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A substance use disorder is a clinical term used to describe addiction to drugs or alcohol. According to guidelines set forth in the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition, withdrawal is one of the diagnostic criteria for a substance use disorder. Withdrawal, which occurs when people with addictions stop using drugs or alcohol, involves unpleasant symptoms as a result of the substance of abuse no longer being active in the body.

When a person enters withdrawal, he or she may experience painful symptoms, making it difficult to permanently stop using the substance of abuse. In fact, people may return to drug or alcohol use to avoid withdrawal symptoms. In cases where a person wants to stop using drugs and/or alcohol but withdrawal symptoms are making the process more challenging, an alcohol and drug detox program may be necessary to manage symptoms and begin the journey toward lasting recovery. Detox programs can also provide life-saving medical treatment in cases where withdrawal becomes dangerous.


What is “detox”?

What is "detox"?

According to the National Institute on Drug Abuse (NIDA), detox is typically the beginning of treatment for a drug or alcohol addiction. Formally, detox is defined as the process the body undergoes to rid itself of drugs and alcohol, and because side effects of detox can be dangerous, doctors who treat patients in these programs will often prescribe medications to manage these side effects. In the addiction field, professionals may use the term “medically managed withdrawal” or “medically assisted detox” to describe detox programs.

Drug and alcohol detox can occur in the form of either an inpatient or an outpatient program. Patients completing inpatient programs will receive 24-hour around-the-clock care in a residential or hospital setting, with doctors and medical staff available to monitor symptoms and provide continuous care. In outpatient settings, patients report to a clinic for prescription medications to treat withdrawal, often on a daily basis so that medical staff can ensure there are no complications.

Outpatient programs may not be appropriate for people with severe addictions to drugs or alcohol. For example, the authors of a 2008 study in Drug and Alcohol Review concluded that outpatient programs are not suitable for homeless individuals with severe drug and alcohol addictions, because this population benefits from residential drug and alcohol detox programs where staff can supervise their withdrawal and manage any complications arising from medical or psychological issues. Given this fact, residential or inpatient detox programs may be safest, especially for those with more serious conditions.


Symptoms of Withdrawal

Symptoms of Withdrawal

The primary purpose of detox programs is to rid the body of substances while alleviating withdrawal symptoms that are extremely unpleasant or dangerous. These withdrawal symptoms will vary based upon a person’s drug of choice.

For example, symptoms of alcohol withdrawal include tremor, anxiety, sweating, fast heartbeat, hallucinations, nausea, and sleep disturbances, according to a report in American Family Physician. Alcohol withdrawal can also create severe symptoms, such as seizures and a life-threatening condition called delirium tremens, making quality alcohol detox programs important.

Withdrawal symptoms may differ for other substances, such as opiates. Per NIDA, opiate withdrawal involves painful symptoms such as aches, muscle tension, chills, stomach cramping, insomnia, anxiety, and depression. Drug and alcohol detox programs can make withdrawal from heroin and other opiates more manageable by reducing the effects of some of these painful symptoms.


What do drug and alcohol detox programs look like?

What do drug and alcohol detox programs look like

While symptoms of withdrawal vary by the drug of choice, most people who undergo withdrawal will experience symptoms like nausea, vomiting, diarrhea, anxiety, and sleep disturbances, which can be managed in detox programs. People who enter a drug and alcohol detox program can therefore expect to take medications to make them more comfortable as the body rids itself of substances of abuse.

According to the World Health Organization, people in detox may take promethazine or temazepam for sleep disturbances, metoclopramide or prochlorperazine for nausea and vomiting, ibuprofen for headaches and pain, and diazepam for anxiety or agitation. They may also take medication for muscle pain, cramps, and diarrhea.

Beyond drugs for treating general withdrawal symptoms, drug and alcohol detox programs may provide medications that are specific to the substance of abuse. For example, a patient who is in a detox program for heroin addiction may be treated with buprenorphine or methadone to alleviate withdrawal and lessen drug cravings, per the World Health Organization. On the other hand, patients with moderate to severe alcohol withdraw often take diazepam during a detox program, sometimes in large doses to treat complications of withdrawal and prevent serious consequences, which can include death.

In addition to providing medications, inpatient or residential drug and alcohol detox programs offer medical monitoring. Medical staff such as nurses and doctors will monitor vital signs, provide needed medical care, and ensure that patients remain as safe and comfortable as possible. Staff also provide supportive care, such as explaining what is happening to patients, protecting patients from harming themselves, and listening to and reassuring patients.

Activities in detox programs are typically minimal. Medical staff provide care in calm, quiet settings, and patients are permitted to rest and sleep as desired. They may be encouraged to engage in light activities, such as walking or meditating, but according to the World Health Organization, drug and alcohol detox programs should never force patients to take part in physical exercise. In fact, strenuous exercise can make withdrawal symptoms even worse.


What Drug and Alcohol Detox Isn’t

Detoxing in Bed

During a detox program, patients can expect to take medications to treat withdrawal, while also receiving care and support from a team of medical professionals as they experience the uncomfortable and potentially fatal consequences of ridding the body of drugs and/or alcohol. On the other hand, they should not expect detox programs to provide comprehensive addiction treatment services, as these programs are only the first step of the recovery process.

Detox programs rid the body of substances, but they are not an appropriate form of psychosocial care for addiction. Patients who are in drug and alcohol detox programs are often so uncomfortable, and perhaps impaired, that they are not able to fully participate in psychological services, like therapy, to address the underlying addiction. A detox program cannot take the place of individual counseling, drug and alcohol education groups, or relapse prevention programs; it can only fulfill the purpose of medically treating drug and alcohol withdrawal in a safe environment.


Life after Detox

Life after Detox

Drug and alcohol detox is just the first step in recovering from an addiction, so patients who complete a detox program will need to receive continued care in order to achieve lasting sobriety. After completing a detox program, patients should enter an ongoing addiction treatment program. Some patients may require residential or inpatient treatment, whereas others can be successful in an outpatient program, in which they live at home but attend appointments at a clinic or counseling center throughout the course of their recovery.

Life after detox is not “one size fits all.” According to a 2015 study in the Journal of Substance Abuse Treatment, 43 percent of patients who completed detox for opiate dependence preferred to participate in a medication-assisted treatment program after they were discharged. On the other hand, 29 percent preferred residential treatment; 12 percent opted for counseling, and another 12 percent chose self-help groups like Alcoholics Anonymous or Narcotics Anonymous.

Regardless of the chosen aftercare treatment option, experts seem to agree on one thing: drug and alcohol detox alone does not lead to lasting sobriety. Relapse is highly likely for those who simply complete detox and return to life without any sort of follow-up treatment. Staff in drug and alcohol detox programs can work with patients to assess their needs and determine which type of follow-up care is the best fit.

Sources:

  1. https://renascent.ca/wp-content/uploads/2015/03/1-DSM-V-and-Substance-Use-Disorders-1.pdf
  2. https://www.drugabuse.gov/publications/principles-drug-addiction-treatment-research-based-guide-third-edition/drug-addiction-treatment-in-united-states/types-treatment-programs
  3. https://www.tandfonline.com/doi/abs/10.1080/09595230701750650
  4. https://www.aafp.org/afp/2004/0315/p1443.html
  5. https://www.drugabuse.gov/about-nida/noras-blog/2018/05/nida-supported-science-leads-to-first-fda-approved-medication-opioid-withdrawal
  6. https://www.ncbi.nlm.nih.gov/books/NBK310652/
  7. https://www.sciencedirect.com/science/article/abs/pii/S0740547215001725
Brooks V.
Brooks V.
Brooks has been a freelance journalist for the better part of two decades, as well as spending a decade as a crisis intervention counselor. Through his own work and researching the work of others throughout the many facets of the detox, crisis intervention, and mental health worlds he has been able to tell the stories of those worlds in an effort to help addicts and those with mental illnesses understand and navigate them.