Detoxification, or detox for short, is almost always the first step in the rehabilitation process for addicts and alcoholics. Before addicted individuals can begin treatment, they must first complete the detox process. There are many different types of detox.
The Detox Process
There are mainly three steps involved in drug and alcohol detoxification:
Evaluation – The patient is first tested and evaluated for detox. Mental health issues and psychological evaluation will also be conducted to help evaluate the patient’s underlying issues.
Medical Stabilization – This can be done with or without medication, but in most cases, medication is necessary to help stabilize the patient and treat withdrawal symptoms.
Treatment– The final step is the recovery process itself, usually involving continuing on in a drug rehabilitation program, aftercare, and long-term recovery program
Alcohol is one of the most dangerous drugs of abuse, not only because of its availability and social acceptance, but also because of its damaging effects and dangerous detox. Many alcoholics who try to stop drinking on their own experience uncomfortable and even dangerous withdrawal symptoms, and in the worst cases, these symptoms can be fatal. Alcohol withdrawal symptoms are dependent on the severity of the alcoholism and length of time the alcohol abuse has be going on. During alcohol detoxification, the patient is medically monitored during the withdrawal of the alcohol from their system.
During this process, alcoholics may experience anywhere from mild to severe withdrawal symptoms such as sweating, headaches, anxiety, increased heart rate, insomnia, agitation, and delirium tremens (DT’s) leading to seizures and sometimes even death. At a medical detoxification program, medical staff will use various medications to ease the most severe symptoms of alcohol withdrawal. Most often drugs in the class of benzodiazepines such as Librium and Diazepam are used to assist with anxiety and act as anticonvulsants to prevent seizures from alcohol withdrawal. Despite medical assistance, alcohol detoxification always runs risks and for very severe cases of alcoholism where the patient has experienced cirrhosis of the liver or other organic diseases caused by drinking, the detox process can last several weeks to months for medical care. Most cases of alcohol detoxification, however, take anywhere from 3 to 10 days.
Heroin and opiate based pain killers like Vicodin, Percoset, Darvon, Morphine, Fentanyl, OxyContin, and Methadone not only cause a psychological addiction, but also a physical addiction that makes the detoxification process especially difficult. With stimulant drugs, the addiction is mostly psychological and the physcial symptoms are kept to a relative low grade of discomfort.
Detofication of opiates from the body is a process that often involves other drugs being administered to make the process more tolerable. Some of symptoms of opiate withdrawal are nausea, vomiting, diarrhea, high fever, cold sweats, shaking, muscles spasms, insomia, extreme fatigue, and muscle aches. Because the pain and discomfort is so severe in many cases of opiate withdrawal, addicts are often given benzodiazepines like Klonopin or Valium to “take the edge off” and help an individual to relax and hopefully sleep through the detoxification process. Alternatively, other opiates are used to gradually taper the addict, most often buprenorphine (Subutex® or Suboxone®) or methadone. These drugs have very long half-lives, so when the effects of them wear off, the user experiences less severe withdrawal symptoms than from their drug of choice.
Detoxification of opiates from the body, like with stimulants, can range in length and severity, depending on the individual and his or her drug and health history. In general, a traditional opiate detox takes anywhere from 3-10 days, and thereafter a period of time when the recovered user may experience mild depression, lethargy, and fatigue, and other protracted withdrawal symptoms, known by the acronym PAWS (Post Acute Withdrawal Syndrome).
Another form of opiate detoxification is rapid opiate detox, in which doctors anesthetize the patient, administer a combination of opiate antagonist medications (usually narcan and/or naltrexone) that send the patient into immediate acute withdrawal for several hours while under anesthesia, until the opiates are out of the system. Patients are usually monitored in the hospital over night and then sent home within 1 day of the procedure.
Benzodiazepines are drugs classified as mild tranquilizers, which act as Central Nervous System (CNS) depressants, slowing brain function and relaxing muscles. Although benzodiazepines have beneficial uses, such as their uses as muscle relaxants and sleep aids, the prolonged use of these drugs can lead to extreme physical dependence, which makes the detox process very dangerous. Generally, when people addicted to benzodiazepines such as Xanax, Ativan, Valium and Klonipin undergo the withdrawal process, they can experience sleep disturbances and insomnia, irritability, headaches, fatigue, sweating, anxiety, and most importantly, seizures.
The withdrawal process generally creates the very symptoms that benzodiazepines are indicated to treat. The way medical staff ensure safety during the withdrawal process for individuals addicted to benzodiazepines is to administer limited amounts of phenobarbital, as it is less addictive and less powerful than the benzodiazepines it is used to treat, but works well as a mild sedative and anti-epileptic (anti-seizure) medication. Until the toxins from benzodiazepine abuse have been completely removed from the body, it is important for the addict to remain under medical care. The cessation of benzodiazepine use can cause dangerous and sometimes deadly seizures until the drug is out of the body. For some of the drugs in this class with longer half-lives, the toxins can remain in the body for as long as 4-6 weeks depending on the severity and length of the abuse.
Detoxification from Cocaine, Methamphetamines, and Other Stimulants
These drugs of abuse do not necessarily create a significant physiological dependence and therefore do not specifically require medical detoxification. The abuse of these drugs, however, result in serious psychological dependence which often requires intense therapy and residential treatment, but not necessarily medically assisted detox. Nevertheless, detox protocols do exist for these substances.
Detoxification from stimulants like cocaine, crack crack cocaine and meth, like with any other substance, can be psychologically grueling. Detoxifying the body of these kinds of drugs can cause significant psychological withdrawal symptoms including anxiety, irritability, insomnia, severe cravings, and fatigue. Detox from methamphetamine specifically can cause psychotic reactions, severe depression, and confusion.
The most common detox medications used to treat stimulant withdrawal are antidepressants and mood stabilizers. The detox process can last anywhere from 3 to 10 days, but in most cases tends towards the shorter end of this scale.
The Importance of Detox for Drug and Alcohol Recovery
The process of detoxification is only the beginning of drug or alcohol rehabilitation, but it is one of the most important parts of this process. Detox is imperative because the psychological, social and behavioral rehabilitation process cannot begin if there is still a physical dependence on drugs and alcohol. This physical dependence is one of the main motivations for alcoholics and drug addicts to continue using, as it is responsible for the painful and sometimes dangerous physical withdrawal symptoms that occur upon cessation.
Detoxification seems imposing because of the horrible stigma it has for being painful and uncomfortable, but rest assured that it is necessary for the recovery process to begin, and pales in comparison to the pain and dangers associated with continuing addictive behaviors, it is worth it for a successful life in recovery.
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