Detoxification from addictive substances is, in a clinical setting, referred to as medical detox, or medically managed withdrawal. This process involves medical oversight while a person stops taking the addictive substance and goes through withdrawal, with help from doctors, therapists and other professionals. This process often involves prescriptions for medications that ease the physical and psychological symptoms of withdrawal, which helps to keep the person focused on the therapeutic recovery process and avoid relapse.
However, medical detox by itself is not the same thing as a rehabilitation program, which can take place on an inpatient or outpatient basis. Detox is one stage of the treatment process, but it is not considered an effective treatment on its own. People who struggle with addictions need help uncovering the reasons for their addictions – what led to the initial substance abuse and what contributes to the ongoing addiction. A full rehabilitation plan that addresses all aspects of the person’s life is the best course of action to fully overcome an addiction.
Some rehabilitation programs require potential clients to detox before they enter the program, while others help their clients detox while in their care. Sometimes, people begin detox after being hospitalized and are then encouraged to continue into a rehabilitation program; in other cases, individuals will begin treatment in a rehabilitation program that includes medical detox.
What Happens to the Body and Mind during Detox?
During detox, the first stage in the larger process of rehabilitation, the individual stops taking all addictive substances. Since the body has become accustomed to the presence of the substance in question, removing it sends the body into withdrawal. If prescription medications can help ease some of the physical or emotional symptoms of withdrawal, medical professionals can prescribe those and monitor the person to make sure the prescriptions are effective. Therapists also often help the person manage the psychological aspects of withdrawal, including anxiety and cravings.
Withdrawal from alcohol or drugs begins after the last dose is ingested, typically within 24-48 hours, depending on the substance. When the body becomes dependent on an addictive substance, the brain and other organ systems rely on certain doses to feel “normal” or good; however, as the substance leaves the body, the body and mind react in its absence. Some withdrawal symptoms are mild and can be managed with distractions or engaging in other activities. Other symptoms can be incredibly uncomfortable and even dangerous, which is why medical oversight during detox is important.
- Loss of appetite
- Physical weakness
- Shaking or tremors
- Tension or worry
- Dehydration from vomiting or diarrhea
- Increased heart rate or irregular heartbeat
- Rapid breathing
- Severe depression or anxiety leading to suicidal ideation
- Confusion or hallucinations
- Severe trembling
- Delirium tremens, or DTs (a cluster of intense withdrawal symptoms, including seizures)
The worst physical symptoms, like nausea or pain, can last about 7-10 days. After symptoms peak, they begin to subside over the following days. In some cases, certain mild symptoms may linger for weeks or even months.
In some cases, people who struggle with addiction have become so physically dependent on the addictive substance that drug replacement therapy is useful. This is especially true for opioid drugs, like heroin or fentanyl. During detox and rehabilitation, the individual may receive methadone or buprenorphine, and then taper off that substance over time until the body no longer needs any opioids.
Medications Used to Help the Detox Process
Prescription medications are often used in the process of medical detox. These help to ease withdrawal symptoms so the person is less likely to relapse to substance use, and they mitigate the severity of withdrawal symptoms. With a doctor monitoring each prescription and the 24-hour supervision provided in most medical detox programs, the person is less likely to abuse the prescriptions.
No single approach to detox works for everyone, and this is in part because of the number of addictive substances that exist. Each addictive substance can cause different clusters of withdrawal symptoms, so one medication does not ease withdrawal symptoms for everyone. While certain medications are approved by the FDA to be used in treatment for addiction to specific drugs, other medications are used to treat specific withdrawal symptoms. Medications can include drug replacement therapies to taper the individual off opiates, anti-seizure medications, anti-nausea medications, antidepressants, and anti-anxiety medications.
Here are a few common medications and their applications in medical detox:
- Suboxone (opiates): This is a combination of buprenorphine, a partial opioid agonist prescribed to treat opiate addiction, and naloxone, an opioid antagonist. Buprenorphine has a long half-life, and binds to opioid receptors in the brain for a long period of time, which helps people struggling with opioid addictions to feel fewer cravings for the substance and also eases withdrawal symptoms. Naloxone prevents this medication from being abused, because if the drug is snorted or injected rather than taken orally, the naloxone will kick in, rapidly binding to opioid receptors in the brain to stop the effects of buprenorphine, sending the individual into withdrawal. Doctors who prescribe Suboxone work with their patients to taper the dose until the person is no longer physically dependent on opiates.
- Valium (alcohol): Valium, the brand name for diazepam, is a medication in the benzodiazepine family that treats a variety of conditions, most typically anxiety and panic disorders, but also alcohol withdrawal. Valium in particular has a long half-life, making it useful for tapering in a clinical setting, much like buprenorphine for opiates. This benzodiazepine is also prescribed to treat some types of seizures or to relieve muscle spasms, which can sometimes be associated with alcohol withdrawal. When used in medical detox, a prescribing doctor will monitor the person to ensure there are no addictive behaviors associated with the Valium.
- Bupropion (nicotine): Although this pill is a nicotine antagonist, exactly how it helps people quit smoking is not entirely understood yet. This medication is also marketed to treat depression under the brand name Wellbutrin, although bupropion seems to work for people who do not have depression but do have a nicotine addiction. Prescriptions require the individual to begin taking bupropion 1-2 weeks before quitting smoking to build up the medication in the person’s body, then continue to take the medication for 7 weeks to up to 6 months after smoking has stopped. This is one of the first medications designed to end nicotine addiction that does not involve tapering the body’s nicotine dependence.
How Long Does Detox Take?
The detox process takes different amounts of time for different people, though in most cases, it takes 5-10 days. The specific timeline depends on individual factors, including the amount of the substance ingested, the length of time the person struggled with addiction, the person’s physical makeup, and what type of drug the person abused.
- Alcohol withdrawal can take as little as 24 hours or as long as two weeks.
- Nicotine withdrawal can last up to five days.
- Prescription painkiller withdrawal can last up to two weeks.
- Heroin withdrawal can last several weeks.
Regardless of how long withdrawal takes, it is a step that has to be taken when overcoming addiction. Medical oversight keeps the detox process safe and comfortable. Just detoxing from a drug is not the same as overcoming addiction, and it is very important to complete comprehensive addiction treatment after detox.