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Detox Handbook: Withdrawal Information for Each Drug Category

Detox Handbook: Withdrawal Information for Each Drug Category

“The fact is that chemical dependency, the term that includes both alcoholism and drug addiction, is a progressive disease that can be cured. It can only be arrested – stopped in its tracks – through drastic, fundamental changes in the addict’s attitude and behaviors.” ~Chris Beckman, Clean: A New Generation in Recovery Speaks Out When someone has finally sought help for their substance abuse problems – whether it is alcoholism, illicit drug addiction, or the misuse of prescription medications – they are often surprised when they learn that the first step on the road to recovery is a drug/alcohol detoxification. For some, it’s frustrating when they want to begin treatment immediately, but find out that they have to wait – DETOX IS NOT TREATMENT. But it is important to understand that it IS absolutely necessary if recovery is to be as safe, smooth, and successful as possible.

Alcohol/Drug Detox is a Critical First Pre-Step

Depending upon the substance of abuse, a proper detoxification can take anywhere from a few days to two weeks. For an addict or alcoholic anxious to start treatment, that can seem like an eternity, but both medical guidelines and the mechanisms of addiction have demonstrated the necessity.

Why Is a Detox Necessary?

First and foremost, it is important to remember that, in and of itself, detox does not address addiction. The purpose of the detox is NOT to teach the individual how to change their attitudes and behaviors to best manage their disease of addiction. The psychological and behavioral aspects of alcohol and drug rehabilitation – the counseling, education, and continuing support – will have absolutely no effect while the person is still physically in the clutches of the addiction. Only when their body has eliminated the drugs and alcohol and they are no longer experiencing acute withdrawal symptoms can a person be clearheaded enough to start to accept the concept of recovery. A medically-supervised alcohol/drug detox takes place in a safe, therapeutic environment where:

  • The substance abuser can overcome their physical dependency
  • Support and – if necessary – medication can be given as a means of relieving the dangerous or unpleasant withdrawal symptoms that inevitably occur when the alcohol/drug is discontinued.

Apart from being an effective pre-step to treatment, detox may sometimes be medically necessary – especially in cases where the substance of choice was alcohol or benzodiazepines. Withdrawal from either of the symptoms can be extremely dangerous – even fatal.

A Few Words about Medication-Assisted Detox

While some drug or alcohol detoxification facilities shy away from using prescription medications to help with withdrawal symptoms, an increasing number of programs are gaining an appreciation of the many positives that these medications provide. It is no longer necessary to simply go “cold turkey”. Because withdrawal symptoms and cravings can be the single largest roadblock during early recovery, any option that increases the chances of success should be considered. Let’s take a look at the detox process for some of the most-commonly abused drugs.

What You Need to Know about Alcohol Withdrawal and Detox

“First you take a drink, then the drink takes a drink, then the drink takes you.” ~ F. Scott Fitzgerald Alcohol is the most widely used addictive substance in America. Approximately 80% of everyone over the age of 12 has experimented with drinking – two-and-a-half times the number of people who have tried marijuana. When a person regularly consumes a sedative-hypnotic such as alcohol, they can develop a physiological dependence, and when that consumption is reduced or stopped abruptly, severe withdrawal symptoms can result, including disturbances in the central nervous system and autonomic functions. Abrupt cessation after chronic alcohol consumption sends the brain into a state of hyperexcitability– the OPPOSITE of what is seen during drinking. Because of this, alcohol detox should ALWAYS be done under medical supervision.

  • Alcohol detox usually takes 72-96 hours, but can last as long as one week.
  • Approximately 50% of alcoholics experience withdrawal symptoms when they reduce/abstain from alcohol.
  • Up to 20% will develop delirium tremens – “the DT’s”.
  • Delirium tremens can occur within two days into alcohol withdrawal and last for up to five days.
  • It is characterized by the rapid onset of extreme confusion and severe hallucinations.
  • Risk factors for the DT’s include:
    • Age
    • Alcoholism that has existed for more than 10 years
    • A history of withdrawal symptoms, especially among heavy drinkers
  • More than a third of alcoholics with the DTs will die without treatment.
  • Even with treatment, 15% of alcoholics with the DTS die.
  • Other symptoms of alcohol withdrawal, which can present in as few as SIX hours after the last drink include–
    • Anxiety
    • Irritability
    • Agitation
    • Possibly-fatal seizures
    • Elevated body temperature
    • Irregular heartbeat
    • High blood pressure
    • Sweating
    • Nausea/vomiting
    • Headache
    • Insomnia
    • Mild hallucinations
  • Alcohol detox is very successful – more than 70% of people entering a facility complete the process, and over half go on to alcohol rehab programs.

What Are Some Medications for Alcohol Withdrawal Used During Detox?

Most doctors agree that severe alcohol withdrawal requires pharmacological treatment. The use of medications during alcohol withdrawal/detox has two goals – reducing immediate withdrawal symptoms and preventing harmful complications. Typical medications include:

  • Benzodiazepines –Librium (chlordiazepoxide), Valium (diazepam), Serax (oxazepam), or Ativan (lorazepam), to help with tremors, confusion, and anxiety, and to reduce the risk of severe symptoms such as the DTs or seizures.
  • Naltrexone –Reduces incidence of heavy drinking, the number of days spent drinking, and the total amount of alcohol imbibed.
  • Tegretol (carbamazepine) –A non-sedating alternative to benzodiazepines that has a low abuse potential
  • Antipsychotics –For agitation and hallucinations
  • Beta blockers –For high blood pressure and elevated heart rate
  • Clonidine –For high blood pressure
  • Dilantin – An anticonvulsant

What You Need to Know About Opioid Withdrawal and Detox

“The story was heroin. It was made out of sensation, not words; it was invisible and murderous and unstoppable”. ~ Alice Hoffman, Skylight Confessions Opioids are that class of drugs that are derived from the opium poppy and include the opiate morphine, the Street drug heroin, and prescription painkillers such as hydrocodone, oxycodone, codeine, and fentanyl. The Director for the Centers for Disease Control and Prevention, Dr. Thomas Frieden, has called the misuse of opioid painkillers a “national epidemic”, and the available statistics support that assertion:

  • Between 1999 and 2013, the death rate from prescription opioids nearly quadrupled.
  • 2010-2013, the number of fatal heroin overdoses skyrocketed by 270%.
  • According to the Trust for America’s Health, prescription drug-related deaths outnumber those caused by cocaine and heroin combined.
  • By 2010, the admissions rate for opioid abuse was seven times greater than it was in 1999.
  • With only 5% of the world’s population, United States consumes 75% of the world’s prescription drugs.
  • Every hour of every day, a baby is born with opioid withdrawal symptoms.

During opioid detox, the worst physical symptoms can manifest between 12 and 30 hours of the last use, and last approximately 5 days, but in some cases can persist up to two weeks. Unlike alcohol (or benzodiazepines) opioids are not particularly dangerous to quit, but the withdrawal symptoms can be among the worst:

  • Anxiety
  • Restlessness/agitation
  • Hot and cold flashes
  • Sexual dysfunction
  • Confusion
  • Loss of motivation
  • Extreme fatigue/excessive yawning
  • Muscle aches/cramping
  • Profuse sweating
  • Increased tear production/runny nose
  • Dehydration
  • A skin-crawling sensation
  • Nausea/vomiting/abdominal cramping/diarrhea
  • Sneezing
  • Dilated pupils
  • Goosebumps – the origin of the term “cold turkey”

The most common complaint is of an overall feeling of being unwell, almost as if the sufferer has a severe case of the flu, which is why opioid-dependent people experiencing withdrawal will describe themselves as being “sick”.

What Are Some Medications for Opioid Withdrawal Used During Detox?

It is common for treatment professionals to recommend opioid replacement therapy (ORT), which involves replacing the abuse opioid with another, longer-acting/less-euphoric one. This allows the recovering addict to achieve a measure of stability while experiencing reduced withdrawal symptoms and drug cravings. With medication and support, up to two-thirds of patients in recovery can abstain from opioids completely, while up to 95% are able to significantly reduce their use of opioids. ORT has been endorsed by the United Nations Office on Drugs and the World Health Organization.

  • Methadone– Methadone maintenance treatment (MMT) is a preferable option for opioid addicts who have difficulty maintaining sobriety. Not only does MMT allow them to return to some level of productivity, it also helps protect against diseases such as HIV/AIDS. Ideally, the dosage can be decreased over time, until the person in recovery is able to maintain sobriety on their own.
  • Buprenorphine–Because it has a lower incidence of overdose-related deaths, buprenorphine is considered to be a safer alternative than methadone.
  • Naltrexone –The most effective formulation is once-per-month injections.

What You Need to Know about Benzodiazepine Withdrawal and Detox

“Benzodiazepine prescriptions are widespread, but their use may not be the smart choice for many patients.” ~ Dr. Marcus Bachhuber, Assistant Professor of Medicine at Albert Einstein College of Medicine Benzodiazepines are a popular class of medications, typically prescribed for depression, anxiety, seizures, alcohol withdrawal, or insomnia. Typical “benzos” include:

  • Librium/chlordiazepoxide (severe anxiety or alcohol withdrawal)
  • Xanax/alprazolam (anxiety or panic disorders)
  • Ativan/lorazepam (anxiety, insomnia, alcohol withdrawal, seizures, and chemotherapy-induced nausea)
  • Valium/diazepam (anxiety, insomnia, restless leg syndrome, or withdrawal from alcohol or other benzodiazepines)
  • Serax/oxazepam (anxiety, insomnia, and alcohol withdrawal)
  • Klonopin/clonazepam (panic disorder, seizures, and akathisia)
  • Restoril/temazepam (severe insomnia or other sleep disorders)

Although opioids are the abused prescriptions making headlines, one-third of all fatal prescription overdoses in America in2013 were because of benzodiazepines– over 7000 deaths.

  • Within the last 20 years, the number of American adults with a benzodiazepine prescription skyrocketed – from 1 million to 13.5 million.
  • Within that same time frame, the amount of medicine in those prescriptions rose by 40%.
  • 75% of all benzo-related fatalities also involved an opioid.

Benzodiazepine withdrawal usually begins within 24-48 hours of the last dose taken, although withdrawal from benzodiazepines with a longer half-life may not result in any symptoms for up to three weeks. Benzodiazepine detox can be much more serious than abstaining from opioids. Abrupt cessation of benzo medication can result in a number of serious withdrawal symptoms, including:

  • Increased risk of suicide
  • Psychosis
  • Homicidal ideation or violence
  • Delusions and hallucinations
  • Potentially fatal catatonia or convulsions

For this reason, benzodiazepine withdrawal/detox should ALWAYS be supervised by medical professionals. Even with gradual dosage reduction, benzodiazepine detox can result in a large number of disturbing withdrawal symptoms, including:

  • Acute anxiety/panic, to the point of terror
  • Agitation/restlessness/mood swings/paranoia
  • Impaired concentration and memory
  • Nightmares and sleep paralysis
  • Hallucinations/sensory disturbances/heightened sensitivity to light or smells
  • Dilated pupils/blurred or double vision
  • Nausea/vomiting/diarrhea
  • Loss of appetite/weight loss
  • Depersonalization and feelings of unreality
  • Muscular spasms or stiffness

What Are Some Medications for Benzodiazepine Withdrawal Used During Detox?

There are currently NO pharmacotherapies approved for benzodiazepine withdrawal. The best way to safely detox from benzos is by gradual dose reduction under medical supervision. However, there are a number of drugs that should be avoided at all costs during benzo withdrawal:

  • Antipsychotics – which can lower a person’s seizure threshold
  • Barbiturates – which are cross-tolerant to benzodiazepines
  • Caffeine – which can worsen withdrawal symptoms
  • Alcohol – even small amounts can cause withdrawal failure

What You Need to Know about Methamphetamine Withdrawal and Detox

“So, in a sense, crystal methamphetamine is the nuclear weapon in the brain, contrasted to conventional weapons of alcohol, cocaine, and marijuana.” ~ Dr. Petros Levounis, Chair of the Department of Psychiatry, New Jersey Medical School Crystal meth is a man-made stimulant used recreationally for its euphoriant and aphrodisiac effects. At high doses, it can cause bleeding in the brain, a breakdown of muscle, psychosis, and seizures. Chronic use damages the brain by causing a reduction in gray matter volume. The legalization of recreational marijuana use in states like Colorado and Washington is directly responsible for the resurgence of methamphetamines in the United States. Legal pot in the U.S. has eaten into the marijuana profits of Mexican drug cartels, so they have switched to heroin and methamphetamines, both of which are then smuggled into America.

  • In fiscal year 2014, federal agents on the U.S.-Mexico border seized a record amount of methamphetamine.
  • In the San Diego DEA office alone, agents confiscated almost 15,000 pounds of meth, representing over 60% of all meth seized in the country that year.
  • From 2009 through 2014, meth seizures in California increased by 300%.
  • In 2013, almost 600,000 Americans admitted that they had used meth in the past month, compared to 440,000 the year before.

Up to 87.6% of heavy users will experience withdrawal symptoms. Acute methamphetamine withdrawal symptoms usually present within 24 hours of the last dose, and will typically last between 5-10 days—although they can persist for up to four weeks.

  • Strong drug cravings
  • Irritability/mood swings
  • Emotional distress/dysphoria
  • Excessive sleepiness OR insomnia
  • Hallucinations/nightmares
  • Depression
  • Loss of motivation
  • Paranoia
  • Confusion/memory difficulties
  • Suicidal ideation and increased risk
  • Increased appetite and substantial weight gain

After acute withdrawal, the individual is usually ready to move on to the treatment phase of their recovery. Long-term, heavy users of methamphetamines can develop amphetamine psychosis, which can manifest similarly to schizophrenia– delusions, auditory/visual hallucinations, grandeur, etc. This prolonged methamphetamine withdrawal symptom can last up to six months. Some methamphetamine-induced brain changes are long-lasting, resulting in long-term withdrawal symptoms that can last for a year or more.

  • Prolonged anxiety and depression
  • Headaches
  • Chronic fatigue
  • Irritability

What Are Some Medications for Methamphetamine Drug Use During Detox?

Unfortunately, there is no pharmacological solution for methamphetamine withdrawal during detox. At best, medical personnel can give medications to ease individual symptoms. Recovering meth addicts should also be closely monitored and receive professional counseling and support at least until their long-term withdrawal symptoms have eased.

Is a Professional Detox REALLY Necessary?

The majority of addicts abuse multiple substances, meaning those other addictions will also have to be addressed, and detoxification from those other substances needs to happen at the same time. Simultaneously detoxing from multiple drugs/alcohol is too difficult for most people. The person may also be struggling with a co-occurring mental disorder such as PTSD, bipolar disorder, ADHD, anxiety, or depression. One-third of all people with mental disorders also abuse drugs and/or alcohol. Such disorders require prescription medications, which are only given when a person is being seen by a doctor. Mental illness and addiction are closely linked, and each plays a role in the development of the other. Over time, heavy drinking or drug use can alter a person’s brain, disrupting their cognitive functions and emotional stability. Fortunately, many of these changes can be successfully reversed with prolonged abstinence. This means that the person should be closely monitored by a doctor who can make any necessary adjustments in their medication. This level of close support is not available during an unsupervised self-detox. To succeed, the person in recovery needs to detox in a safe, controlled therapeutic environment. There is no need to suffer overly-harsh withdrawal symptoms or put yourself in danger by trying to detox from drugs or alcohol on your own. You give yourself a much better chance of a successful recovery when you check into a medically-supervised detox facility that can offer you the support you need at this vulnerable time. When you are free from the physical compulsion to use or drink and past the worst of the physical withdrawal symptoms, you will be truly ready for rehab– with a mind that is clear enough to receive the positive message of recovery. If you are considering treatment for any substance abuse disorder– alcoholism, illicit drug abuse, or the misuse of prescription medications – for yourself or a family member, and are unsure if detoxification is necessary, Northpoint Recovery is here to help you make that decision. Call today for a free and confidential intake assessment and more information. Northpoint offers detox and residential drug and alcohol rehab services. When you are ready, the experienced and caring staff at Northpoint Recovery will be standing by to assist you in taking the next steps on your journey towards reclaiming your sanity, stability, serenity, and sobriety.