called delirium tremens, or DTs, which can be very dangerous or fatal.
Symptoms of DTs include:
- Hallucinations that are indistinguishable from reality
- Confusion and disorientation
- Severe anxiety
- Increases in blood pressure, heart rate, and breathing rate
- Severe tremors
Medications used to treat alcohol withdrawal symptoms include central nervous system sedatives like benzodiazepines and anti-convulsant and anti-psychotic medications.
Opioids include heroin and prescription painkillers like OxyContin and Vicodin. While opioid withdrawal isn’t particularly dangerous, it can be extremely intense and uncomfortable. Symptoms of opioid withdrawal typically set in between eight and 48 hours after the last dose, depending on whether the opioids taken are short-acting, such as heroin and painkillers, or long-acting, such as extended-release opioid medications. Withdrawal from short-acting opioids generally lasts for four to 10 days, while withdrawal from long-acting opioids generally lasts for 10 to 20 days.
Early symptoms of opioid withdrawal include:
- Agitation and anxiety
- Muscle aches
- Runny nose
The flu-like symptoms of opioid withdrawal may be treated with a variety of medications, including:
- Methadone, which reduces the severity of symptoms – including intense cravings.
- Buprenorphine, which reduces the intensity of symptoms and shortens the duration of detox.
- Clonidine, which helps to reduce anxiety, agitation, and muscle cramps.
Later symptoms of opioid withdrawal include:
- Abdominal cramps and diarrhea
- Nausea and vomiting
- Chills and goosebumps
Other medications may be used to treat symptoms like:
Five Levels of Care for Detox
The American Society of Addiction Medicine identifies five levels of care for detox. During the initial evaluation process, a variety of criteria are used to place the client in the appropriate level of care.
- Level I-D: Ambulatory Detoxification Without Extended Onsite Monitoring. This level of care is outpatient detox, which involves living at home while undergoing detox. Clients visit an outpatient clinic or doctor’s office for regular monitoring.
- Level II-D: Ambulatory Detoxification With Extended Onsite Monitoring. This level of care involves day hospital services, where clients are monitored by licensed nurses before returning home each day.
- Level III.2-D: Clinically Managed Residential Detoxification. This level of care takes place at an inpatient facility but doesn’t involve medications. Rather, the focus is on around-the-clock support from peers and staff.
- Level III.7-D: Medically Monitored Inpatient Detoxification. This level of care also takes place in an inpatient facility, which may be a stand-alone detox center or a detox program that’s part of a comprehensive inpatient treatment program. Detox at this level is supervised by medical professionals. It involves medications that are given as needed to alleviate symptoms and prevent or treat medical emergencies related to withdrawal.
- Level IV-D: Medically Managed Intensive Inpatient Detoxification. This level of care is given through a hospital setting where intense medical care is provided around the clock to manage severe symptoms and prevent or treat complications of withdrawal.
Three Components of Medical Detox
According to the Substance Abuse and Mental Health Services Administration, a high-quality detox program will have three components: evaluation, stabilization and fostering readiness for addiction treatment.
The evaluation component of medical detox involves testing for substances in the bloodstream and screening individuals for co-occurring mental disorders like anxiety or depression.
A comprehensive medical and psychological assessment and an assessment of an individual’s social situation helps clinicians determine the appropriate level of care for detox. It also helps to guide addiction treatment following successful detox.
The stabilization period of detox involves assisting a client through detoxification and withdrawal to a medically stable, substance-free state.
During the stabilization period, medications may be administered as needed, and clients learn about their own role in treatment and recovery. A high level of emotional support is offered by staff, providers, and peers during this phase.
When it’s appropriate, and with the permission of the client, practitioners may seek the involvement of family members, friends, employers and other people significant in an individual’s life.
This gives clinicians a clearer idea of the client’s needs and issues that will need to be addressed in treatment.
Fostering Entry into Treatment
Detox addresses the physical dependence on drugs or alcohol only and does very little to address addiction, which is far more complex.
Without treatment, the chance of relapse after detox is very high. The fostering phase of detox involves preparing a client for entering addiction treatment by communicating the importance of treatment for helping to end the addiction.
Clients who have a history of undergoing detox but not following through with treatment may agree to sign a written contract to encourage entry into a treatment program.
Although this contract is not legally binding, it can help foster the client’s commitment to treatment and recovery.
Complementary Therapies Used During Medical Detox
Regardless of the level of care at which an individual is placed, an important focus during withdrawal is on providing clients with emotional and practical support.
A holistic approach to medical detox promotes a client’s physical, mental and spiritual well-being during the withdrawal process. Complementary therapies are increasingly becoming standard in quality medical detox programs.
These therapies are shown to help reduce stress, ease withdrawal symptoms and provide an added layer of support during detox. Complementary therapies also increase client engagement in detox and treatment.
Restorative yoga combines controlled breathing with long, gentle stretches. It brings the mind and body into the present moment, promoting mindfulness and helping to reduce cravings. Yoga has been shown to help prevent relapse through increased self-awareness and better control over emotions, according to an article published in the journal Substance Abuse.
Mindfulness meditation effectively reduces anxiety and depression, according to a study published in JAMA. It’s also a powerful on-the-spot stress reliever that also helps the body respond better to future stressors. Meditation reduces cravings by helping clients respond to the body’s cues and sensations with mindful awareness and accept them without judgment.
Acupuncture can help alleviate symptoms associated with withdrawal, including nausea, headaches, insomnia, anxiety, and depression, according to the National Institutes on Health. Acupuncture also reduces stress and improves the function of the body’s systems.
Massage therapy in detox reduces stress hormone levels, lowers blood pressure and heart rate, increases serotonin levels and alleviates feelings of depression and anxiety, according to the Center for Women’s Health at Massachusetts General Hospital. Massage also promotes relaxation and well-being.
Addiction and dependence often lead to poor nutrition, which can hamper detox and recovery. Nutritional therapy in detox involves consultation with a licensed dietician to identify any nutritional deficiencies and create a healthy eating plan. Good nutrition during detox helps to ease withdrawal symptoms, reduce cravings and improve sleep, according to the National Institutes of Health.
Developing a Post-Detox Treatment Plan
Once a client is medically stable and past the worst of withdrawal, the focus turns to actively preparing the client for treatment. This is an important step in detox because many clients believe that once all traces of drugs or alcohol have left the system, they’ve achieved abstinence. But research shows that most people who leave detox without getting help for the addiction relapse very quickly. In one study, published in the Irish Medical Journal, 91 percent of opiate-dependent people in a residential detox program relapsed following discharge – 59 percent within a week. Convincing clients to engage in treatment after detox dramatically increases their chances of achieving long-term abstinence. Fostering a readiness for treatment involves a variety of therapies and interventions.
An individualized treatment plan is essential for successful recovery, according to the National Institute on Drug Abuse’s Principles of Effective Treatment. Comprehensive assessments help identify the client’s strengths, vulnerabilities, characteristics, issues, and needs – all of which influence the treatment plan. A variety of assessments help determine:
- How ready the client is for change.
- Whether a mental illness co-occurs with the addiction, which indicates a need for dual diagnosis addiction treatment.
- Any missing coping skills the client needs to develop for a successful recovery.
- The level of support a client has at home and in the community.
- Underlying issues behind the addiction, which may include a history of trauma or chronic stress.
- Whether any medical issues need to be addressed.
- Whether the client has safe, stable housing.
- Any unmet vocational or educational needs.
- Whether the client has pending legal problems that need to be addressed.
- Whether the client has insurance and what it covers.
- Whether special treatment considerations are needed, such as trauma-informed treatment or a gender-specific program.
- The clients’ barriers to treatment, such as a lack of transportation or dependent children at home.
Armed with this information, treatment providers link the client to an appropriate treatment program and other essential resources that address the individual’s multiple needs and issues. Providers and clients work together to develop a comprehensive treatment plan that encompasses all areas of their lives.
Developing a Therapeutic Alliance
The therapeutic alliance is the quality of the relationship between a client and his or her care providers. An empathetic, supportive, non-judgmental and clinically appropriate therapeutic relationship predicts better treatment outcomes. During detox, providers will work to provide a high level of support and foster a positive, engaging relationship with each client.
Case Management Services
Case management helps providers tailor services to an individual’s unique needs and issues. It helps to minimize barriers to treatment and ensure access to a variety of services, including vocational or educational assistance, legal aid, and housing assistance. A case manager oversees the treatment plan and helps to coordinate services and link the client to them. Throughout treatment, the case manager reviews the plan periodically to identify changing and emerging needs. The plan is amended as needed as the client progresses through treatment.
Getting Into Treatment After Detox is Essential
Detox is the first step by addressing the physical dependence on drugs or alcohol but does little to help people recover from an addiction for the long-term. Without treatment, the risk of relapse is high. However, most people who engage in their treatment plan enjoy successful recovery, according to the National Institute on Drug Abuse.
A holistic treatment program offers the best possible outcomes of treatment, according to the Substance Abuse and Mental Health Services Administration. A holistic approach to treatment involves a variety of both traditional “talk” therapies and complementary therapies that help clients:
- Address the underlying causes that led to the substance abuse and addiction.
- Develop essential coping skills for handling cravings, stress and other relapse triggers.
- Identify self-destructive thought and behavior patterns and learn to think and behave in healthier ways.
- Find purpose and meaning in a life free of substance abuse.
- Learn to have fun and relax without drugs or alcohol.
- Repair damaged relationships and restore function to the household.
- Envision a desirable future and set goals to achieve it.
Inpatient vs Outpatient
The two main options for treatment are inpatient and outpatient treatment. While inpatient treatment offers the best outcomes for most people, outpatient treatment can work for some people. During detox, your care providers will work with you to determine the best type of treatment program for your unique needs and circumstances.
Hope is the Foundation of Recovery
The Substance Abuse and Mental Health Services Administration stresses that hope is the foundation of recovery. Hope is the belief that a better future is possible, and it can help sustain you through the inevitable challenges of recovery. Recovery from addiction is possible, and medical detox is the first crucial step. Medical detox is far more than medicating withdrawal symptoms. It’s a gateway to getting linked to an appropriate treatment program and all of the essential services needed to improve your life on all fronts.
A high-quality detox program followed by holistic treatment leads to whole-person healing and a higher quality of life for the long-term.