The American Society for Addiction Medicine (ASAM), which is the largest organization of addiction medicine physicians in the country, helps to establish the guidelines for medical treatment protocols that are designed for people who are diagnosed with different substance use disorders.
The programs are based on research findings and empirically validated approaches to dealing with numerous issues, including physician-assisted medical detox procedures for different substances of abuse.
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The goal of a medical detox program is to help the client withdraw from alcohol or another drug safely and comfortably, and to prepare them to transition into a formal alcohol use disorder recovery program.
According to ASAM and the Substance Abuse and Mental Health Services Administration (SAMHSA), there generally are three components to the physician-assisted detox approach.
A mental health professional conducts a formal evaluation to assess the client’s physical, mental, and social functioning and to determine the severity of their addiction to alcohol.
Stabilization occurs when physicians and other staff members monitor and support the person throughout the withdrawal process. They identify complications that may occur and interventions that should be used.
Transition occurs when the individual is medically stabilized, and withdrawal symptoms are under control. The person can be transitioned into a recovery program that can provide them with relapse prevention skills to help them maintain their sobriety.
The program is personalized for each individual, even though the programs follow a general overall protocol or blueprint. Many individuals will not require intensive medical management of withdrawal symptoms while others may require inpatient admission to address their issues.
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Addressing the Severity of Alcohol Dependence
Typically, the severity of the individual’s alcohol withdrawal is rated on a three-stage continuum.
Mild withdrawal symptoms include insomnia, anxiety, headache, tremors, and potential nausea.
Moderate withdrawal symptoms include the above symptoms as well as sweating, rapid pulse rate, rapid breathing, and confusion.
Severe withdrawal symptoms include all the above symptoms from the prior two stages, plus disorientation, hallucinations (visual or auditory), severely impaired attention, and seizures.
Typically, individuals begin by expressing initial symptoms and may progress to the other stages, depending on the severity of the withdrawal syndrome. The most severe symptoms are often expressed within three days of stopping alcohol use.
There is a direct relationship between the severity of the alcohol use disorder and the severity of the withdrawal syndrome. The severity of the disorder is based on the number of symptoms expressed, per the American Psychiatric Association’s (APA) diagnostic criteria. Individuals who have more symptoms are diagnosed with more severe alcohol use disorders.
However, the relationship between the severity of the person’s alcohol use disorder and the severity of their withdrawal symptoms is not perfect. Some individuals diagnosed with mild alcohol use disorders may express severe symptoms, such as seizures, whereas some individuals diagnosed with severe alcohol use disorders may not express these severe symptoms.
Withdrawal from alcohol can be quite uncomfortable without the appropriate treatment. Withdrawal symptoms can begin as soon as two hours after discontinuation and may continue for days or weeks, depending on the severity of the alcohol use disorder. Typically, the withdrawal symptoms will peak within 72 hours, but the potential for seizures can be high through all stages of the withdrawal syndrome.
There are several different treatment options a person can choose from, according to ASAM.
Inpatient medical detox is typically reserved for moderate-to-severe cases of alcohol withdrawal. The person lives in a hospital unit or clinic for the duration of detox.
Residential treatment can provide detox services, but these services are not typically utilized for people who need 24-hour medical monitoring. The person remains on the residential site and is administered medications and other needed interventions as needed.
Outpatient detoxification programs exist for individuals who are only experiencing mild manifestations of alcohol withdrawal. Individuals who begin to display moderate-to-severe symptoms should be monitored around the clock, either in a residential unit (where there is 24-hour supervision but no medical care) or an inpatient unit (where there is 24- hour access to medical care).
The decision to be involved in any of these levels of care depends on numerous factors. Individuals who have complicated medical histories, severe co-occurring psychiatric problems, or numerous unsuccessful attempts at recovery may be more appropriate for inpatient treatment, particularly if they need to receive 24-hour medical monitoring.
Medications Used During Alcohol Detox
Various medications can be used to address symptoms of withdrawal during the physician-assisted detoxification process.
Most often, individuals who are suffering from alcohol withdrawal will be prescribed a long-acting benzodiazepine like Valium (diazepam) or Librium (chlordiazepoxide). These benzodiazepines control most of the symptoms of the withdrawal from alcohol, including severe symptoms like seizures. Other medications might also be used, such as a mild stimulant (Provigil [modafinil]) for individuals who experience lethargy, ReVia (naltrexone) or Neurontin (gabapentin) to address cravings, and other medications for specific symptoms that may linger.
Benzodiazepines are usually given on a tapering schedule. The initial dose depends on the individual and the severity of the withdrawal symptoms. The dose will typically be designed to reduce the major discomfort associated with the withdrawal process. The physician will slowly taper the dose on a set schedule to gradually wean the person off the medication.
In many cases, the withdrawal management program will last for several weeks or longer. The length of time the program takes is dependent on the person, their symptoms, and any other complications they may have.
The goal is to get the person to transition successfully out of the withdrawal management program into treatment, but there is no rush. Typically, a formal physician-assisted medical detox program takes longer than withdrawing from alcohol without assistance; however, the chances of success and safety are significantly higher.
Those in a medical detox program should also receive treatment for their alcohol use disorder. This will consist of behavioral interventions like therapy (individual sessions, group sessions, or both individual and group sessions), peer support group participation (Alcoholics Anonymous or some other group), and family support.
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Does Everyone Need Formal Detox?
Due to the potential for serious issues during alcohol withdrawal, medical detox is always recommended. If a physical dependence on alcohol is present, the person cannot simply stop drinking. If they do, there is the potential for life-threatening withdrawal symptoms, such as seizures.
Medical detox ensures that the person is safe throughout the entire detox process. In addition to mediations and social support, those in medical detox are prevented from relapsing. Relapse during alcohol withdrawal is highly likely if the person isn’t under medical supervision.
How Does Aftercare Relate to Medical Detox?
Comprehensive treatment programs should follow medical detox. A person is not finished with treatment just because they have been able to get through the withdrawal period.
Moving through detox is only a preparation stage for enrollment in a long-term treatment program. People who simply go through withdrawal and don’t engage in further treatment are almost sure to relapse.
In treatment, clients engage in therapy to address the issues that led to their alcohol abuse. Without examining these issues, the person is likely to return to drinking when life stresses arise.
Often, medical detox is part of a comprehensive addiction treatment program that includes traditional and complementary therapies to address alcohol abuse effectively.
While most treatment programs include an overall outline for recovery, each program should be tailored to the unique needs of each client in treatment. Adjustments to the treatment plan may need to be made as the person progresses in recovery.
Following completion of a full program, the client will create an aftercare plan with their therapist. This consists of various structured activities that can help to sustain the person’s sobriety once they return to life in the outside world. Aftercare planning is crucial to long-term success in recovery.
While completing alcohol detox is an essential part of recovery, it doesn’t signify success. It simply leads the individual to the next stage of the treatment process where true change takes place, enabling them to build a balanced life in sobriety.
Call (844) 432-0416 to hear more about the therapy options that might be available to you. Even though addiction is difficult to overcome, you don’t have to go through it on your own. Start your road to recovery today.
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