The first step in addiction treatment is often detox. Medical detox is the method of ending physical dependence on alcohol or drugs by managing withdrawal symptoms with medical oversight, often in a clinical setting.
Detox programs range from outpatient monitoring to medically monitored inpatient treatment. They can be short term, lasting the two weeks or less that withdrawal takes, or they can be long-term, in some cases taking years to slowly manage the tapering process off a substance.
Detox is a crucial first step in recovery, so it is important to find an evidence-based detox process that works best for you. This program should be based on a combination of one’s personal needs and a diagnosis from a doctor.
Because it is important for all components of addiction treatment to offer a range of options so that individuals can get the treatment plan they need, different types of detox take different amounts of time.
As the opioid abuse epidemic grew in the early 2000s, several clinics developed a procedure called rapid detox or ultra-rapid detox, in which a patient was anesthetized for up to one day, and drug antagonists like naloxone were intravenously administered. These drugs would kick opioids out of the body so that the brain would reportedly no longer be dependent on these substances, and there would be no medication left in the body to trigger intoxication.
This process was found to be dangerous, partially due to the risks of anesthesia, partially due to the shock to the system caused by such quick flushing of drugs, and partially because the programs touted themselves as successful cure-alls for addiction without addressing compulsive behaviors and cravings. They are not recommended approaches to detox.
Still, the allure of a fast detox process is appealing to many, and the National Institute on Drug Abuse (NIDA) has reported on further changes to the rapid detox process that are being investigated for safety. It is possible that these programs could become viable at some point, which would be helpful to the hundreds of thousands of people who struggle with opioid addiction, but they are not currently considered safe or effective.
This is the basic approach to detox from substances that do not have available medications that can ease withdrawal symptoms. Some of these substances include cocaine, methamphetamine, sedative-hypnotics like Lunesta and Ambien, marijuana, hallucinogens like LSD and mushrooms, inhalants, and steroids.
Common withdrawal symptoms to expect regardless of the substance of abuse include:
Although you will not receive a medication that is specifically designed to taper your body off dependence on the substance, you may receive prescription medications such as anti-nausea drugs or anticonvulsants to manage side effects of the withdrawal process; psychiatric medications like sedatives or antidepressants to ease cravings and mood swings; or over-the-counter medications like nonsteroidal anti-inflammatory drugs (NSAIDs) to manage pain and aches.
You will work with a physician to monitor the progress of withdrawal so that your doctor can help you when new symptoms appear and when symptoms become more uncomfortable.
You will also receive recommendations to help you manage symptoms at home, like taking some time off work, using ice packs or heating pads to ease muscle and joint pain, eating nutritious foods, and gently exercising. Once withdrawal is complete, which may take up to 10 days, your doctor can help you find a rehabilitation program.
Medication-assisted treatment (MAT): Although most substances of abuse do not have medications that can taper the body off dependence, some drugs (like nicotine, alcohol, opioids, and benzodiazepines) do have medication approaches to tapering and dependency management. These approaches take longer than standard detox, but easing the body off certain substances of abuse slowly appears to work best for most people.
Most of the medications used in treating alcohol use disorder (AUD) are prescribed after withdrawal. Disulfiram, acamprosate, and naltrexone all manage cravings and reduce relapse risk in different ways. Prescribing small doses of benzodiazepines like Valium can ease withdrawal symptoms associated with alcohol. Anticonvulsants can be prescribed as well because seizures are among the riskiest withdrawal symptoms associated with alcohol.
While there are few physical risks associated with nicotine withdrawal, tobacco is one of the most addictive substances on the planet, and quitting smoking or other forms of tobacco consumption can be difficult. Nicotine replacement drugs include gum, patches, and lozenges that step down the amount of nicotine provided to the brain while also helping the person stop the habit of smoking. Bupropion, known as the brand name Wellbutrin, also helps ease nicotine cravings.
Medications that ease opioid withdrawal are crucial to ending this addiction. Buprenorphine can be prescribed by physicians with specific training, so people using this to taper off opioids do not need to go to special clinics. Methadone is not the preferred treatment for opioid addiction anymore, but it still works well for people who struggled with high-doses of strong opioids like heroin or fentanyl for a long time.
While detox is a very important first step in recovery, it is equally important to follow detox with rehabilitation to change behaviors around drugs and alcohol. Evidence-based treatment options may be associated with your detox program, or you can get referrals from clinicians in your detox program.
(January 2018). Types of Treatment Programs. National Institute on Drug Abuse (NIDA). Retrieved January 2019 from https://www.drugabuse.gov/publications/principles-drug-addiction-treatment-research-based-guide-third-edition/drug-addiction-treatment-in-united-states/types-treatment-programs
(March 2017). Frequently Asked Questions: What is Detoxification, or ‘Detox’? National Institute on Drug Abuse (NIDA). Retrieved January 2019 from https://www.drugabuse.gov/about-nida/frequently-asked-questions#detox
Closed Settings: 4. Withdrawal Management. World Health Organization (WHO). Retrieved January 201 from https://www.ncbi.nlm.nih.gov/books/NBK310652/
(July 6, 2017). Advancing the Science of Rapid Opioid Detoxification. National Institute on Drug Abuse (NIDA). Retrieved January 2019 from https://www.drugabuse.gov/news-events/meetings-events/2017/07/advancing-science-rapid-opioid-detoxification
Withdrawal State. World Health Organization (WHO). Retrieved January 2019 from https://www.who.int/substance_abuse/terminology/withdrawal/en/
(February 7, 2018). Medication-Assisted Treatment (MAT). Substance Abuse and Mental Health Services Administration (SAMHSA). Retrieved January 2019 from https://www.samhsa.gov/medication-assisted-treatment
(September 28, 2015). Medication and Counseling Treatment. Substance Abuse and Mental Health Services Administration (SAMHSA). Retrieved January 2019 from https://www.samhsa.gov/medication-assisted-treatment/treatment#medications-used-in-mat
(June 13, 2018). Treatments for Substance Use Disorders. Substance Abuse and Mental Health Services Administration (SAMHSA). Retrieved January 2019 from https://www.samhsa.gov/treatment/substance-use-disorders