Detoxification, or detox, is a procedure during which any drugs and alcohol, and their toxins, are flushed from someone’s body to treat acute intoxication. Detox is beneficial to mitigate the physical and psychological damage caused by long-term chronic substance abuse.
Medical detox treatment can be done through an inpatient or outpatient treatment program. There will be, at least, some level of medical support and monitoring. This includes the administration of medication as part of medication-assisted treatment (MAT) and medical maintenance therapy to keep the individual in detox both stable and in the least amount of discomfort possible.
Medical detox teams are also tasked with dealing with any kind of health complications that can happen during detox, whether this is due to withdrawal symptoms or other reasons relating to the individual’s overall physical or mental health.
The three stages involved in the process of medical detox treatment are as follows:
Admittedly, the idea of using drugs in a process that is meant to remove them from someone’s body can seem counterintuitive or even possibly harmful. As previously mentioned, detox medication is incredibly useful and is generally utilized to prevent harm, particularly when it comes to handling withdrawal symptoms. Withdrawal symptoms are often very unpredictable, depending on the substance in question, the severity of addiction, or if there is a co-occurring disorder present.
There is a wide range of different medications that have been officially approved by the U.S. Food and Drug Administration (FDA) for therapeutic use during the process of detox. These include prescription opioids to over-the-counter medications like ibuprofen. Detox medications are generally administered to help those experiencing very common, uncomfortable withdrawal symptoms that include:
Detox medications are also employed as a key part of medical maintenance therapy. This is the process of weaning someone off of a substance they have become dependent on by slowly reducing their dosage over time until it is deemed safe for them to stop using altogether.
It is generally referred to as a tapering schedule and is necessary for certain substances that are dangerous to try and immediately quit cold turkey, such as benzodiazepines and other central nervous system depressants that can cause delirium, seizures, and other life-threatening symptoms when not stopped via a tapering schedule.
Medication used in medical maintenance therapy can also help to subdue drug cravings and make the tapering process less of an ordeal.
Opioids, from prescription drugs like OxyContin to illicit ones like heroin, currently take center stage in the overdose epidemic that covers the United States. Undergoing detox from opioids is almost never a life-threatening experience, but is still usually very uncomfortable, with difficult and sometimes painful withdrawal symptoms. These symptoms include the previously listed common side effects of drug and alcohol withdrawal along with:
In combination, these symptoms can often border on intolerable, and occasionally be dangerous in the instance of certain flu-like symptoms such as diarrhea, vomiting, and sweating, which can lead to severe dehydration. This could become serious if the person in withdrawal is not being monitored by a detox staff.
The detox medications most commonly used in opioid detox treatment are other, substantially weaker opioids. These are used during medical maintenance therapy to help lessen drug cravings and slowly wean someone off of stronger, more dangerous opioids. Some of these opioid detox medications include:
Methadone has long been one of the go-to medications when it comes to opioid dependence. Methadone is a long-acting opioid whose half-life can be anywhere between 15 and 55 hours, depending on the amount administered. The amount of time it spends taking up space in the brain’s opioid receptors is, in part, why it is so useful in tapering therapy.
Tapering with methadone involves administering carefully monitored amounts of methadone to relieve cravings and withdrawal symptoms, replacing the much shorter-acting opioids like heroin and taking up space in the body and brain’s opioid receptors.
The goal is to have methadone replace the opioid that someone has become dependent on and, once that has been accomplished, lower the dosage of methadone with the eventual outcome of sobriety.
Methadone has been proven to be clinically effective when paired with counseling and behavioral therapy and has been in use for many years. However, its use is still a bit controversial since methadone does have active addictive potential, and so its administration must be strictly monitored by a medical professional. Generally, a doctor will try other detox medication first before turning to methadone.
Suboxone is the brand name medication that is a combination of buprenorphine and a different drug called naloxone. Unlike methadone and buprenorphine, naloxone is a “full opioid antagonist,” which means that it works against the effects of full opioid agonists and essentially deactivates the opioid receptors in the brain.
Because of this effect, naloxone is an extremely effective overdose reversal drug but is too strong to be prescribed on its own for someone in detox, as there are risks of triggering sudden, dangerously intense withdrawal symptoms. So instead, naloxone is combined with buprenorphine to create a detox medication that is meant to be less addictive than buprenorphine and less dangerous than naloxone.
Like naloxone, naltrexone is also an opioid antagonist, blocking out the effects of other opioids by binding to the brain’s opioid receptors without activating them. Also like naloxone, naltrexone is generally used to treat and reverse opioid overdoses, but it also can be used during addiction and detox treatment with the goal of slowly reducing opioid cravings.
Buprenorphine is another opioid that is used in the same way and for the same reasons as methadone. But unlike methadone, buprenorphine is a “partial opioid agonist,” which means that unlike other opioids that may be “full agonists,” buprenorphine is much weaker. This means that it is unable to produce the euphoria and other symptoms of an opioid high that people get from other, more powerful opioids.
So instead of getting someone high, buprenorphine does what methadone does, namely, takes up space in the brain’s opioid receptors to both weaken withdrawal symptoms and cravings as well as keep other opioids out. This generally lasts for about 24 hours per dose. While it is weaker than methadone, it does also possess the potential for abuse and dependency, and so the use of buprenorphine must also be carefully monitored.
Alcohol, benzodiazepines, and barbiturates are all substances that fall under the classification of central nervous system depressants, which have among the most severe and potentially dangerous withdrawals of any kind of substance. Attempting to suddenly stop taking depressants after regular long-term abuse can give someone’s nervous system an intense shock and cause, on top of the previously mentioned common withdrawal symptoms:
And, specifically in the case of benzodiazepines, someone can experience what is known as benzodiazepine withdrawal syndrome. This is when the symptoms of withdrawal become even more intense and unpredictable, and can make the withdrawal period itself last much longer than it typically would.
Detox medications can quite literally mean the difference between life and death when it comes to detoxing from central nervous system depressants. Common detox medications for depressants include:
Acamprosate is a drug that is used to treat the symptoms of alcohol withdrawal during alcohol detox. Acamprosate helps to balance out the disrupted GABA levels in the brain. GABA is the neurotransmitter that regulates feelings of relaxation and sedation and is most affected by central nervous system depressant abuse. However, while it has proven to be effective at this, common side effects of acamprosate use include depression and suicidal thoughts, so it should always be used carefully and with caution.
Much like opioids, even though benzodiazepine abuse can have extremely serious health consequences, these drugs can still prove helpful during detox for both other benzos and alcohol. Benzodiazepines can be used in tapering schedules, much like methadone is, but, also like methadone, requires the same strict levels of dosage control to avoid the danger of replacing one addiction with another.
Disulfiram is a drug that is typically sold under the name Antabuse and works by changing how the body breaks down alcohol, producing an extremely negative bodily reaction when someone drinks any alcohol. This reaction can include migraines, heart palpitations, and nausea.
The idea of using disulfiram as a detox medication is that it can be used to rewire the brain of someone who is dependent on alcohol by creating a new, negative association that would substantially reduce the urge to drink. Unfortunately, because it is such an unpleasant drug, many people in detox are unwilling to take it, so it is not typically considered very effective.
Clonidine is a medication that regulates blood pressure, and it reduces specific chemicals that are found in the blood when someone has high blood pressure. It allows the heart to beat slowly and regularly.
Medical professionals have found that clonidine has several off-label uses. One of them is to treat people going through alcohol and opiate withdrawal. The medication will ease feelings of anxiety and agitation, including muscle aches, cramps, sweating, flu, or cold-like symptoms that are associated with opioid withdrawal. Clonidine has some effect to stop smoking as well.
Unlike the other substances on this list, stimulant withdrawal symptoms are largely psychological and mood-based instead of physical. This is because stimulants mainly act on the neurotransmitter dopamine, which is responsible for controlling and regulating emotions and mood.
The symptoms of stimulant withdrawal typically include:
The handful of physical symptoms are usually treated via over-the-counter medications, but the psychological symptoms will most likely require stronger forms of detox medications, most commonly:
Again, much like methadone, modafinil is a medication that works in the same way as stimulants like cocaine in that it blocks the reuptake of dopamine, but at a significantly weaker level. This works to both treat the sleep disorders that often appear during stimulant withdrawal as well as ease stimulant cravings.
While some individuals will choose to detox on their own, it is not the most efficient or safest method moving forward. Medical detox is the best way to get sober in the care of medical professionals. For those struggling with alcohol or benzodiazepine addiction, medical detox is crucial.
Supervised detox will allow someone to mitigate any potential dangers that can occur. Medical professionals will monitor and track heart rate, breathing rate, temperature, and fluid levels of the client. In addition to ensuring your safety, addiction specialists will help to relieve any pain or discomfort that may accompany this process.
They will adjust medication doses according to the client’s fluctuating needs and will make long-term plans for medication-assisted treatment. Those with health issues requiring immediate attention must also seek medical detox. Withdrawal can complicate problems, and doctors will work to prevent any severe issues.
Detox is part of residential treatment, and in most cases, residential treatment will take 30 to 90 days to complete. The first week will consist of an observed detox, and treatment will include behavioral therapy to reinforce your behaviors and solidify your treatment.
It’s essential to remember that addiction is a complex but treatable disease, and no single treatment approach will be appropriate for everyone. Treatment must be readily available, and it should show that approaching detox on your own is not a feasible option. Effective treatment must address multiple needs, and the client must remain in treatment for a specific period of time. Many drug-users have mental health disorders, and working to find a solution and treat those will help their desire to use drugs.
Medication and Counseling Treatment. (2015, June 15). Retrieved April 23, 2018 from https://www.samhsa.gov/medication-assisted-treatment/treatment
National Institute on Drug Abuse. (n.d.). Pharmacotherapies. Retrieved April 23, 2018 from https://www.drugabuse.gov/publications/principles-drug-addiction-treatment/evidence-based-approaches-to-drug-addiction-treatment/pharmacotherapies
(2006).Overview, Essential Concepts, and Definitions in Detoxification. The National Center for Biotechnology Information. Retrieved April 23, 2018 from https://www.ncbi.nlm.nih.gov/books/NBK64119/
Clonidine: MedlinePlus Drug Information. (n.d.). Retrieved from https://medlineplus.gov/druginfo/meds/a682243.html#other-uses
National Institute on Drug Abuse. (n.d.). 8: Medical detoxification. Retrieved from https://www.drugabuse.gov/publications/teaching-packets/understanding-drug-abuse-addiction/section-iii/7-medical-detoxification
Center for Drug Evaluation and Research. (n.d.). Information about Medication-Assisted Treatment. Retrieved from https://www.fda.gov/drugs/information-drug-class/information-about-medication-assisted-treatment-mat
National Institute on Drug Abuse. (n.d.). Principles of Effective Treatment. Retrieved from https://www.drugabuse.gov/publications/principles-drug-addiction-treatment-research-based-guide-third-edition/principles-effective-treatment