Understanding Drug Rehab Detoxification
Detoxification is the process of removing drugs from the body. It is used to help individuals cope with drug withdrawal symptoms. The detoxification process helps clients access personalised treatment. However, each client may have a different experience, depending on the drug they were addicted and the period they used the drug. (1)
Detoxification uses medicine that helps clients to be comfortable while undergoing rehabilitation. The client may take days or weeks to overcome withdrawal symptoms for most drugs. (2) The process of detoxification involves the following three major steps (2):
Evaluation: The client is screened for physical and mental health issues. Blood tests are conducted to assess the amount of drugs in the client’s body, which will determine the amount of medication required.
Stabilisation: The person is stabilised with both medical and psychological therapy to avoid any form of injury. To reduce withdrawal symptoms and avoid complications, the doctor may advise the client to take addiction treatment drugs.
Preparing Entry into Treatment: This is the last stage in the detoxification process. It involves explaining to the client the whole treatment process and what they should expect.
What are the various methods for drug detoxes?
‘Cold Turkey’ Detox with Medical Support: ‘Cold turkey’ means abrupt quitting of drug use and is a great way to commence the treatment process. Most people who quit using cold turkey have a lower chance of relapsing compared to other methods. This method is likely to be successful if the client has access to medical support to help them cope with the drug withdrawal symptoms. (1)
Direct Tapering: In this method, the client reduces drug consumption steadily over time to help the brain adjust and respond well to the lack of a substance. This encourages the brain and body to start releasing natural chemicals again. The person may also experience a few withdrawal symptoms (1).
Substitution Tapering: This method involves replacing the abused drug with a different drug with similar components before tapering. An example of the substitution tapering method is heroin users who are put on methadone to help them quit. Methadone prevents heroin cravings by producing similar effects without the intense highs and has a lower addiction potential (1).
Titration Tapering: In this method, the dosage of the drug is initially dissolved in water. A specified quantity of the water is then carefully removed to decrease the dose by a small amount before the water with the drug in it is consumed. This enables the removal of minuscule amounts of the drug’s dose, allowing for an extremely gradual taper. It is often used in benzodiazepine or club drug detox.
The person suddenly stops the addictive behaviour, such as drinking alcohol, eating compulsively, smoking, drugs or gambling. In this detox method, the user overcomes a harmful habit without any assistance. In this type of detox, the person lacks a secure environment and the necessary supervision to deal with the excruciating and strenuous body changes that occur when quitting substance dependence, so this method may not be successful in some cases.
The cold turkey method is effective only when the individual has access to medical support to enable them to overcome the withdrawal symptoms that arise during the detox process. The client should consult a physician before trying this method. A person using the cold turkey detoxification process may be advised by a physician to take several over-the-counter drugs for the process to be successful.
A short-term detox
Clients going through a medical detox are required to quit alcohol and substance abuse. During the process, the doctor may recommend an interim medication plan to help with withdrawal symptoms. The client may also have to use specific drugs for a limited time to relieve pain.
Persons suffering from insomnia are prescribed non-addictive sleeping pills, and those experiencing withdrawal symptoms like muscle pains or bone discomfort are provided with pain relievers. The medical team ensures that all clients have access to these drugs to enable them to manage the painful detoxification process in the shortest time possible. Individuals detoxifying from alcoholism are offered benzodiazepines frequently or whenever the symptoms arise. The medications are not harmful and also prevent seizures. Benzodiazepines are taken for a short while and have been used for decades to help people detox successfully from alcohol because of their cross-tolerance with alcohol.
A long-term detox
Long-term detox is mostly used in the treatment of opioid drugs like heroin and prescription painkillers. Clients are advised to use longer-term drugs to enable them to manage their withdrawal symptoms.
For instance, the doctor may put a heroin addict on methadone or Suboxone, a combination of buprenorphine and naloxone, to prevent the person from enduring the violent withdrawal symptoms. Over time, the physician will slowly reduce the dosage until the client is drug free.
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Why Medication Is Often Needed for Drugs Addiction Treatment
A client may be advised to take medication when recovering from drug addiction and its complications. Medication helps clients stay sober by making it easier for them to cope with intense withdrawal symptoms.
The drugs used for treatment imitate the effects of the abused substances, which helps control the urge to relapse and withdrawal issues. The medication prescribed to the client may differ, depending on the drugs the person was addicted to.
Physicians might change the dosages in the course of treatment according to the client’s reactions and progress. Sometimes, clients may be put on long-term medications to help diminish cravings and prevent the person from relapsing after recovering from the addiction. However, medication alone is not enough treatment for substance dependence. Rehab clients may undergo other treatment methods like psychotherapy.
The rehabilitation professionals may put the client on certain drugs that address possible mental health conditions like anxiety and depression that can be caused by substance-related disorders. Sometimes the clients are required to receive testing for infectious diseases such as tuberculosis, hepatitis or HIV they may have acquired as a result of being in high-risk situations during their drug activities, like sharing injections.
Medications Approved for Drug Detox
According to the National Institute on Drug Abuse (NIDA), several drugs are efficacious in treating adults addicted to nicotine, opioids, stimulants or alcohol. However, none of these drugs have been officially been approved by the MHRA in the UK. Brand compounds are being researched for possible treatment of drug addiction and related disorders in both adults and teenagers. The medication currently prescribed by doctors has not yet shown convincing results. (1)
Abrupt detoxification from benzodiazepines like Xanax and Valium or alcohol may be fatal and that is why it is never recommended for such users to quit cold turkey. Quitting other drugs is not always lethal, but complications may still emerge. That’s why medical detox is recommended to ensure safety and successful rehabilitation. (1)
Medications used in the treatment of opiate and heroin addiction make it easier for the client to overcome the urges and withdrawal symptoms. Long-term replacement drugs help to stop cravings, and person recovering from addiction may be required to take the detoxification tablets daily.
Benzodiazepines are drugs used for curing anxiety and some other drug-related conditions. These drugs interact with the brain’s nerves and spinal cord, causing muscle relaxation, low anxiety levels and sedation. Approved benzodiazepines in the UK include Xanax, Librium, Klonopin, Tranxene, Valium, Prosom, Halcion and Doral, among many others. (4)
Benzodiazepines are used in the detoxification process to reduce irritability and anxiety. Most people trying to quit drugs like opiates and cocaine suffer from anxiety. Benzos produce a sedative effect that assists the users in successful abstinence from alcohol.
Benzodiazepines are, however, extremely addictive, and only licensed physicians are allowed to issue the drugs while exercising caution. This is why they have been classified as schedule IV depressants. However, they have a low potential for abuse compared to the drugs listed in schedules B and C. All benzodiazepines create physical dependence, and stopping treatment may lead to withdrawal symptoms like insomnia, feeling a loss of self-worth and agitation. (4)
Naltrexone is commonly used in alcohol and narcotic detoxification. It works by obstructing the brain receptors that release alcohol’s pleasurable effects and also help the user overcome the desire to drink. Naltrexone may be administered via an injection every four weeks, and the user may experience common side effects like nausea or headaches. (5)
The drug induces withdrawal symptoms in people who are physically dependent on narcotics, so it should be used on clients who are no longer abusing drugs. Before a client is put on Naltrexone, they must stop taking narcotics for at least 10 days. (5).
Naltrexone should not be mixed with opium, codeine, methadone, oxycodone or buprenorphine. Individuals suffering from medical conditions like liver disease, depression, mental illness or kidney disease are likely to be affected by the drug. Such individuals should be examined by a physician before being put on such medication.
Disulfiram is a drug used to treat alcoholism, and in most cases, it must be combined with psychotherapy and other support services for it to be successful. The drug interrupts alcohol breakdown and produces harmful effects like feeling sick, facial redness, chest pains, vomiting, laboured breathing, nausea and irregular heartbeat.
The medication inhibits the activities of a particular enzyme critical in digesting alcohol by forming acetaldehyde, a chemical intermediary that causes the physical effects. This method is thought to prevent users from continuing to drink because they know they will suffer painful effects if they do so. (6).
Users suffering from nephritis, epilepsy, diabetes, cerebral damage, hypothyroidism and hepatic impairment are advised to use Disulfiram cautiously and only under strict medical supervision. The drug should not be administered to people with psychosis or severe heart disease or clients who may be allergic to the drug (6).
Antidepressants have several functions during detoxification. For instance, sedating antidepressants like trazodone and imipramine may be prescribed to a client who is struggling with withdrawal symptoms. Clients withdrawing from amphetamines may be prescribed antidepressant medication to minimize depression, which is usually associated with quitting drugs. (7)
Some tricyclic antidepressants react with neurotransmitters like norepinephrine, dopamine and serotonin that regulate moods. Drugs like methamphetamines severely affect the neurotransmitters, and tricyclic antidepressants block the absorption of serotonin and norepinephrine. This allows the buildup of the compounds in the brain, which helps in improving the client’s moods. (7)
A 2010 study found that antidepressants were not helpful in treating opioid addiction. However, if the substance abuse is co-occurring with a mental disorder like depression, then antidepressants can be prescribed to manage the depression. (7)
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Opioid drugs are extracted from opium poppy plants and used to relieve pain. They include codeine, morphine, oxycodone and hydrocodone. Heroin is also extracted from the poppy plants, but it is not used as a painkiller.
Opioid drugs function by attaching to opioid receptors in the central nervous system and the body, hence removing the feeling of pain. However, these painkillers may cause addiction because they produce euphoric effects when they act on the brain’s reward system. (11)
An opioid agonist functions by attaching to the brain opioid receptors and intensifying the effects of the naturally occurring neurotransmitters. Methadone is a common opioid agonist that is frequently supplied in clinics. It is an opioid agonist that’s regularly used in detoxing from heroin.
This drug stays in a person’s system longer than illicit drugs and is more effective in relieving withdrawal symptoms. Methadone use has to be closely monitored because long-term use may result in addiction. (11)
Non-opioid agonists also help with opioid withdrawal symptoms and have proved effective during detoxification. Clonidine has been identified as one such alpha-adrenergic agonist that functions by subduing symptoms associated with opioid withdrawal. Clonidine acts on the brain’s alpha receptors and diminishes nerve signals transmitted to blood vessels. (12)
Clonidine is regularly used as a blood pressure drug that decreases the surge of adrenaline, which is responsible for the fight-or-flight response.
Clonidine has been used in detoxification from methadone, narcotics and even alcohol. (12) Propranolol is another high blood pressure drug that acts as a beta-blocker and has the same effects as Clonidine. This drug may be used in detoxification from serious cocaine addiction and for drastic alcohol withdrawal symptoms.
An opioid antagonist operates by literally hindering the brain opioid receptors that block the stimulation of neurotransmitters when a new medication is introduced. This implies that the body of a user using an opioid antagonist will not welcome any form of opioid.
This prevents the client from getting high and reduces the urge to abuse drugs. Antagonists are effective after a detox process has been completed to prevent the person from relapsing. However, some are still used during detoxification. (11)
Naltrexone is an opioid antagonist available in tablet and extended-release injected form. It is mostly prescribed to a client after detox because none of its available forms prevents opioid withdrawal symptoms. It is commonly used for long-term treatment of alcohol addiction.
Naloxone, also known as Narcan, is another opioid antagonist commonly used to reverse opioid overdose effects. It functions swiftly when inhaled or when administered via injection. If the withdrawal symptoms are not extreme, Naltrexone and naloxone may be prescribed for detox. (11)
Other Medication Used for Withdrawal Management from Drugs
Apart from the drugs listed above, other medications used for withdrawal management include:
Acamprosate (trade name: Campral): This medication is used during alcohol detox. It functions by preventing the brain from overstimulation that occurs when a person tries to quit alcohol.
Modafinil: This drug is a non-amphetamine that acts by stimulating the central nervous system. It is prescribed to users suffering from sleep-related disorders. Scientists have discovered that Modafinil has properties that make it suitable for treating cocaine dependence, a condition that has no formal MHRA approved pharmacotherapy. It is scientifically assumed that its stimulant effects can help relieve acute cocaine withdrawal symptoms and diminish cocaine cravings.
Bupropion: Bupropion is used in treating depression and has also been helpful in smoking cessation. A study found that the drug was also effective in reducing cravings for cocaine use and even reduced methamphetamine cravings.
Baclofen: This drug is used for muscle spasticity treatment, but medical research has revealed that it is also effective for opioid dependence treatment.
Gabapentin: Research evidence shows that this anticonvulsant medication can prevent specific withdrawal symptoms for clients undergoing methadone-assisted detox.
Mirtazapine (trade name: Remeron): Remeron is used for users suffering from depression. However, limited research suggests that the drug, combined with therapy, can be effective in alcohol detoxification.
Do Drug Rehab Medications Have Addiction Potential?
A number of the drugs used in detox have addiction potential, and most of them can only be issued by a certified physician. These drugs are listed under schedule II, III or IV, indicating the potential of their abuse. For instance, opioid drugs like codeine, morphine, oxycodone and hydrocodone are used to relieve pain in opioid detoxification. However, they act on the central nervous system, and the brain produces a euphoric effect that can be addictive.
According to the BBC, misuse of prescriptions for non-medical purposes is rampant in the UK because they are easily available over the counter. (14) Methadone is an opioid agonist that’s readily available in clinics and used for heroin detox. However, this drug can cause dependence when used for a long period, even though it doesn’t produce the same high as other opioids. That’s why methadone prescriptions need to be highly regulated.
Benzodiazepines are psychoactive drugs that work to slow down the central nervous system and help to relieve alcohol withdrawal symptoms with tranquilizing and anticonvulsant effects. However, they are prescribed for short-term use because of their abuse potential.
The Importance of Detox for Substance Abuse Disorders
Detoxification reduces the strength of a disorder in individuals who need to abstain or who are required to maintain sobriety. The first and most critical step in addiction treatment is removing drugs or alcohol from the client’s system because most drugs are capable of remaining in the body for several days, or even months, after the last use.
Drug detox is important for substance use disorders because it is the first major step a person struggling with addiction takes towards a drug-free life full. Without drug detox, a client may be exposed to gruelling health problems like cancer, heart problems, hallucinations and kidney and liver failure. (10)
A person who has undergone detoxification is likely to experience the following health benefits:
- Greater Energy Levels
- Increased Appetite
- Less Inflammation
- Stronger Immune System: After detoxification, the body has better lymphatic and digestive functions that are critical to a powerful and balanced immune system.
- Improved Mood: Most clients have terrible mood swings as a result of toxin accumulation in their body, which affects their brain functions. After detoxification, the person may experience improved sleep, intelligible thoughts and positive energy. (10)
Tapering Off Using Medication Assisted Dose Management
Tapering off opioids and other drugs to decrease physical dependence or side effects is distinct from tapering because of addiction. Most clients are terrorized by withdrawal symptoms like writhing in agony, sweating or a formidable urge for the drug, and that’s why most end up abusing the drugs to avoid the withdrawal symptoms. (9)
Additionally, clients managing atrocious pain due to opioid therapy fear that the pain will rebound the moment they taper off their medications. Comprehensive medical and non-medical therapies are available to assist recovering drug users in coping with pain. Individuals should consult with a doctor to know the appropriate approach that’s available for them. (9)
Medication-assisted treatment (MAT) is the most frequent procedure used to help users addicted to alcoholism or opioids. The procedure uses medications individually authorized for the treatment of various addictions, incorporating counselling and behavioural therapies. Research shows that medication-assisted therapy is highly beneficial to people with opioid use disorder. (9)
Suboxone, a mixture of buprenorphine and naloxone, is used for MAT. However, the client should start the drug once they experience withdrawal symptoms. Other drugs like methadone, naltrexone and buprenorphine are also options for the treatment of opioid use disorder.
The Dangers of Detoxifying Alone
Some people may prefer to detox from drugs or alcohol alone because it seems a convenient and simple option. However, this ends up not only being counterproductive and ineffective but also comes with severe risks. Detoxification from alcoholism or opioids, benzodiazepines and other drugs could result in health complications if not monitored by medical professionals. Here are some of the dangers of detoxifying alone.
High Chances of Relapse: Relapse rates are high in users recovering from drug addiction, but the number is even higher among users attempting to detox on their own.
Lack of Emotional Support and Counselling: Emotional support and counselling are integral to the recovery process. In rehabilitation centres, individual and group counselling sessions are integrated into the treatment plan for clients going through the detoxification process. This type of help is not available at home; hence, the chances of recovery are very minimal.
Severe Withdrawal Symptoms: Severe withdrawal symptoms like muscle aches, fatigue and high blood pressure begin a few hours after the person quits taking the substances, and most of these symptoms are highly dangerous. It is recommended for the detox to be done in a rehabilitation facility to help the person manage the withdrawal process.
The Benefits of a Fully Managed Detox Process
It’s not recommended that a person undergo detoxification alone without medical supervision because of the withdrawal symptoms that are bound to arise. They may even prove fatal in some cases. The following are the benefits of a fully managed detox program.
First Stage of Successful Addiction Treatment: A medically supervised detox process is a crucial step offered by inpatient and outpatient rehabs to clients to increase their chances of recovery. The person is safe because they have a 24/7 surveillance team around them ready to assist during painful withdrawal symptoms. After detoxification, the team helps the client access treatment and therapy programs. (1)
Can Be Life-Saving: A fully managed detox is emphasized to identify and treat all alcohol and drug-related medical emergencies caused by substance abuse. A client experiencing the process without supervision is likely to undergo unanticipated fatal symptoms.
Prescription Medications Can Ease Uncomfortable Withdrawal Symptoms: Addiction treatment medications are available in almost all managed detoxes. Such medication is used to ease the seriousness of the withdrawal symptoms and may be harmful when self-administered without proper management. (1)
May Uncover and Lead to the Treatment of Co-Occurring Disorders or Diseases: Many users with a drug addiction problem may have a co-occurring mental illness and could be unaware since most abused substances are likely to suppress such disorders. For example, a person abusing a drug like heroin may not feel abdominal pain caused by undiagnosed hepatitis. Such suppressed health conditions may only be revealed during a fully managed detox. (1)
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Medical care during detox
Medical care is needed in the detoxification process because, in some situations, withdrawal symptoms from drug abuse can be deadly. Medical care is available in all detox centres and addiction rehabilitation centres. In these facilities, the client is treated in secure surroundings and has medical personnel at their disposal who offer medication and sound healthcare techniques to make the whole withdrawal process trouble-free by being in control of the dangerous side effects.
The moment a person builds tolerance, they become dependent on the drug, and their body only functions if they use the drug. Failure to use the drug may lead to the body responding negatively by causing headaches, vomiting and other withdrawal symptoms.
Because of such cravings and withdrawal symptoms, most people are unable to quit using drugs or alcohol. Therefore, medically supervised care is needed during detox to enable them to get through the process safely. Medical care helps adjust the body to the condition it was in before the person started abusing the drug and diminishes the cravings.
Personalised detox and therapy plan
Drug rehabilitation centres understand that each client has different needs, so they provide clients with a personalised detox and therapy plan that meets their individual situation. Personalized detox services include around-the-clock care, a physician-led supervised medical detox plan and professional therapeutic assistance in secure surroundings.The facilities are usually well equipped to handle all types of detoxification and offer comprehensive medication. After accomplishing the medical detox,
the client proceeds to the therapeutic rehabilitation phase. At this point, the client will have full access to amenities such as gymnasiums, swimming pools, treatment rooms and gardens during free-time periods.
Various therapies are offered in drug rehabilitation centres depending on the clients’ needs. For instance, behavioural therapy enables clients to understand the behavioural changes that pushed them to substance dependence. Some therapies educate clients on the underlying causes of addiction such as genetics, while others motivate clients to become drug-free and find their life purpose.
Psychiatric assistance during detox
Psychiatric assistance during detoxification is commonly required in situations where the client is suffering from both drug addiction and a mental health disorder like anxiety, depression or bipolar disorder. In medical terms, it is referred to as a dual diagnosis or co-occurring disorder. It is already challenging to deal with alcoholism, substance abuse or drug addiction, and it’s even more difficult to deal with mental health issues simultaneously. (13)
In such a situation, it is recommended for the client to undergo the detoxification process and seek psychiatric assistance. Most drug rehabilitation centres provide psychiatry services that may help individuals address mental health problems.
Detox Timeline for Different Drugs
The amount of time detox takes depends on various factors like the type of substances abused and the seriousness of the abuse. (13)
Stimulants: Withdrawal side effects like food cravings, mood swings and insomnia after quitting drugs are common for cocaine and amphetamine users. The symptoms differ in effect and become powerful before subsiding. In less than 72 hours, individuals experience a flow of depression accompanied by the notorious crash that will leave them exhausted.
Heroin and Opioid Pain Relievers: Withdrawal symptoms for opioids start from six to 12 hours after the final drug consumption and worsen from day 3 to 4 of detox. Major symptoms include cramping, salivation, nausea, breathing difficulty and trembling.
Benzodiazepines: Withdrawal symptoms last for a few weeks and could last for a few months in some users.
Alcohol: Alcohol addicts start experiencing withdrawal symptoms within the first eight hours of abstinence from a drink. After 24 hours, the addicts may start experiencing hallucinations, which are known to last for days.
Marijuana: Detoxifying from marijuana is quite simple compared to other substances. Symptoms may start one to three days after the last consumption and, for most users, end in two weeks. However, some users have been known to struggle with fatigue and insomnia for up to a month.
Recovery Support Groups and Life After Drugs Detox
Recovery addiction support groups allow the user to share their journey to recovery, including challenges as well as personal experiences. Support groups are beneficial to everyone and helpful for recovering addicts with accompanying mental conditions like depression. Former users can get support and emotional guidance, especially when they feel the urge to take the drugs. (12)
There are many benefits to being in recovery addiction support groups, like learning skills to conquer cravings, meeting new people who are seeking a sober life, knowing you’re not alone, getting support during difficult emotional times and having accountability partners. Some drug users have managed to achieve complete drug and alcohol abstinence through the assistance of addiction support groups.
Life after drugs detox is a great achievement worth celebrating, but maintaining the sobriety is the most challenging lifelong process. After the drug detox, the first step for the former user is to maintain a sober life when they return to normal life. (12)
Most relapses happen during the first six months after detox. Former users are encouraged to take a daily routine and build a new social life. Building a social life may involve playing sports, taking a class, going to the movies, learning how to play an instrument, volunteering, taking dance lessons, playing video games or attending conventions, among other activities that will help prevent a relapse. (12)
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- (1) http://www.drugabuse.gov/
- (2) http://www.csam-asam.org/
- (3) https://www.medicalnewstoday.
- (4) https://www.rxlist.com
- (5) http://www.nlm.nih.gov/medlineplus/
- (6) https://www.medicinenet.com
- (7) https://www.ncbi.nlm.nih.gov/
- (8) https://pubs.niaaa.nih.gov/publications
- (9) https://www.practicalpainmanagement.com
- (10) https://bmcpublichealth.biomedcentral.com
- (11) https://www.dualdiagnosis.org
- (12) https://www.webmd.com
- (13) http://www.nlm.nih.gov/medlineplus/druginfo
- (14) https://www.bbc.com/news/
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