Your Guide to Medically-Assisted Detox from Drugs and Alcohol

detoxing from drugs People that consistently abuse substances like alcohol, prescription sedatives, or opioids put themselves at risk of developing physical dependence and eventually becoming addicted to the substances, which can lead to a variety of negative physical, mental, and social repercussions 1,2. Continued substance abuse is problematic, but a person attempting to curtail their use or altogether quit will likely experience complications in the form of withdrawal symptoms that appear shortly afterwards 3,4. Since these withdrawal symptoms are often extremely uncomfortable and, in some cases, potentially life-threatening, professional detoxification treatment is always a recommended recovery option, especially for people dependent on alcohol, sedatives, and opioids 3,4. A medically-assisted detox program offers a high level of medical support and access to medications that help improve the individual’s comfort, safety, and success during the earliest stages of recovery 1,3,4.

Drug Detoxification

When a psychoactive substance is consumed, it eventually travels to the brain where it then effects changes in activity across various neurotransmitter systems (chemical messengers in the brain) and alters the physiological processes controlled by them 5. Continued drug abuse leads to several neuroadaptations, which underlie addiction-related phenomena such as tolerance and dependence. It’s important to note that a person can develop tolerance and dependence even if the drug is used as prescribed 2.

Choosing a Clinic

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Tolerance occurs when the current dose of the substance produces a diminished effect. This results in the individual requiring increased or more frequent doses to achieve the desired results 2,5,6. Tolerance is a common and expected result of substance use 2.

Dependence is the product of the brain's attempt to maintain balance. A person dependent on a substance functions at an optimal level when the substance is available in the body because it has grown accustomed to the drug's presence 2,5,6. When the drug is absent or available at lower doses, the individual will feel uncomfortable and uneasy.

Withdrawal is the emergence of these distressing symptoms. When a drug is routinely used, the body 5,6:

  1. May reduce production of the neurotransmitters released when the substance is used, resulting in temporarily lower natural or baseline levels (when the drug is no longer used).
  2. Increases production and release of neurotransmitters that counteract the direct effects of the substance. With alcohol and sedatives, the body will release excitatory chemicals like norepinephrine and serotonin 5.

When drug use ends, these changes result in an imbalance of the neurotransmitters in the brain, leading to physical and mental health withdrawal symptoms that are specific to the drug being used. Withdrawal symptoms can range from uncomfortable in some instances to fatal in others depending on factors including 1,4:

  • The drug used.
  • The dose, frequency, and route of administration used.
  • The chronicity or duration of use.
  • Other mental and physical health complications.
  • Previous withdrawal symptoms and effects.

doctor discussing medical detox Because of the risks involved with ending use of alcohol, sedatives, and opioids, someone dependent on these substances should always employ professional detox treatment to maintain comfort and safety 4. Based on the information acquired during the initial assessment, the treating professional may recommend a period of medically-assisted detoxification, which is a set of interventions that strives to manage dangerous symptoms of acute intoxication and withdrawal symptoms until the drugs are removed from the body 1,4.

Medically-assisted detox can occur in a wide variety of settings, intensities, and lengths based on the needs of the individual. Detox treatment options are often separated into the following general categories, based on the program requirements for on- or offsite residence 1,4:

  • Inpatient treatment: This level of care signifies that the individual will live at the treatment facility while receiving care. The most intensive treatments will occur in hospital settings with 24-hour medical care. Non-hospital options include programs that take place in a residential setting—still providing a safe, supportive environment and access to medical services, when needed, yet with more residential comforts, freedoms, and flexibility.
  • Outpatient treatment: In this level of care, the individual will live at home and receive detox services at an outpatient setting, such as a treatment facility or a doctor’s office.

Regardless of the type of detox treatment, many people in medically-assisted or medically-supervised detox receive medications to mitigate withdrawal symptoms and reduce cravings 1,4. Some medications will serve to first stabilize the recovering individual on a safer, more predictable alternative to the drug of abuse while others will treat specific withdrawal symptoms 1,4.

For those seeking to end their addiction to alcohol or drugs, professional detox can be very beneficial. If you or a loved one requires assistance in overcoming substance abuse, call 1-888-509-8965 today for information regarding detox and available treatment options.

Alcohol Detox Treatment

When someone has been struggling with chronic alcohol abuse or alcoholism, the decision to quit drinking must be made with caution. The acute alcohol withdrawal syndrome usually emerges between 6 and 24 hours following the last drink and can include symptoms like 4,7:

  • Increased activity of the autonomic nervous system (ANS) including:
    • Sweating.
    • Increased pulse rate.
    • Rapid breathing.
  • Shakiness in the hands.
  • Inability to sleep.
  • Nausea and vomiting.
  • Agitated movements.
  • Increased anxiety.
  • Fleeting hallucinations that may include:
    • Seeing things.
    • Hearing voices.
    • The sensation of touches.
  • Delusional thinking.
  • Delirium tremens (DTs).
  • Seizures.

Alcohol withdrawal symptoms are at their most severe from 36 to 72 hours after final use and can last for 10 days.The final four detox complications mark the most serious and dangerous results of alcohol withdrawal and illustrate the need for professional treatment to maintain medical and psychiatric safety. Left untreated, these symptoms could lead to unpredictable behaviors, violence, and death. Alcohol withdrawal symptoms are at their most severe from 36 to 72 hours after final use and can last for 10 days 3.

Several medications may be used during medically-assisted detox for alcohol dependence including 3,4:

  • Benzodiazepines, like diazepam, chlordiazepoxide, and lorazepam. These medications help to reduce the emergence of potentially lethal withdrawal effects by reinforcing therapeutic inhibitory gamma-aminobutyric acid (GABA) activity in the brain, the same neurotransmitter that alcohol impacts. Once a helpful dose is established, the medical provider will gradually reduce the amount and frequency of the medication in a tapering process.
  • Anticonvulsants, like carbamazepine and valproate. These medications can help lower the risk of seizures during withdrawal.
  • Antipsychotics, like haloperidol. These medications reduce the intensity and duration of agitation, hallucinations, delusions, and DTs.
  • Beta blockers and alpha adrenergic agonists like clonidine. Though these medications will not prevent seizures, they can reduce blood pressure and slow heart rate.

Later, once detox has been completed, other medications may be used to prevent relapse like 1,4:

  • Naltrexone (Vivitrol): A medication that blocks opioids receptors from being activated, this medication helps to lower cravings and the pleasurable effects of alcohol, thus deterring continued use.
  • Acamprosate (Campral): Interacting with GABA and glutamate neurotransmitters, this medication can reduce persisting withdrawal symptoms, such as anxiety, insomnia, and depression, especially in people with severe dependence.

It must be noted that detox programs typically focus on establishing safety in the short-term. Alone, detox is not usually enough to effect the changes in behaviors and thinking patterns that will provide the basis for long-term abstinence, so additional treatment following detox is necessary 1.

Sedative Detox Treatment

Inpatient Detox

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Sedative is a broad term used to describe several categories of prescription medications, including 2:

  • Benzodiazepines like:
    • Valium.
    • Klonopin.
    • Xanax.
  • Barbiturates like:
    • Butalbital (Fiorinal, Fioricet).
    • Phenobarbital (Luminal).
    • Secobarbital (Seconal).
  • Sleeping medications like:
    • Zolpidem (Ambien).
    • Eszopiclone (Lunesta).
    • Zaleplon (Sonata).

When someone is intoxicated on these medications, they can present with symptoms that resemble alcohol intoxication 4. For this reason, the treating professional must complete a thorough evaluation to determine the source of the behavioral changes. Additionally, sedative withdrawal may closely resemble alcohol withdrawal with signs and symptoms including 3,7:

  • Increased activity of the autonomic nervous system (ANS) including:
    • Sweating.
    • Tachycardia or fast pulse.
    • Higher respiration rate.
  • Insomnia.
  • Tactile, auditory, and visual hallucinations.
  • Hand tremors.
  • Jerky or agitated movements.
  • Increased anxiety, worry, and nervousness.
  • Seizures.

In the case of sedatives, the potential for seizures and erratic behaviors resulting from psychotic symptoms present as the most significant hazards 3,4. A person using a short-acting sedative can begin to experience withdrawal as early as 6-8 hours after the last taken dose, with symptoms persisting for several days to a couple of weeks, depending on the specific medication 3,7. Alternatively, a person on a longer-acting sedative may not have significant symptoms emerge until up to a week following last use with symptoms that last 2-8 weeks 3,7.

Medications used during medically-assisted detox for sedatives include 3,4:

  • Benzodiazepines or barbiturates: It may seem odd to keep giving someone withdrawing more of a similar substance, but that is a common treatment for sedative withdrawal. A xpatient may be put on a gradual tapering schedule for the sedative they are currently using or the sedative may be replaced with a longer-acting alternative, like diazepam (Valium), chlordiazepoxide (Librium), or phenobarbital. When stability is achieved, the dose can be tapered over the course of weeks or months to end use while avoiding medical complications.
  • Anticonvulsants: Carbamazepine and valproate can reduce withdrawal symptoms and prevent seizures.
  • Sedating antidepressants: Trazodone can be helpful in improving patient comfort, reducing anxiety, and aiding with sleep.

Just like with alcohol detox, sedative detox can keep someone safe through withdrawal, but does little on its own to improve future outcomes related to recovery. Detox is only the first stage in treatment 1.

Opioid Detox Treatment

opioid detox The term “opiate” refers to the psychoactive alkaloid substances that are derived from the opium poppy. Often used interchangeably, the term “opioid” refers to substances—both illicit and prescribed—that are synthesized from or resemble the opiates in chemical structure and effect. Opioids include 2,4:

  • Heroin.
  • Morphine.
  • Hydrocodone (Vicodin).
  • Oxycodone (OxyContin, Percocet).
  • Codeine.
  • Fentanyl.
  • Methadone.

The timelines for the various opioid withdrawal syndromes vary for each specific drug, but in general, symptoms may begin within 6-12 hours following last use of heroin or painkillers and as slowly as 2-4 days after the last dose of methadone 3. Regardless of the substance, opioid withdrawal will encompass a similar constellation of unpleasant symptoms, including 7:

  • Depression.
  • Nausea and vomiting.
  • Muscle aches.
  • Teary eyes and runny nose.
  • Pupil dilation.
  • Sweating.
  • Goosebumps.
  • Diarrhea.
  • Yawning.
  • Fever.
  • Insomnia or sleep disturbance.

As with other substances, medications are commonly used during opioid detox to mitigate the uncomfortable withdrawal symptoms and reduce cravings 3,4. If the opioid withdrawal syndrome is not managed properly, the individual will be more likely to return to opioid abuse, which could easily result in overdose and death, due to a reduction in tolerance that occurs during detox 1,2.

Medications used during medically-assisted detox for opioids include 1,3,4:

  • Methadone: As a full opioid agonist, methadone works much like other opioids in the body. It has a long duration of action, which makes it a good choice for reducing withdrawal symptoms. Methadone use will be tapered in a short-term detox program lasting fewer than 30 days or a long-term program lasting between 30 and 180 days.
  • Buprenorphine: As a partial opioid agonist, buprenorphine interacts with the opioid receptors but elicits a less robust opioid effect, resulting in increased safety due to a lower risk of overdose. It was previously available as monotherapy (Subutex), but is now frequently combined with an opioid blocker called naloxone (available as the combination treatment drug, Suboxone). Like methadone, Suboxone would be tapered gradually to prevent any withdrawal symptoms.
  • Clonidine: Clonidine is not an opioid, but rather an alpha-adrenergic agonist regularly used as an antihypertensive medication. Though it is helpful for treating some of the symptoms of opioid withdrawal, such as high blood pressure and rapid heart rate, clonidine does not effectively treat insomnia, muscle aches, and cravings. It is often used in conjunction with Suboxone.
  • Additional medications to improve:
    • Headaches (over-the-counter pain medications).
    • Poor sleep (Benadryl).
    • Gastrointestinal issues (Pepto-Bismol, etc.).

Addiction specialists may prescribe methadone or Suboxone after the acute detox process is complete in order to support ongoing recovery and reduce cravings 1. When combined with behavioral therapies in an inpatient or outpatient setting, medication-assisted treatment (MAT) with any of these medications is a proven measure to better maintain abstinence and engage in a drug-free lifestyle 1.

Find a Detox Program

Seeking professional detox and addiction treatment is of critical importance for someone physically dependent on alcohol, sedatives, and opioids. Don’t hesitate to call 1-888-509-8965 today. You will be connected to a representative that can discuss available detox and treatment options that suit your needs.

Sources

  1. National Institute on Drug Abuse. (2012). Principles of Drug Addiction Treatment: A Research-Based Guide.
  2. National Institute on Drug Abuse (2016). Misuse of Prescription Drugs.
  3. World Health Organization. (2009). Clinical Guidelines for Withdrawal Management and Treatment of Drug Dependence in Closed Setting.
  4. Medscape. (2016). Withdrawal Syndromes.
  5. Kosten, T., George, T. (2002). The Neurobiology of Opioid Dependence: Implications for Treatment. Science and Practical Perspectives, 1 (1), 13-21.
  6. American Psychiatric Association. (2013). Diagnostic and statistical manual of mental disorders (5th ed.). Arlington, VA: American Psychiatric Publishing.
  1. Substance Abuse and Mental Health Services Administration. (2015). Detoxification and Substance Abuse Treatment.