Guide to Drug Detox

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What Is Drug Detoxification?

Drug addiction is a multilayered psychosocial phenomenon, and for this reason, there should be little surprise to learn that the drug detoxification process can be equally complex. Detoxification, most simply, involves the elimination of drug or alcohol substances from the body. While there is no single crowning definition that encompasses every facet of drug detoxification, the Washington Circle Group (WCG) provides an insightful and workable definition.

WCG is composed of experts in the field of alcohol and drug abuse who share a professional mission to track medical efforts in the field of drug treatment as a means of improving drug prevention, recognition, and treatment on a national scale.[1] According to WCG, detoxification is a medical intervention process that safely helps a substance abuser through the experience of acute withdrawal.[2] The WCG is careful to note that detoxification is a means to an end (recovery), but not an end in itself; after detoxification, recovering drug abusers can best aid the recovery process by entering and staying in a treatment plan.[3]

Identifying the Drug Problem

The drug epidemic in America is multifaceted. While it is a critical first step to look at the face of addiction, the next is to consider whether drug abusers are finding their way into treatment. As long as there is not a 1:1 ratio of drug abusers to persons in treatment, America continues to have a drug problem. In 2009, according to the Substance Abuse and Mental Health Services Administration (SAMHSA, an agency within the U.S. Department of Health and Human Services), 23.5 million people age 12 or older were in need of treatment for an illicit drug or alcohol problem, but only 2.6 million of these people were in treatment at specialty centers.[4]Drug abuse continues to carry a social stigma, and it is often not a transparent activity (family, friends, and colleagues are often in the dark or in denial and may not recognize a person’s drug abuse until it reaches the tipping point). For this reason, one of the most reliable sources of information on drug abuse comes from emergency room intakes. SAMHSA oversees the Drug Abuse Warning Network (DAWN). DAWN is a public health surveillance system that requires SAMHSA to review emergency room visits from participating hospitals that involved recent drug use.[5] The DAWN review encompasses many drugs, such as illicit drugs, over-the-counter drugs like cough suppressants, prescription drugs, alcohol (in some instances), and inhalants with mind-altering effects.[6]
The 2011 DAWN findings included the following:
  • Drug problems continue to rise. Of all 125 million emergency room visits falling within the purview of DAWN guidelines, more than five million visits were drug-related (including misuse and non-misuse) – a 100-percent increase from 2004.
  • Age remains a factor in drug use. In the age group of 6-11 years, drug-related emergency room visits amounted to 288 per 100,000 in the population compared to 2,477 visits per 100,000 in the population aged 18 to 20 years.
  • In the 18-20 age group, drug misuse is often the reason for the drug-related emergency room visit. For instance, in the 18-20 age group, while 2,477 overall had a drug-related visit, over 1,500 presented with drug misuse or abuse.
  • The trend of drug misuse exists across most of the age groups studied. Of all the age groups studied, there was greater drug misuse than non-misuse in the following age categories: 12-17, 18-20, 21-24, 25-29, 30-34, 35-44, and 45-54.
  • The incidence of drug misuse is high. Approximately 2.5 million of the emergency room visits that were drug-related involved drug misuse or abuse.[7]

The reality of SAMHSA’s findings is that however effective DAWN may be in collecting data, the actual occurrence of drug misuse and abuse must be even higher. DAWN helps to present a baseline measure of the drug problem in America, and the results are a testament to the need for ongoing drug intervention and treatment, which can be commenced with detoxification services.

The Detoxification Process

Detoxification is widely considered to be the first step in drug treatment. For a drug addict, the psychological burden of detoxification is apparent. Not only may he fear the loss of the drug itself, but also the possibility of undesirable physical, emotional, and mental effects due to the withdrawal. Withdrawal symptoms usually occur when the body becomes habituated to a substance that is consumed over a long enough period of time and then either stopped completely or radically reduced in dosage.

Medical professionals should be consulted prior to beginning any course of detoxification. In many cases, those undergoing detox should be supervised by consulting physicians to ensure health and safety throughout the process.

The following are some general withdrawal symptoms based on some commonly abused drug types:

Withdrawal Signs

Benzodiazepines:
including Valium, Ativan, and Xanax
Symptoms
sedation, palpitations, hand tremors, sweating, panic attacks, anxiety, and sleep problems

Opioids:
including heroin, morphine, and prescription pain medications such as OxyContin
Symptoms:
sweating, muscle aches, agitation, diarrhea, abdominal cramping, and vomiting

Synthetic Drugs:
synthetic marijuana (street names: “Spice” or “K2)
Symptoms:
frequent users may experience withdrawal symptoms

Stimulants:
cocaine and amphetamines
Symptoms:
sleepiness, muscle pain, anxiety, tremors, low mood, and, in some cases, suicidal ideations or cardiovascular problems

Club Drugs:
hallucinogens (LSD), GHB, MDMA/Ecstasy, Ketamine, and PCP
Symptoms:
serious physical and mental health complications

 

 

Medically Managed Detoxification

Medical professionals trained in detoxification treatment can help treat undesirable effects of withdrawal. Often, the detoxification process includes medications to manage unpleasant withdrawal symptoms and thus make the process safer and more tolerable for the patient. Drug detox management medications can be administered both at inpatient and outpatient facilities.

Medication treatments for withdrawal are linked to the particular type of substance that was abused, the length of time of abuse, and the volume of intake. Some common types of treatments, based on particular drugs, are as follows:

  • Opioid withdrawal. The U.S. Food and Drug Administration has approved both methadone and buprenorphine (forms include Subutex and Suboxone) for treatment of opioid addiction.[13]
  • Benzodiazepine withdrawal. Strategies include the patient continuing to take benzodiazepines in gradually decreasing amounts, switching to another benzodiazepine, or phenobarbital substitution.[14]
  • Stimulant withdrawal. There are no FDA-approved medications acting as antagonists for cocaine addiction treatment. However, inpatient detox programs may utilize benzodiazepines to treat withdrawal from cocaine and methamphetamines. Although benzodiazepines can be addictive, they are prescribed to calm the effects of stimulant withdrawal largely because of the lack of other medication alternatives.[15]


Risks of Quitting Cold Turkey

For many, the method of self-detox, popularly known as “quitting cold turkey,” does not involve medical intervention, and it can lead to fatalities in some cases, such as when a person is a longtime alcohol abuser, benzodiazepine user, or withdrawing from long-term use and/or high amounts of methadone.[16] Users of these drug types therefore will likely require medically supervised detox programs.

Drugs, such as cocaine, amphetamines, and nicotine, do not tend to cause fatality in the withdrawal process, but they can still nonetheless present severe difficulties for the person quitting cold turkey and medical attention should be considered.[17] A serious complication of quitting cold turkey is the relapse factor. The effect of quitting cold turkey is that the body loses its tolerance for the previously abused substances, and if those substances are then reintroduced into the body at the level of prior consumption, there is a high risk of overdose, which can cause death or other serious negative side effects.[18]

Detox Is Necessary but Not Sufficient for Recovery

Recovery from drug addiction is often aptly described metaphorically as a journey on a long road – and the road can be as long as a lifetime. Detoxification is a critical first step, though it will feel like a huge leap for most. The detoxification process addresses the physical dimension of addiction, but still it most often takes months for the brain to return to normal functioning and successfully manage cravings.[19]

Addiction specialists are in near unanimous agreement that detoxification should occur in specialized detoxification facilities.[20] There are several benefits to being in a medically supervised detoxification program, which can effectively:

  • Stem cravings, as care is supervised and medications may be available to temper any drug abuse impulses
  • Administer medications to help with any uncomfortable or severe effects of withdrawal
  • Provide a support system that acts as a soothing mental balm for the emotional and psychological challenges detoxification can present[21]
  • Offer comforting amenities and non-addiction-forming treatments, including a diet that complements the detox process, nutritional supplements, and pain relievers for body aches and other physical ailments


Beyond Detox

A 2012 John Hopkins study found that while the relapse rate post-detox is 65 to 80 percent, recovering drug addicts who remained in treatment were 10 times more likely to stay drug-free.[22] The level of time commitment to treatment is also an important factor. Research demonstrates that there is a direct correlation between the length of time in treatment and rate of relapse. In other words, a commitment to treatment has a high rate of return for recovering drug abusers and can be an effective way to combat the perilous odds of relapse.[23]
Treatment must be controlled for quality. The recovery process is not only about being in treatment, but also about being in an effective treatment program. The National Institute on Drug Abuse has provided the following guidelines to assist recovering drug abusers and their loved ones in evaluating the effectiveness of treatment programs:

  • Treatment plans should not be based a one-size-fits-all approach and must be appropriately tailored to the patient’s needs.
  • Treatment plans should interact with the patient not only on the physical level of addiction, but also take into account her psychology, social background, and even factors such as age, culture, gender and occupation.
  • A treatment plan should not be static. It must be periodically reviewed and revised, as necessary, to be most responsive to the patient’s needs.
  • Many patients have a Dual Diagnosis of drug addiction and mental health disorder(s), and treatment should address all known diagnoses.
  • Treatment does not have to be voluntary; involuntary treatment does not present a barrier to successful recovery.[24]


Beyond Treatment

Addiction is a chronic disease; in addition to the physical aspects, the psychological and social aspects require healing. Graduation from a drug treatment program does not signal the end of healing. At most, it means that the supervised part of recovery has come to a conclusion, and the program graduate must now apply all the tools and insights culled during treatment. The avoidance of relapse – or stated affirmatively, the continued pursuit of abstinence – is a preeminent concern post-treatment. It is important that the recovering person build a healthy infrastructure for her life. The following measures can be taken to further ensure ongoing and successful recovery:

  • Engage in healthy social settings that are not reminiscent of the days of using drugs.
  • Spend time with people who are drug-free and provide a healthy social network.
  • Remember the structured living environment of treatment and use it as template or guide to create a schedule that supports the healthy use of time.
  • Actively maintain motivation to avoid falling into stale routines that may lower mood and invite relapse.[25]

In addition, participation in a 12-Step program like Narcotics Anonymous (NA) program can be another healing resource as attending meetings essentially provides therapy at the community level. The faith-based program has long garnered attention as it can bring about a personal transformation that not only can help a drug abuser over to the side of abstinence, but also help him to stay there. The program is based on anonymity, and for this reason, there is little empirical research available about its effectiveness.[26] However, the program continues to grow in popularity; in 1978, there were fewer than 200 registered groups in three countries, but by 1994, groups were holding 19,822 weekly meetings in 70 countries.[27]

In view of the interrelation of many recovery treatment factors for drug abusers, a treatment strategy focused on drug detoxification alone would be myopic and not properly address the possibility of relapse. In the short term, the goal of detoxification is the elimination of drugs from the body system, but even this critical step must comprehend the need for a long-term effective treatment plan. Detoxification, treatment, and aftercare measures can work successively to address each facet of addiction to ensure that abstinence is not only achieved but also maintained.

If you’d like more information on how you or your loved one can effectively address a Dual Diagnosis, and how detox factors into the recovery process, contact us today. Our admissions coordinators are available to help you find the best treatment option for your situation.

Citations

[1] McCorry, F. et al. “Developing Performance Measures for Alcohol and Other Drug Services in Managed Care Plans.” Joint Commission Journal on Quality Improvement (2000) p.4. Accessed July 10, 2014

[2] ibid, p. 11.

[3] Ibid.

[4] “Drug Facts: Treatment Statistics.” drugabuse.gov. (2011) Accessed July 10, 2014.

[5] Substance Abuse and Mental Health Services Administration(SAMHSA), U.S. Department of Health and Human Services (HHS) “Drug Abuse Warning Network, 2011: National Estimates of Drug Related Emergency Room Visits.” Rockville, MD: SAMHSA (2013). Accessed July 10, 2014.

[6] Ibid.

[7] Ibid.

[8] “Opiate Withdrawal.” nlm.nih.gov (n.d.). Accessed July 10, 2014.

[9] Petursson, H. “The Benzodiazephine Withdrawal Syndrome.” Addiction 1994 Nov, 89(11) 1455-9. National Center for Biotechnoly Information. Accessed July 10, 2014.

[10] “Stimulant Abuse, Cocaine and Mental Illness.” nami.org (n.d.). Accessed July 10, 2014.

[11] SAMHSA, HHS, Detoxification and Substance Abuse Treatment Improvement Protocol (TIP). Rockville, MD: SAMHSA (2006). Accessed July 10, 2014.

[12] “Drug Facts: Spice (Synthetic Marijuana).” drugabuse.gov (2012). Accessed July 10, 2014.

[13] SAMHSA, Detoxification and Substance Abuse Treatment Improvement Protocol (TIP).

[14] Ibid.

[15] Ibid.

[16] Jaffe, A. “Alcohol, Benzos, and Opiates – Withdrawal that Might Kill You.” Psychology Today (2010). Accessed July 10, 2014.

[17] Hartney, E. “What are the Risks of Quitting Cold Turkey?” About.com (2011). Accessed July 10, 2014.

[18] Ibid.

[19] Sack, D. “Home Detox: What’s The Worst That Could Happen?” Psych Central (2014). Accessed July 10, 2014.

[20] Ibid.

[21] Ibid.

[22] Ibid.

[23] Sack, D. “How Long Does Addiction Recovery Take?” Psych Central (2012). Accessed July 10, 2014.

[24] nih.gov (1999). Accessed July 10, 2014.

[25] White, D. “5 Ways to Avoid Addiction Relapse.” Psych Central (2013). Accessed July 10, 2014.

[26] “Facts About Narcotics Anonymous.” nanj.org (n.d.). Accessed July 10, 2014.

[27] Ibid.

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