Drugs and alcohol interfere with brain chemistry, making changes to both physical and emotional attributes. In short, alcohol and drugs make you feel differently than normal. With repeated interaction of mind-altering substances on the brain and the central nervous system, the chemical makeup and some of the circuitry in the brain can be changed. A kind of shortcut to reward is formed, and it may become difficult for a person to feel pleasure without the influence of the drug.
Withdrawal symptoms can occur in between doses and when the substance processes out of the body. Cravings can be intense. When brain chemistry is altered and withdrawal symptoms set in, this is drug dependence. A person will no longer feel “balanced” without the drug, and compulsive and out-of-control drug use may result.
Drug dependence and withdrawal symptoms are components of addiction, which the American Society of Addiction Medicine (ASAM) classifies as a reoccurring and chronic brain disease. Over 21 million adults in the United States struggled with alcohol and/or drug addiction in 2014, the National Survey on Drug Use and Health (NSDUH) publishes. When drug dependence is present, medical detox is the optimal method for allowing the substances to safely process out of the body.
What Is Medical Detox?
Medical detox is the most comprehensive form of detox that provides safety and security in a controlled environment. An individual will stay on site in a specialized medical detox facility for a period of 3-7 days on average. During medical detox, a person’s vital signs can be continuous monitored, and medical care can be delivered as needed.
Common physical withdrawal symptoms include irregular heart rate and blood pressure levels, breathing issues, sleep difficulties, tremors, muscle aches and tension, headaches, dizziness, nausea and vomiting, diarrhea, appetite fluctuations and possible anorexia or weight loss, sweating, and changes in body temperature. Medical detox can provide physical stabilization through medical means by trained treatment providers.
Emotional side effects of withdrawal can be significant and include depression, anxiety, irritability, agitation, psychosis, restlessness, trouble thinking clearly, concentration and memory difficulties, edginess, and intense cravings. Mental health support is provided during medical detox to address these issues.
When Medical Detox Is Ideal
Not everyone who battles drug dependence will require medical detox. In general, the more significant a person’s dependence is, the more likely it is that medical detox will be the ideal option. Several factors can influence the severity of drug dependence.
- Amount and duration of drug use: High dosages and frequency of drug abuse can increase dependence levels.
- Method of abuse: Injecting, snorting, or smoking drugs may lead to more significant dependence more quickly than ingesting or swallowing them.
- Age at first use: Using drugs before the brain is fully developed can increase the odds for later problematic drug use, the National Institute on Drug Abuse (NIDA) warns.
- Biological factors: Metabolism, gender, race, and co-occurring medical or mental health disorders can affect dependence.
- Type of drug abused: Different drugs induce dependence at different levels.
- Family history of drug dependence and addiction: Addiction is considered to be heritable about half of the time, the Psychiatric Times
- Environmental factors: High levels of stress, exposure to trauma, and a lack of a stable home and good support system can result in higher levels of dependency.
- Polydrug abuse: If a person abuses multiple substances, dependency will result more quickly.
Significant drug dependence is optimally treated with a medical detox protocol that can manage the more intense withdrawal symptoms and cravings that accompany this level of dependence. The Substance Abuse and Mental Health Services Administration (SAMHSA) reports that people suffering from addiction also battle co-occurring mental health disorders at very high rates. In 2014, nearly 8 million Americans struggled with co-occurring disorders.
When both a mental health or medical condition are present in someone who is battling addiction, medical detox is needed to safely manage all potential medical and mental health issues that can arise during withdrawal. Co-occurring disorders can complicate and exacerbate each other, and they should be carefully monitored and managed with specialized care.
When a person abuses more than one substance, such as both drugs and alcohol, withdrawal may be unpredictable. As a result, medical detox is the optimal place to allow these toxins to process out of the body.
Opioid drugs like heroin and prescription painkillers, benzodiazepine sedative and tranquilizer drugs, and alcohol may lead to life-threatening withdrawal symptoms. An individual suffering from dependence on these substances should never attempt to stop taking these substances “cold turkey.” Instead, medical detox is the safest place to allow these substances to process out of the body, as medications may be used to stabilize the withdrawal process.
Delirium tremens (DTs) is one of the most significant forms of withdrawal; it involves alcohol and sometimes benzodiazepines. About 3-5 percent of people battling alcohol withdrawal may suffer from DTs, the New England Journal of Medicine (NEJM) warns. DTs is especially dangerous, as it may begin later than normal withdrawal – as long as a few days after stopping drinking. It is indicated by seizures, fever, significant confusion, and psychosis.
When a person takes a depressant substance, such as alcohol, opioids, or benzodiazepines, the central nervous system is suppressed, lowering anxiety levels, blood pressure, heart rate, respiration rates, and body temperature. With repeated abuse of depressant drugs, the brain gets used to this dampening effect. If these substances are then stopped suddenly, a kind of rebound effect can occur that can lead to DTs and potentially life-threatening seizures. These complications can be minimized and managed through medical detox. Due to the potential severity of withdrawal, if a person is dependent on opioids, benzodiazepines, or alcohol, medical detox is required.
Treatments Used during Medical Detox
The overarching goal of medical detox is to help a person become physically and emotionally stable while managing cravings and withdrawal symptoms. Medical detox is often the initial stage of an addiction treatment program. Housed in a specialized facility staffed with medical, mental health, and substance abuse professionals, medical detox provides a stable and secure environment with constant supervision 24 hours a day.
Treatments during medical detox are aimed at gaining stability so a person can safely enter into a drug addiction treatment program directly following withdrawal. Emotional support and encouragement to remain abstinent as well as brief interventions and behavioral therapies, like Cognitive Behavioral Therapy (CBT), work to sustain abstinence during detox. CBT can help to uncover potential triggers to relapse and teach coping mechanisms for dealing with them. Relapse prevention is especially important, as the brain and tolerance levels will begin to reset after stopping drug use. If a person then returns to using drugs at prior levels, it could result in a fatal overdose.
Medical detox often uses medications to manage withdrawal symptoms and cravings. Some common medications used during detox are outlined below.
- Benzodiazepines: These medications can counteract the side effects of withdrawal from alcohol and central nervous system depressant drugs. Long-acting benzodiazepines, such as diazepam (Valium) and chlordiazepoxide (Librium), can stabilize brain chemistry to minimize the rebound effect of the brain’s neurotransmitters. These long-acting benzodiazepines can be slowly tapered off in a controlled manner on a set schedule until they are no longer necessary.
- Opioid agonists and partial agonists: Short-acting opioid drugs like heroin and fentanyl are often replaced with the longer-acting full opioid agonist methadone (Methadose, Diskets, Dolophine). Methadone can be distributed once daily to keep withdrawal symptoms and cravings at bay. The dosage can then be weaned off over a set period of time. Partial agonists containing buprenorphine (Subutex, Buprenex, Butrans) work in a similar fashion; however, they have less potential for abuse as they do not create the same “high” as full opioid agonists. They also have a plateau feature where they stop working after a certain dosage is taken.
- Antidepressants: Mood-stabilizing drugs can be very helpful during medical detox, and medications such as desipramine (Norpramin) can aid in minimizing some of the emotional side effects of withdrawal.
- Medications used off label: Drugs like the anticonvulsant medication topiramate (Topamax) have shown promise in treating withdrawal symptoms for many different substances. These drugs may be used off label to reduce withdrawal symptoms.
During medical detox, providers often introduce vitamins, supplements, and a nutritious meal plan to counteract the malnutrition that accompanies drug abuse and addiction. Fluids may need to be given intravenously during medical detox, as individuals are often significantly dehydrated when entering detox.
Medical detox is not a standalone treatment for drug abuse and addiction; instead, it should be viewed as an important first step. After a detox program, individuals should enter directly into an addiction treatment program that can continue to build on relapse prevention tools, healthy habits, coping mechanisms, medication management, and more.
Detox helps to set the stage for recovery by providing a stable foundation for people. When detox is followed with a comprehensive addiction treatment program, long-term recovery can be enhanced.
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