Detoxification is the first major step of substance use disorder 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.
