Addiction is a complicated disease that requires a wide range of treatment options to address it effectively. If you’re seeking addiction treatment, your needs may not be identical to someone else who has a substance use problem. People approach treatment at different levels of need. Some have recently stopped using and are looking for help for the first time. Others have gone through treatment many times and need to reinstate treatment after a relapse.
When you first enter treatment, clinicians will help you find an appropriate level of care for your needs. If you don’t have any significant risk of dangerous withdrawal symptoms or medical complications, you may not need highly intensive medical detox. Instead, you may only need to start with subacute detox.
Learn more about subacute detox and if it’s right for you.
Acute is a term used to describe immediate and severe conditions and symptoms that require urgent, high-level care. In the medical field, a chronic condition or symptom is often seen as the opposite of an acute condition. Chronic conditions are ongoing and need long-term treatment. Addiction is a chronic disease that requires a long-term commitment to recovery and treatment. However, addiction may come with acute conditions such as intense withdrawal symptoms.
The word subacute is sometimes used in the addiction treatment industry to refer to conditions that require immediate attention but may not need extremely high levels of medical care. For instance, certain drugs can cause acute withdrawal symptoms that can be life-threatening like seizures, delirium, and dehydration. These acute withdrawal symptoms are best treated by medical professionals in a hospital or medical detox setting.
Acute withdrawals can be serious, uncomfortable, and difficult to get through on your own, but post-acute withdrawal symptoms (PAWS) can also pose a threat to your sobriety. Post-acute withdrawal refers to the symptoms that linger after the initial period of acute withdrawal. These symptoms can last as long as two months or longer.
In some cases, certain symptoms can persist until you seek treatment. PAWS are usually psychological symptoms like depression, anxiety, and drug cravings. Without treatment, these symptoms can threaten your sobriety.
Subacute detox can help people who don’t have a high risk of experiencing intense or life-threatening withdrawal symptoms but still may have detox needs. Post-acute withdrawal symptoms can be uncomfortable and, if you go through them on your own, you increase your likelihood of a relapse.
When you first enter a treatment program, clinicians may use the ASAM criteria to find the best placement for your needs. The criteria, outlined by the American Society of Addiction Medicine, is a set of six dimensions that need to be considered when determining the appropriate level of care for someone who’s seeking rehab.
The first dimension concerns acute intoxication and withdrawal. If you have a high potential for acute withdrawal, or if you show up to treatment intoxicated, you may be placed in medical detox. However, if you don’t have a significant potential for acute withdrawal, you may be placed in a lower level of care.
The second and third dimension deals with biomedical and psychological conditions and complications. If you have significant needs in these categories, you may need attentive medical or clinical care, but 24-hour medically managed treatment may not be necessary. Medically monitored and clinically managed treatment are available at lower levels of care like in subacute detox or residential services.
Here are a few scenarios that might warrant subacute detox without needing full medical detox:
If you’ve been through detox, you may have already gotten through the worst of your symptoms. Typically, withdrawal symptoms peak within a few days and start to subside. Acute symptoms will have faded after five to 10 days, and you will no longer need 24-hour medically managed care. However, you may still have post-acute symptoms and drug cravings that can warrant additional monitoring.
If you have gone through acute withdrawals and no longer have urgent medical needs, you may not need high-level medically managed treatment. However, if you have ongoing medical needs that require daily monitoring, medical issues that have been stabilized may require additional care that can be provided in inpatient treatment after medical detox.
Certain psychoactive substances do not have a high likelihood of causing physical dependence. For instance, marijuana and most psychedelics aren’t likely to cause changes in your brain that lead to chemical dependence, but they can become psychologically addictive. For instance, someone with a psychological addiction to marijuana may feel like they can’t get to sleep without smoking, even though marijuana may not have any effects that directly cause sedation or hypnosis. Psychological addictions can also lead to more severe symptoms like depression, anxiety, or drug cravings.
If you have gone through treatment and recently used again, you may not have developed a chemical dependence on the drug, but it’s still important to reinstate treatment.
Withdrawal symptoms are caused when your brain chemistry is suddenly thrown out of balance. As you become dependent on a drug, your brain will adapt your natural brain chemistry to include the new psychoactive substance. Your brain may stop producing some of its own endogenous chemicals and replace them with the effects of the drug. It may also increase the production of other chemicals that are used to counteract the drug to achieve balanced brain chemistry. When you stop using a drug suddenly, you’ll tip the chemical scales in your brain like when one child jumps off a seesaw, letting the other one crash to the ground.
Some drugs can be extremely uncomfortable during acute withdrawal symptoms while others can be potentially life-threatening. For instance, opioids cause flu-like withdrawal symptoms that people describe as the worst flu they’ve ever had. Opioid withdrawal isn’t usually life-threatening, but symptoms like diarrhea, vomiting, and sweating can lead to quick dehydration, which can be dangerous without medical attention.
Stimulants like cocaine typically cause psychological symptoms like depression and anxiety, though there may be a few physical symptoms. However, depression can be severe, leading to suicidal thoughts or actions.
Depressants like alcohol and benzodiazepines are the most life-threatening class of drugs when it comes to withdrawal. Depressants suppress excitability in the central nervous system and can cause it to become overexcited when you stop using. This phenomenon can lead to seizures, and a condition called delirium tremens, which can be life-threatening without medical intervention.
The safest way to go through withdrawal symptoms is to go through detox in a medical setting. Medical detox services offer 24-hour care from medical professionals. In detox, your safety will be a top priority, and your uncomfortable symptoms will be alleviated as much as possible.
If you or someone you know is struggling with a substance use disorder or withdrawal symptoms, and you’d like to learn more about treatment and safe detox, speak to an addiction specialist at Serenity at Summit.
Addiction is a chronic disease that can be extremely difficult to overcome, especially if you try to go through it on your own. However, it’s treatable, and you don’t have to go through it by yourself. Call 844-432-0416 at any time to hear about the therapy options that might be open to you.
American Society of Addiction Medicine. (2019 May, 15) Definition of Addiction. Retrieved from https://www.asam.org/Quality-Science/definition-of-addiction
Psychology Today. (2015, May 26) Detoxing After Detox: The Perils of Post-Acute Withdrawal. Mager, D. MSW Retrieved from https://www.psychologytoday.com/us/blog/some-assembly-required/201505/detoxing-after-detox-the-perils-post-acute-withdrawal
American Society of Addiction Medicine. (n.d.). What is the ASAM Criteria? Retrieved from https://www.asam.org/resources/the-asam-criteria/about
Darke, S., Larney, S., & Farrell, M. (2016, August 11). Yes, people can die from opiate withdrawal. Retrieved from https://onlinelibrary.wiley.com/doi/full/10.1111/add.13512
US National Library of Medicine. (2017, January 14). Delirium tremens: MedlinePlus Medical Encyclopedia. Retrieved from https://medlineplus.gov/ency/article/000766.htm