Drug and Alcohol Detox

Detox is just the first step of addiction treatment, but it’s an important one. Read on to learn more about “getting clean,” the symptoms of withdrawal, and how rehab centers help a patient safely get through this challenging stage so they can work on long-term recovery.

Detoxification is the first major step of substance abuse treatment.

Also known as withdrawal management, the goal is to manage the emotional and physical pains that follow once a person stops using drugs or alcohol. The degree of dependence, the substance in question, and the health of the individual will determine how intense the process may be.

Some substances like marijuana or stimulants can be uncomfortable to quit, but they can be halted cold turkey with little risk. Other drugs like alcohol, opioids, and benzodiazepines produce painful and sometimes dangerous withdrawal effects. For those cases in particular, having professional medical oversight can be crucial. An extended period of alcohol abuse, for example, can cause a patient to have life-threatening complications if they suddenly stop using.

Some people may relapse or resume use simply to make the pains of withdrawal go away. As a result, medicines may be prescribed to make the detoxing go safely and be more comfortable.

Intake

When entering inpatient (or residential) rehab, a patient will first check-in, and the staff will collect their medical history. The person suffering from a substance use disorder (SUD) will be asked about their use, including:

  • Drugs commonly taken (both prescribed and illicit)
  • Doses/frequency
  • Why they use

Physical and toxicology screenings are performed, too. Staff will also examine the patient to gauge their current health. If medications are needed for co-occurring or dual diagnosis situations — where the patient has both a substance use disorder and a mental health condition such as depression or anxiety — those will be addressed as well.

Once the patient’s background and current situations are known, a plan can be shaped, and detox gets underway.

The detox process can take days or weeks, depending on the severity of the addiction and the methods used to get the patient free of toxins.

Healthcare should be available around the clock, and a quiet and calm environment should be provided for a safe and distraction-free withdrawal.

Alcohol Withdrawal Symptoms

Alcohol exacts a steep toll on our society. It factors into assaults, deaths, and disease. According to 2019 data, nearly 15 million Americans ages 12 and older had an alcohol use disorder. Approximately 95,000 people in the United States die from alcohol-linked causes every year.

Withdrawal can be especially dangerous if delirium tremens sets in. Fevers, seizures, hallucinations, and confusion are red flags. In such a case medical intervention is necessary; otherwise, the patient may die.

Many people eventually stop or slow down on alcohol use, but for a person with severe dependence, it can be challenging. Alcohol withdrawal can set in about eight hours after a person’s last drink but may start days later. The worst symptoms occur within 24 to 72 hours. Side effects include:

  • Anxiety
  • Fatigue
  • Shakiness
  • Headaches
  • Nausea, vomiting
  • Depression 
  • Moodiness
  • Sweating
  • Insomnia
  • Elevated heart rate

Alcohol Withdrawal Treatment

The goal in treating alcohol withdrawal, particularly in the most severe cases, is to get the patient stable and comfortable. That includes:

  • Monitoring vitals — including heart rate, body temperature, blood pressure.
  • Replenishing fluids or administering medications via intravenous methods, to remedy dehydration, vitamin and mineral deficiencies, and to ease pain or nausea.
  • Sedation, to make withdrawal less arduous.

Opioid Withdrawal Symptoms

Opioid withdrawal can also be an uncomfortable process, with experts likening it to a terrible flu. Withdrawal for short-acting opioids like heroin begins within a day of last use and lasts up to 10 days. For longer-acting opioids like methadone, symptoms begin within two days of stopping and can last nearly three weeks.

A person quitting opioids after becoming dependent may experience:

  • Anxiety
  • Restlessness
  • Muscle aches and bone pain
  • Insomnia
  • Diarrhea
  • Vomiting, nausea
  • Cold and hot flashes
  • Muscle cramping
  • Runny nose, tearing eyes

Opioid Withdrawal Treatment

During withdrawal, the patient will be monitored for symptoms and their severity. Fluids will be administered to help combat dehydration resulting from diarrhea. Added vitamin supplements may be dosed as well. Medications to ease discomfort and ease the transition to going opioid-free may be given as well. These include buprenorphine or naloxone, which can significantly reduce withdrawal symptoms and provide some of the desired opioid effects without the euphoria, which can help better manage cravings.

Benzodiazepine Withdrawal Symptoms

Benzodiazepines are sedatives and tranquilizers commonly prescribed for anxiety, sleeplessness, and phobias. They include Xanax, Klonopin, Valium, and Ativan.

Some have a short half-life where their effects are felt (and wear off) quickly, and for some, that pack a bigger punch. Other benzodiazepines have longer-lasting effects and tend to be viewed as less addictive. (It really depends on a number of factors, however, whether faster-acting Xanax will prove more problematic for one individual but longer-acting Klonopin won’t.)

Ideally, a patient will be screened thoroughly before being prescribed benzodiazepines. Generally, these drugs are not recommended for long-term consumption.

A person may be at risk of becoming addicted in as little as a couple of weeks of use, but each case is unique. Benzodiazepines also tend to be misused with other substances, which can up the danger. (Xanax, for example, chased by a couple of big glasses of wine.)

Once dependence has set in it can be risky to quit benzodiazepines cold turkey. Withdrawal can occur in several stages.

The early stage can bring a return of the symptoms the medication was meant to address — like anxiety or sleeplessness. After that more acute withdrawal sets in, which is the most intense and troubling stage. Symptoms include:

  • Panic
  • Seizures
  • Delirium tremens
  • Hallucinations
  • Mania
  • Psychosis
  • Suicidal thinking and behaviors

Once that acute withdrawal stage is passed a patient may continue to have a protracted withdrawal that includes anxiety, depression, insomnia, tremors, and confusion. Those symptoms can linger for several months.

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Benzodiazepine Addiction Treatment

Treating an addiction to benzodiazepines can be complicated and difficult. Suddenly stopping can prove extremely dangerous, so a common route is to taper (reducing the dose in increments to wean the patient off the drug) or switch from a shorter-acting medication to something with more drawn out and less intense effects.

Detox Does Not Equal Recovery

A person may be clean of drugs and toxins after detox, but that doesn’t necessarily mean they’re free of their addiction. It is, however, a crucial early step in that it gets the patient safely and comfortably free of drugs, and prepares them for the next steps of rehab.

The symptoms of withdrawal can be intense and painful. A patient may feel anger, confused, ill, and on edge. The right drug and alcohol rehab facility will be aware of and prepared to help the patient through this difficult stage, using a combination of compassion, patience, and evidence-backed practices.

From there the focus shifts to addressing psychological issues that fueled drug and alcohol abuse, usually via behavioral therapies and counseling. Throughout the rehabilitation process, the medical and counseling staff also will work with the patient to form an aftercare plan so they have the tools to remain sober. Those tools include learning to identify and work through triggers, typically through adopting healthier coping mechanisms.

Medical disclaimer:

Lincoln Recovery strives to help people who are facing substance abuse, addiction, mental health disorders, or a combination of these conditions. It does this by providing compassionate care and evidence-based content that addresses health, treatment, and recovery.

Licensed medical professionals review material we publish on our site. The material is not a substitute for qualified medical diagnoses, treatment, or advice. It should not be used to replace the suggestions of your personal physician or other health care professionals.

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