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Pros & Cons of Medical Detox

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When a person is dependent upon drugs or alcohol, the desire to stop using is often mixed with questions about how to go about withdrawing safely and comfortably. Medical detox is often the safest and most effective option for withdrawal and holds many potential advantages over a nonmedical detox or otherwise unmanaged withdrawal situation. This article explains what medical detox is and how it can manage acute withdrawal from drugs or alcohol.

What is Medical Detox?

Chronic substance abuse can lead to physiological dependence, which means that the body has adapted to the presence of the substance and requires continued use in order to function optimally. When a person is physically dependent upon alcohol or certain drugs, such as opioids or benzodiazepines, stopping the use of these substances can result in the person experiencing unpleasant symptoms of withdrawal. Withdrawal symptoms vary depending on the type of substance involved but, in general, they can be very uncomfortable if not outright painful, as well as occasionally life-threatening.1

The benefits of medical detoxification.

Detox programs are designed to help a person safely and comfortably withdraw from alcohol or other drugs on which they have become dependent. Detox should not be confused with comprehensive substance abuse treatment. It is only the first step on a continuum of addiction care, but it is a crucial step that prepares someone to begin on the road to recovery.

There are generally two types of detox—social detox and medical detox. Social detox is an approach for individuals at relatively low risk of experiencing severe or complicated withdrawal; it emphasizes peer and social support. People who do develop complications during withdrawal are usually transferred from a social detox setting to a hospital or other facility able to provide adequately intensive medical intervention.

By contrast, a medical detox program consists of 24-hour monitoring by a team of medical professionals. Medically managed withdrawal typically involves the use of some form of medication for relief of certain acute withdrawal symptoms. This is critically important for someone who is withdrawing from benzodiazepines or alcohol, as abruptly stopping the use of these substances can result in life-threatening seizures. In addition, although withdrawing from opioids is seldom medically dangerous, people in opioid detox are almost always in need of medical intervention to alleviate their very uncomfortable symptoms, such as nausea, vomiting, stomach cramps, fever, chills, and body aches.2

Medical detox can take place in a variety of settings—including but not limited to inpatient or residential facilities. However, the level of care required for detox depends on numerous factors, such as a person’s mental and physical health and social support system, which may be most reasonably determined after a thorough assessment by a substance abuse professional.

Depending on a person’s needs, the possibilities for detox settings include:2

  • Outpatient settings, such as an intensive outpatient program (IOP), or a partial hospitalization program (PHP). A person may attend treatment for a few hours, 2 to 3 days per week in an IOP, or 4 to 6 hours per day, as often as 7 days per week in a PHP.
  • A doctor’s office, where a doctor may prescribe certain types of medications to assist a person with drug withdrawal and require the person to come for monitoring one or more times per week.
  • Inpatient/residential programs, which are able to provide 24/7 monitoring and supervision throughout the detoxification period.
  • Hospital, which is a viable option for someone who has been admitted to the emergency department for a substance-related emergency or is at exquisitely high risk of experiencing withdrawal complications.

That said, the Substance Abuse and Mental Health Services Administration (SAMSHA) recommends that detox for alcohol and benzodiazepines take place in some type of inpatient, medically monitored setting due to the risk of withdrawal seizures. In addition, although withdrawal from opioids is seldom fatal, the intensity of the highly unpleasant symptoms often requires 24-hour care due to humanitarian concerns.2

What Medications Are Used?

Several detox medications are used to manage withdrawal; their administration may vary according to the type of substance a person has been using. 

For opioid withdrawal, the most commonly used medications are:2

  • Methadone: This full opioid agonist interacts with opioid receptors in the brain to mitigate withdrawal symptoms and opioid cravings. Though a treatment medication such as methadone will be carefully dispensed, as an opioid drug, there is some potential for misuse or abuse.
  • Buprenorphine: This partial opioid agonist interacts with and activates opioid receptors in the brain to mitigate withdrawal, but has a ceiling to its effects. This diminishes some of its abuse potential and renders it a uniquely effective alternative to methadone for withdrawal management. A combination formula of buprenorphine and naloxone—the latter added to the mix to additionally decrease the potential for misuse—is also commonly used as a treatment drug for opioid dependence.
  • Clonidine: This alpha adrenergic agonist is sometimes used to manage the symptoms of autonomic arousal, such as rapid heart rate and high blood pressure. This drug is often used in combination with other opioid detox medications, but may also be used alone should someone elect to withdraw without the help of opioid replacement medications.

When a person who is dependent on alcohol stops drinking, it can result in life-threatening seizures, as well as delirium and hallucinations. A medical detox approach may be utilized to manage uncomfortable symptoms, such as tremors and anxiety, as well as prevent dangerous ones, such as seizures. The most commonly used medications for alcohol withdrawal are benzodiazepines, such as diazepam (Valium) and chlordiazepoxide (Librium).2,3,4 Generally, the use of benzodiazepines to treat alcohol withdrawal is fairly limited in an outpatient setting, due to concerns over a person using alcohol when not in treatment, which could have serious medical complications, such as respiratory depression and coma.2

The difference between abuse and addiction.In some cases, anticonvulsant drugs are used in managing alcohol withdrawal, as they are less sedating and present a lower risk for a secondary dependence than with the use of a benzodiazepine. However, anticonvulsants are not always as effective as benzodiazepines at controlling seizures. Therefore, doctors tend to only use anticonvulsants in cases of relatively mild alcohol withdrawal. In some cases, antipsychotic medications, such as Haldol, may be used to treat the withdrawal-induced hallucinations and delirium. That said, these drugs can increase the risk of seizures. As a result, antipsychotics are not used frequently and only under close supervision.4 Although clinical trials have explored the use of various additional medications (e.g. acamprosate, baclofen, and GHB) to assist with alcohol detox, these medications have not been demonstrated to be consistently effective in the research to date.

Similarly to problematic alcohol use, benzodiazepine abuse can result in physical dependence; suddenly quitting these drugs can result in life-threatening seizures, although this is rare. Therefore, treatment protocols commonly call for a gradual reduction in their use over a period of several weeks to several months. Although this can work on an outpatient basis, there is not a great deal of consensus on exactly the best way to taper a person off of benzodiazepines.5 When a person is dependent upon a short-acting benzodiazepine, such as oxazepam or alprazolam, doctors will oftentimes substitute a longer-acting benzodiazepine, typically diazepam, and use it to taper the person off benzodiazepines.6 In rare cases, a doctor may also use phenobarbital to assist with benzodiazepine withdrawal.2

Several popularly abused drugs, such as cocaine, methamphetamine, amphetamines, MDMA (ecstasy), LSD, bath salts, and marijuana have no specifically FDA-approved medications for the management of withdrawal. Detox for these substances emphasizes managing any significantly troublesome withdrawal symptoms as they arise.2 For example, while going through withdrawal from stimulants, such as cocaine or methamphetamine, people commonly experience agitation. Doctors may use diazepam to control these symptoms.6 Over the years there has been some research into the potential for pharmaceutical management of some of these withdrawal syndromes, such as lithium for marijuana withdrawal, however there still remain no FDA-approved medications for such a purpose.6

What Are the Benefits?

What does medicated detox feel like?There are many benefits to undergoing a medical detox. Although people can and do attempt to detox at home, it is not always advisable to do so, especially for certain types of substances. If you struggle with an addiction to certain drugs or alcohol, medical detox can provide:

  • Medications to relieve cravings, such as methadone for opioid dependence.
  • Medications to relieve unpleasant symptoms, such as anxiety or insomnia.
  • Medications to decrease the risk of potentially lethal withdrawal effects.
  • Readily available emergency care in the event that you should have a medical complication, such as a seizure.
  • Supportive staff members to help you with the emotional distress of undergoing detox and to encourage you to keep going.
  • Other supportive interventions, such as an IV for fluids and ongoing vital sign monitoring.

A medical detox protocol, especially one utilized in an inpatient or residential setting, offers many advantages, including increased comfort during withdrawal and the prevention/management of medical emergencies.

Are There Potential Disadvantages?

Although medical detox is a great option for managing withdrawal, there are some potential disadvantages, such as:

  • Cost, which is usually higher than a social detox program.
  • Being away from home and typically having to stay at a facility while undergoing treatment.

Nevertheless, when you weigh the advantages and disadvantages, the most important thing to consider is your health and well-being. The pros of medical detox often greatly outweigh the cons, since this intervention can ensure your safety during a distressing and trying time.

Who Requires Medical Detox?

There is no way to determine whether or not you or your loved one is in need of medical detox without a thorough evaluation by a doctor or other experienced substance abuse treatment professional. Medical detox is typically recommended, however, for people who:2,6

  • Are dependent on more than one drug or a combination of drugs and alcohol.
  • Have undergone previous detox experiences.
  • Have underlying medical or psychiatric conditions.
  • Do not have adequate social support at home, or are in a drug-filled environment.
  • Have had a complication from withdrawal in the past.

If you or your loved one is struggling with an addiction to drugs or alcohol, reach out for help. With many different options for medical detox, you can find one to meet your specific needs. There is hope for addiction, and detox is the first step on the road to recovery.

 Sources

  1. American Psychiatric Association. (2013). Diagnostic and statistical manual of mental disorders (5th ed.). Arlington, VA: American Psychiatric Association.
  2. Center for Substance Abuse Treatment. (2006). Detoxification and substance abuse treatment. Treatment improvement protocol (TIP) series, No. 45. Rockville, MD: Center for Substance Abuse Treatment.
  3. Diaper, A. M., Law, F. D. & Melichar, J. K. (2014). Pharmacological strategies for detoxificationBritish journal of clinical pharmacology77(2), 302-314.
  4. Kattimani, S. & Bharadwaj, B. (2013). Clinical management of alcohol withdrawal: A systematic reviewIndustrial Psychiatry Journal22(2), 100–108.
  5. Lader, M., Tylee, A. & Donoghue, J. (2009). Withdrawing benzodiazepines in primary care. CNS drugs23(1), 19-34.
  6. World Health Organization. (2009). Clinical guidelines for withdrawal management in closed setting. Geneva, Switzerland: WHO Press.

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