Medical Detox

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Managing Alcohol and Drug Withdrawal Symptoms through Medical Detox

Stories like that of Demi Lovato may seem discouraging to anyone who is trying to recover from addiction. The young singer has been open and honest about her battle with addiction since 2011, when she entered drug rehab for the first time. Unfortunately, Lovato relapsed earlier this year and was hospitalized in July after a heroin overdose. Though this may seem like a bleak narrative, there is something to be learned by this example, and a bit of hope can be gleaned from stories like these.

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Relapse is often a part of the recovery process. "Revolving door syndrome" (the common occurrence of addicts repeating drug treatment programs several times over) exists because substance use disorder is a chronic condition. This is not a disease that vanishes after a good treatment program; it is a lifelong chronic illness that must be dealt with each and every day. Just as diabetics and cancer patients can suffer relapses, so can drug and alcohol addicts.

"What I’ve learned is that this illness is not something that disappears or fades with time. It is something I must continue to overcome."
-Demi Lovato

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Since drug or alcohol withdrawal symptoms are the most common cause of relapse, managing withdrawal symptoms is key to successfully completing the detoxification stage and continuing with the recovery process. One very effective method for alleviating withdrawal symptoms and reducing their severity is through medical detox.

Medical detox is the process of taking prescription medications to help soothe withdrawal symptoms, cope with their psychological effects, and make the detox stage a little less painful. Some of these medications can also reduce cravings, which is a deterring factor against the possibility of relapse. In this article, we'll discuss the benefits of medical detox and why it may be an essential part of successful, long-term recovery.

What is Alcohol or Drug Withdrawal Like?

If you or a loved one has experience with drug or alcohol abuse, you have probably learned a thing or two about withdrawal. There is no sugarcoating drug withdrawal; it is difficult, ugly, and painful. Although there are ways to alleviate some of the symptoms, it is no fun, which is why so many well-intentioned recovering addicts suffer from relapse during this stage.

Managing Alcohol Withdrawal Symptoms
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Withdrawal symptoms occur after someone who has become physically addicted to illicit substances or alcohol attempts to become sober. A brain and body that are physically addicted can no longer function normally without the presence of illicit substances and the chemicals that those substances release in the brain. When someone suddenly stops using after regular substance abuse, a severe chemical imbalance occurs inside the body, affecting cognitive function, mood, as well as the overall functionality of the body and its organic systems. This process can last anywhere from five days to three weeks or more, but the symptoms will differ according the user's substance of choice.

Quitting Cold Turkey

Because of the physical changes that drug and alcohol abuse impose on the brain and body, withdrawal symptoms will set in within a few hours of the last drink or dose. Some people insist that "quitting cold turkey" is the best and fastest way to detoxify the body and begin recovery.

The problem with this method is the sheer difficulty of achieving it. Withdrawal symptoms can be so severe and unpleasant, many addicts cannot resist the temptation to have "just one more fix" to alleviate their suffering. It is not necessarily a matter of being strong enough to resist, since some patients can suffer from life-threatening withdrawal symptoms. Below we'll describe what to expect during withdrawal from the most commonly abused substances, and what it might feel like to quit cold turkey.

Alcohol Withdrawal Symptoms

Alcohol withdrawal is one of the most severe and dangerous types of substance withdrawal. On average, it lasts for seven days, although the symptoms may vary according to the severity of the addiction and the time that has passed since the last drink. In general, someone going through alcohol withdrawal will experience the following symptoms:

  • Tremors in the hands
  • Insomnia
  • Anxiety
  • Stomach pains
  • Heavy sweating
  • Headache
  • Vomiting and nausea
  • Confused thought processes
  • Heart palpitations
  • Mood swings
  • Irritability
  • Mental confusion
  • Hallucinations
  • Seizures
  • High blood pressure
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In some rare cases, a person going through alcohol withdrawal will develop delirium tremens, a condition in which they undergo severe confusion, hallucinations, agitation, and a dangerously high heart rate. Since this condition can lead to sudden death, it is highly recommended for severe alcohol addicts to attend a medically supervised professional detox program to reduce the risk caused by delirium tremens.

Opioid Withdrawal Symptoms

Opioid withdrawal is often referred to as being "dope sick" because the symptoms mimic those of both the flu and a stomach virus at the same time. Withdrawal from opioids generally lasts from five to seven days, but differs for each person. Some of these symptoms include:

  • Muscle aches
  • Excessive yawning
  • Insomnia
  • Anxiety and agitation
  • Runny nose
  • Excessive sweating
  • Racing heartbeat
  • Hypertension
  • Fever
  • Nausea and vomiting
  • Diarrhea
  • Stomach cramps
  • Goosebumps and "crawling skin" sensation
  • Depression
  • Intense cravings

Although these symptoms may seem unbearable in the moment, relapsing during opioid withdrawal can be extremely dangerous because of drug tolerance. Drug tolerance happens when a user needs to consume more and more of a substance in order to achieve the same high, leading to increasingly larger doses over time. Opioid tolerance tapers off very quickly during detox however, so if a user relapses during the detox stage and takes the same large dose they were taking before, drug overdose is much more likely. This is another addiction that will be well-served with medical supervision, if only to prevent a dangerous relapse overdose.

Medical Detox Withdrawal
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Stimulant Withdrawal Symptoms

Stimulants include "uppers" like cocaine, meth, ecstasy, and prescriptions such as Adderall or Ritalin. Withdrawal from these types of substances is different than those listed above, but no less unpleasant. Stimulant drug withdrawal is marked by severe psychological symptoms that are dangerous in and of themselves, and even though most of these taper off within seven days, some psychological side effects may last for several weeks. Here are a few common stimulant withdrawal symptoms:

  • Irritability
  • Restlessness
  • Confusion
  • Depression
  • Disorientation
  • Remorse
  • Dysphoria (general dissatisfaction with life)
  • Paranoia
  • Apathy
  • Suicidal thoughts
  • Anxiety
  • Exhaustion
  • Hallucinations
  • Panic
  • Mood swings
  • Aches & pains
  • Agitation
  • Intense Cravings

As you can see, most of the drug withdrawal symptoms listed above are psychological rather than physical, but that does not mean that they are any less intense or dangerous. Some patients experience such acute feelings of depression and anxiety that they do themselves harm or attempt suicide during stimulant detox, even if they did not exhibit suicidal tendencies before. Once again, medical supervision is beneficial during stimulant withdrawal for the safety of the patient, especially if medical detox is used to reduce the severity of symptoms.

How to Manage Drug and Alcohol Withdrawal Symptoms?

The key to a successful drug or alcohol detox program is to effectively manage the withdrawal symptoms. Although the process can be completed at home, it is not recommended because of the dangers mentioned above. Also, in a home environment the patients will be forced to undergo the process with little to no help, and the risk of relapse is much higher.

How to Manage Withdrawal Symptoms
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In a professional drug treatment and rehab center, patients will be offered a variety of treatments and therapeutic exercises to ease the withdrawal process, such as:

  • Mindfulness and meditation
  • Massage
  • Yoga
  • Gym workouts with a personal trainer
  • Art therapy
  • Medical intervention

Of the above methods, medical intervention is generally considered the most effective, since the prescriptions not only help users to cope, but can actually reduce the severity of withdrawal symptoms.

Professional Detox and Rehab Programs

There are a wide range of benefits to gain from completing alcohol or drug detox in an inpatient facility, not the least of which is medical intervention.

Benefits of Professional Detox and Rehab Programs
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Medically-Trained Personnel

For one thing, an entire staff of nurses, doctors, and counselors are available to monitor the health and emotional well-being of each patient. Regular examinations will take place to ensure the patient is as healthy, stable, and comfortable as possible. If a certain treatment plan does not seem to be working, on-site medical professionals will recognize the problem and make the appropriate changes to improve the patient's progress.

Dual Diagnosis

More than half of all people with substance use disorder also suffer from co-occurring emotional or social conditions that contribute to their addiction. A drug rehab facility can diagnose any underlying mental illness and prescribe the right balance of prescription medications and therapeutic activities to treat both the addiction and the mental conditions that caused it. This may help to facilitate the medical detox process, and it could also make a world of difference for maintaining a long future in addiction recovery.

Transition from Detoxification to Rehabilitation

Detox is only the beginning of a long recovery journey. Once drug withdrawal has been vanquished, intensive drug treatment is necessary to free the mind and social patterns of psychological dependence, as well as to prepare the patient for a sober lifestyle.

If detox is being completed at a residential care rehab center, each patient will slowly be transitioned into drug or alcohol rehab as the withdrawal symptoms begin to decrease. This is a natural transition that will both aid the patient through the final days of withdrawal and allow them to become accustomed to a more rigorous treatment schedule. By the time the patient has left the detox stage behind, they will already be immersed in a full drug rehab schedule.

What Is Medical Intervention During Alcohol or Drug Detox?

Finally, the most obvious benefit of entering a professional detox and rehab program is the assistance of medical prescriptions to facilitate the withdrawal and treatment process. Medical intervention, also called medical detox or medically assisted treatment, can help to alleviate physical withdrawal symptoms, reduce psychological symptoms, and calm cravings.

Medical Intervention During Detox
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Since each person reacts differently to medications, it is important to undergo medical detox under the strict supervision of a doctor so that dosages can be monitored and adjusted as needed. Different medications are used to treat specific types of substance abuse and certain withdrawal symptoms.

Medical Detox for Alcohol Addiction

For patients suffering through the throes of alcohol withdrawal, prescriptions may be used to alleviate withdrawal symptoms, reduce cravings, and to remove the pleasurable feelings associated with drinking alcohol. These are some of the most popular medical solutions to treat alcohol addiction:

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1. Naltrexone

Naltrexone works by blocking the receptors in the brain that cause pleasure when the user drinks alcohol. Addiction is caused by the brain's need for the "happy chemicals" released by alcohol when it enters the brain; naltrexone can help the brain to dissociate alcohol with pleasure, reducing the power of alcohol addiction, soothing withdrawal symptoms, and minimizing cravings. It can also greatly reduce the likelihood of relapse. The two leading brands that make naltrexone are:

Naltrexone to Manage Drugs Dependence
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  • Revia - This oral version of naltrexone is taken daily in order to reduce cravings and block the effects of alcohol.
  • Vivitrol - An injectable form of naltrexone that stays in the system for several weeks. This option might help facilitate long-term recovery.

2. Disulfiram

Disulfiram works by creating a negative association with alcohol in the brain. If a patient drinks alcohol after taking disulfiram, they will experience highly unpleasant side effects such as throbbing headaches, nausea, vomiting, and weakness. In this way, the medication helps the brain to terminate its dependence on alcohol. The only available brand of disulfiram is Antabuse.

Managing Alcohol Addiction With Disulfiram

3. Acamprosate

Acamprosate is a mild sedative that helps to calm the patient and alleviates some withdrawal symptoms. Although its effects are less dramatic than those of naltrexone and disulfiram, this medication has been to shown to markedly reduce cravings for alcohol and helps to bring a healthy balance to the brain, especially in patients who have suffered from long-term or severe alcohol abuse. This prescription is available under brand name Campral.

4. Benzodiazepines

Benzodiazepines are anti-anxiety medications that can help reduce severe psychological symptoms of withdrawal such as hallucinations, seizures, or delirium tremens. The use of benzos is often criticized since these medications can also be habit-forming. They should be used only in the severest of cases and under constant supervision. The most common types of benzodiazepines are:

  • Xanax - an effective treatment for anxiety, headaches, insomnia, and nausea in low doses.
  • Librium - similar to xanax but with a longer-lasting effect.
  • Ativan - appropriate for severe cases, Ativan depresses the Central Nervous System and can reduce some of the most severe symptoms of alcohol withdrawal. It is also safe for patients with liver conditions.
  • Klonopin - behaves similarly to other benzos but may be more effective than others at preventing seizures.
  • Valium - effective in reducing severe withdrawal symptoms such as tremors, delirium, hallucinations, and agitation.
  • Restoril - causes more drowsiness than some other benzos and so is helpful as a sleep aid for withdrawal-related insomnia.

Medical Detox for Opioid Addiction

The most successful medically assisted treatment options for opioid addiction (known as opioid replacement therapy or ORT) are those that mimic some of the effects of opioid substances while blocking opioid receptors in the brain, effectively preventing opioids from causing their usual pleasurable effects. This type of prescription can greatly reduce opioid withdrawal symptoms while also helping to prevent cravings and relapse:

Medical Detox for Opioid Addiction
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1. Methadone

First and foremost, methadone tricks the brain into thinking it is still receiving opioids. Although it does not produce a euphoric "high", methadone works along the same neural pathways, calming cravings and staving off opioid withdrawal. It is a pain reliever, so it can reduce the pain associated with withdrawal, but it also blocks opioid receptors so that heroin and other opioids can no longer have any pleasurable effects. In this way, the patient will feel less miserable during the withdrawal process and will experience less cravings, which are the biggest reasons for relapse. The most common brands of methadone are listed below, but there is no real difference between the two, besides their manufacturer:

  • Dolophine
  • Methadose

2. Buprenorphine

Buprenorphine behaves similarly to methadone and has the same general effects and benefits but at less intensity. Since its effects are milder than those of methadone, buprenorphine presents less risk of abuse, overdose, and addiction.

  • Suboxone - a mixture of buprenorphine and naltrexone that will prevent any opiates from causing a feeling of euphoria, helping to prevent abuse and relapse due to the immediate unpleasant effects if combined with opiates.
  • Subutex - a simple dissolving tablet of buprenorphine that wears off within one to two days.
  • Sublocade - a slow-release monthly injection that may prove more effective for outpatient or home use.
  • Probuphine - a small implant that slowly releases buprenorphine into the bloodstream over a period of six months. Appropriate for severe, long-term addicts.

3. Naltrexone

Naltrexone is a medication used for both alcohol and opioid use disorders to block the receptors in the brain that create feelings of euphoria or a "high". As with use during alcohol withdrawal, it blocks all of the pleasurable feelings associated with opiate abuse and greatly reduces cravings. The two leading brands that make naltrexone are:

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  • Revia - This oral version of naltrexone is taken daily in order to reduce cravings and block the effects of alcohol.
  • Vivitrol - An injectable form of naltrexone that stays in the system for several weeks. This option might help facilitate long-term recovery.

Of the three options listed above, buprenorphine is currently the most popular since it is less addictive than methadone. Since some forms of buprenorphine can be taken in longer-lasting or injectable forms, it is a more viable option for outpatient or long-term use.

Medical Detox for Stimulant Addiction

No specific addiction treatment medications have yet been approved by the FDA for treating stimulant withdrawal, but doctors may prescribe medications to relieve specific symptoms, such as:

Stimulant Withdrawal Symptoms
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  • Antidepressants - to treat severe symptoms of depression, apathy, anger, or suicidal thoughts.
  • Pain relievers - non-narcotic pain relievers may be used for general aches, pains, and headaches.
  • Sleep aids - to aid patients with severe insomnia and exhaustion.
  • Benzos or sedatives - for patients with severe anxiety, agitation, paranoia, and mood swings.
  • Mild stimulants - in extreme addiction cases, a mild stimulant prescription like modafinil may help patients with the harsh "come down" and erratic, restless behavior of stimulant addicts.
Medical Detox for Stimulant Addiction
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Doesn't Medically Assisted Treatment Represent a Paradox?

While medically assisted drug treatment can be highly effectual, it has received some criticism in the medical community because it essentially "replaces one drug with another." It is true that prescriptions like benzodiazepines, methadone, and buprenorphine can be addictive, especially when abused by those who do not suffer from substance use disorder; however, if the prescriptions are controlled under the strict supervision of a doctor and tapered off over time, they can lead to much higher recovery success rates for patients.

It is essential that patients who undergo medical detoxification do so in a controlled environment with exact doses that are approved by a doctor. If the medications listed above are abused, they can become just as problematic as the illicit substance addictions that they are supposed to counteract. In the vast majority of cases, the patients will be slowly weaned off the medications during the rehab phase and can usually leave the residential care facility free of any prescription medications.

One great exception to this rule is a patient who has received a dual diagnosis for mental illness or an emotional/social condition. In this scenario, a patient may need to continue to take psychiatric medications indefinitely in order to manage their mental condition and addiction.

Can Medical Detox Be Completed at Home?

Performing medical detox at home is not recommended for several important reasons:

  • Without medical personnel present, it will be more difficult to monitor the patient's withdrawal symptoms and adjust dosage levels as needed.
  • Abusing the medical detox prescriptions is much more likely without supervision.
  • The risk of relapse and overdose is significantly higher at home.
  • The risk of suicide or self harm is higher during home detox.
  • The rate of completing detox successfully is lower when performed at home.
  • Successful addiction recovery rates are higher for patients who transition into drug or alcohol rehab during or immediately after detox.
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With that being said, it is not unheard of for certain patients to perform medical detox at home. For patients who have authorization from a doctor, medical detox can be performed at home under certain conditions. For example, a doctor may recommend buprenorphine injections once a day at their office for a patient going through opioid detox; this type of treatment plan can reduce the chance that buprenorphine medications will be abused.

Anyone who plans to attempt medical drug or alcohol detox at home should take careful precautions to reduce the risks:

  • Receive a full physical and mental health examination from a doctor before starting to ensure that the mind and body are up to the task.
  • Receive a treatment recommendation and prescription plan from a doctor with addiction treatment experience.
  • Carefully follow dosages and medication recommendations as laid out by a doctor.Never change or adjust dosages without specific instructions from a doctor.
  • Stay in touch with the medical personnel who are overseeing the process and inform them immediately of any sudden or alarming changes in withdrawal symptoms or medication side effects.
  • Make sure a trustworthy (and sober) support group of family and/or friends is in place to monitor the patient's health and daily habits. This support group should monitor eating, drinking, and exercise and be prepared to call for emergency medical assistance if necessary.
  • Remove all temptations from the residence, including drugs and alcohol, paraphernalia, and (if possible) any people who may not be helpful to the recovery process.
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What Comes Next?

If you or someone you care about is suffering from drug or alcohol addiction, medically assisted treatment could be a viable option that can help you on the way to a long and successful recovery journey. Medical detox is not a quick fix, however.

"I have always been transparent about my journey with addiction... I look forward to the day where I can say I came out on the other side. I will keep fighting."
-Demi Lovato

Remember, substance use disorder is not simply a "phase" or a habit that can be broken. It is a chronic illness. Even after you have successfully completed detox and rid your brain and body of the physical addiction, there is still a long road ahead. Comprehensive counseling, therapy, and drug treatment will be necessary to address the psychological factors of your addiction and prepare you for coping with the daily challenges of a sober lifestyle. That's what rehabilitation is for.

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At a drug or alcohol rehab center, you will be provided with activities, tools, counseling, and therapeutic treatments to address all aspects of addiction. At a quality drug treatment center, you will first be examined to determine if you need dual-diagnosis therapy for underlying mental conditions that can attribute to addiction. Other types of rehabilitation therapy include:

  • One-on-one counseling
  • Gender-specific process groups
  • Neurofeedback therapy
  • Family therapy
  • Cognitive behavioral therapy
  • Contingency management
  • Dialectical behavior therapy
  • Educational classes
  • Community assimilation outings
  • Strength-based therapy
  • Bibliotherapy
  • Balanced diets and vitamin replenishment
  • Exercise and movement therapies
  • Massage therapy
  • Yoga
  • Acupuncture
  • Hipnosis
  • Mindfulness and meditation
  • Art therapy

A combination of the treatments listed above will help you to understand the nature of your addiction, its causes, and how to address it. Another very important thing that rehab can do is to help you to identify your own personal triggers - things in your life that may trigger drug or alcohol abuse - as well as how to cope with those triggers and cravings in the future.

The goal of all these techniques is for you to gain some insight and control over your addiction and prepare you for the challenges that will lie ahead as you begin a sober lifestyle in recovery.

What Are the Different Options for Drug and Alcohol Rehab?

There are several different kinds of rehabilitation programs, and the best plan for you will depend on many factors, such as your health, the severity of your addiction, and your living situation. Here are some of the options:

Drug or Alcohol Rehab Center
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Outpatient: Ideal for functional addicts who maintain a steady job and/or family, outpatient rehab allows the patient to live at home and attend several hours of treatment each week at an outpatient facility.

Intensive Outpatient: A step up from standard outpatient, intensive outpatient takes a more rigorous approach. Although the patient will still live at home, 12 or more hours per week of treatment will be required to complete the program.

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Residential Care: Generally considered the most successful approach for long-term recovery, inpatient care takes the patient out of their everyday environment and provides full accomodations for the duration of the program. A full-time schedule of treatment and therapy will be administered, usually for a duration of 28 days.

Happily Ever After

No, finishing detox or rehab does not mean that everything will be lovely and easy when it's time to move on with your life. Let's face it; real life is never easy and "happily ever after" only happens in fairy tales. However, there are millions of individuals who have overcome addiction and are now living fulfilling and successful lives.

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After you have completed the detox and rehabilitation process, you will be equipped with the insight and tools you need to build a new kind of life, free from the pain and suffering brought on by addiction. Depending on your individual case, you may continue to receive outpatient care and medical intervention for weeks or months after rehab. Other options include attending regular meeting at your local addiction support group and visiting addiction counselors and therapists in one of the many addiction resource centers that exist in every state.

The bottom line is, there are many, many resources that can help you achieve recovery if you simply reach out and ask. As Demi Lovato once said, "One of the hardest things was learning that I was worth recovery." You too are worth recovery; are you ready to make it happen?

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