Is Detox Necessary?
When drugs and alcohol are involved, detox is often part of a comprehensive addiction treatment program. In order to move forward with addiction treatment, a person must first reach a level of physical balance without drugs and alcohol. This is often achieved through a formal detox program. Residential treatment facilities often require individuals to take a drug screening upon admission in order to ensure that they are sober before entering into the program. If drugs or alcohol are present, and the treatment program doesn’t offer medical detox, a referral to a detox program may be provided.
Residential treatment programs work with families and individuals via therapeutic and supportive care models to give people the tools to sustain recovery and prevent a return to drug abuse, or relapse. The National Institute on Drug Abuse (NIDA) recommends that addiction treatment programs (both residential and outpatient) are at least 90 days in duration so a strong foundation for recovery can be built. Detox, on the other hand, is much shorter and often a first step in addiction treatment. A detox program lasts 3-7 days on average and provides a secure environment to aid in processing drugs and alcohol out of the body.
Medical detox is the most comprehensive form of detox. It is performed in a specialized facility that staffs medical, mental health, and substance abuse professionals to provide a high level of care. During detox from drugs and alcohol, individuals may experience intense physical and emotional withdrawal symptoms. In some cases, withdrawal symptoms can even be life-threatening. Many drugs, as well as alcohol, should never be stopped suddenly, or “cold turkey,” due to the potentially hazardous consequences.
A specialized detox program can help a person to process drugs out of the body as smoothly as possible while helping to manage withdrawal symptoms and cravings. Professional detox programs are typically considered the safest method of stopping problematic drug and alcohol abuse, and they are often precursors to addiction treatment programs.
Rebalancing the Brain in Detox
Drug and alcohol abuse interferes with normal functioning of the brain, causing a disruption in the production, re-absorption, and transmission of many of its chemical messengers, or neurotransmitters. Parts of the brain that are involved in reward processing, the regulation of moods, short-term memory, motivation, impulse control, decision-making, and learning are impacted through regular drug and alcohol abuse, NIDA publishes. The more a person uses drugs, the more prominent these changes in the brain and its chemistry become. A dependence on drugs and/or alcohol is then formed.
At this point, the brain will not keep working the same way it did before the introduction of drugs or alcohol. It may now require these substances in order to feel pleasure, to keep emotions in check, and to feel balanced in general. Drug cravings and difficult withdrawal symptoms may occur when the substance wears off, as the brain struggles to regain its natural balance.
Typical withdrawal symptoms may include insomnia, anxiety, irritability, agitation, depression, suicidal thoughts, trouble feeling pleasure from everyday things, muscle tension, body aches, stomach issues, headaches, tremors, trouble concentrating and thinking clearly, fatigue, sweating, drug cravings, and goosebumps. Withdrawal symptoms can range from mild to severe and can include both physical and emotional symptoms. The brain needs time to heal and to restore itself after chronic drug abuse, and this is often most safely accomplished in a specialized detox program.
There are many “do-it-yourself” detox remedies that can be found online or kits that are sold in local drugstores. These products are generally ineffective and not proven to be safe.
Drug and alcohol withdrawal can be unpredictable and intense. Support during detox can help individuals to withstand the cravings and avoid relapse. A relapse after any period of abstinence is particularly dangerous since tolerance level to drugs and alcohol may have dropped after stopping regular use. If a person then tries to resume taking drugs at previous levels, the body and brain can become quickly overwhelmed, potentially leading to overdose.
Drug overdose has overtaken even motor vehicle crash fatalities in the United States as a cause of death, accounting for close to 50,000 deaths in 2014, according to the Centers for Disease Control and Prevention (CDC). A professional detox program can help to manage cravings and prevent a return to drug use; therefore, it may even be a potential lifesaver.
No two people are exactly the same, and while one person may really need a specialized detox program in order to safely process drugs out of the body, another person may not have the same requirements. Signs that a detox program will be highly beneficial include:
- A heavy dependence on drugs and/or alcohol: Someone who has taken large amounts of drugs for a long time is likely to be significantly dependent on them.
- Injecting, snorting, or smoking drugs: These methods of use send the drugs more rapidly into the bloodstream, which may quickly increase the level of dependence on them.
- Dependency on opioids, benzodiazepines, or alcohol: All of these substances can have significant medical and psychological side effects during withdrawal that Psychology Today warns may even be life-threatening and require a high level of supervision and care during detox.
- Abuse of multiple substances: Polydrug abuse can complicate withdrawal, and individuals who regularly use multiple substances need medical detox to avoid any adverse reactions or complications.
- History of addiction: People who have been through treatment before, or who have a personal or familial history of addiction and drug dependence, often require the help of a specialized detox program to safely process the drugs out of the body.
- Presence of a mental health or medical disorder: Any co-occurring disorders may be exacerbated during drug and alcohol withdrawal; therefore, the safety and security of medical detox are optimal.
- Environmental stressors: Those who are victims of trauma, live in an environment that includes high levels of stress, and have limited support at home will benefit from medical detox.
Generally, individuals will undergo a thorough assessment and drug screening prior to detox in order to determine what level of care is optimal for them. Detox is not a “cure” for addiction, but rather the initial stage of treatment. There is no cure for addiction but it can be managed on an ongoing basis.
Medical Detox: The Highest Level of Care
The main goal of detox is to help a person reach a safe physical state so the psychological aspects of addiction can be addressed through an addiction treatment program. Medical detox is the most comprehensive level of detox that is provided in specialized facilities by highly trained professionals.
During medical detox, vital signs can be monitored and professionals can intervene in the case of complications. Alcohol withdrawal, for example, can lead to a dangerous, and potentially fatal, syndrome called delirium tremens (DTs), which is characterized by seizures, delirium, confusion, and fever. The New England Journal of Medicine (NEJM) warns that 3-5 percent of those who suffer from alcohol withdrawal will deal with DTs, which can be deadly and requires immediate medical attention.
Benzodiazepine drugs that are often used to treat anxiety, panic, and seizure disorders, like Xanax (alprazolam), Valium (diazepam), and Klonopin (clonazepam), may also cause the brain to rebound during withdrawal, leading to more severe anxiety, panic, and even seizures. Opioid drugs, such as heroin and prescription painkillers, tend to cause flu-like symptoms as well as intense emotional “lows” during withdrawal. Stimulant drugs (e.g., cocaine, methamphetamine, and prescription ADHD medications) increase pleasure and energy, and decrease appetite and sleep requirements, and the opposite effects occur during stimulant withdrawal.
Withdrawal symptoms from drugs and alcohol typically begin as soon as the substance stops being active in the bloodstream. Depending on the type of drug and the person’s individual metabolism, this timeframe can range from a few hours after last use to a day or so later. The Substance Abuse and Mental Health Services Administration (SAMHSA) reports that for most drugs, the bulk of the intense, or acute, withdrawal symptoms typically last around a week or so. Beyond that, symptoms tend to gradually subside.
During medical detox, medications are often used to control withdrawal symptoms. In some cases, drugs are slowly tapered off during detox in order to avoid the abrupt rebound that withdrawal can cause. Short-acting drugs may also be replaced by longer-acting ones during a drug taper, which lowers the amount of drugs in the body over a scheduled amount of time until they are weaned off altogether. Other pharmaceutical tools are also helpful in targeting and managing specific symptoms of withdrawal. Mental health professionals provide care, support, and encouragement during detox to keep individuals safe and on the path to recovery.
Medical detox helps to rebalance the brain, often with the aid of medications, and set a person up for an addiction treatment program. Medical detox can help to shorten withdrawal timelines, manage cravings, and smooth out withdrawal symptoms, helping to prevent relapse and increase readiness for a comprehensive treatment program. Detox should not be used as a standalone treatment plan, but instead as part of a complete program that includes therapeutic, supportive, and potentially pharmaceutical methods to achieve and sustain recovery.