Medical Detoxification

Addiction to any substance is a complex psychosocial phenomenon. In other words, it is a chronic and relapsing disease. After a quitting drug or alcohol abuse, the first treatment process the patient has to go through is detoxification. Detoxification is a natural process that is carried out by the body to remove harmful, foreign substances accumulated due to drug/alcohol abuse. Abuse and addiction, not only disrupt the physical functioning but the mental and psychological state of a person gets deranged as well. It is very important to address the issue and treat the person as early as possible. A medical detox followed by a series of other programs is the only reliable option available for treating drug abuse and addiction.

What is Medical Detoxification?

Detoxification is a natural process by which toxins or harmful chemicals accumulated due to substance abuse are removed from the body. Medical Detoxification is the term used when the process is taken under medical supervision. The goal of medical detoxification is to effectively manage withdrawal symptoms appearing after quitting alcohol or drug abuse. It forms the basic step of any treatment program for addiction. A detoxification program also helps to stabilize the patient, and prepare him to go through the further treatment process. The detoxification process is not same for every patient. An initial physical and mental evaluation is carried out to determine the state of the individual. Furthermore, blood tests are performed to know the levels of drug in the body. All these factors dictate the duration of detoxification and needs of a specific person for a successful medical detoxification.

Starting detoxification process:

There are two basic ways to start the detoxification process, going Cold Turkey and gradually Tapering off the drug.

  • Cold Turkey:going cold turkey means quitting the drug/alcohol use all at once. People who opt for the home detoxification often use this method. This process, though seems attractive and fast, is associated with a lot of disadvantages. First, there can be severe withdrawal symptoms that can even be lethal for the patient if not managed properly. Effectively managing and treating withdrawal symptoms becomes even more difficult during a home detox. The patient is most likely to experience dehydration that can even prove to be fatal. Second, the chances of failure and relapse are very high. Once detox has started, taking even the small amounts of the drug in the middle of process can cause an overdose since the body has become intolerant to the drug.
  • Tapering method: It is the favorable method as the body is allowed to become adapted to less and fewer doses before finally, the supply of the drug is cut-off. The withdrawal symptoms are quite manageable and immediate risks of any severe problem are less. However, the process may take a lot of time and success is further based on a large number of factors.

Professional Medical Detoxification: It is the safest and most recommended option for the detoxification. The patient is under 24/7 monitoring and supervision of the trained staff. Any of the withdrawal symptoms can be actively dealt and treated.

Steps of Detoxification:

The length of detoxification may vary from one user to the other depending upon a number of factors. This is why it is important to evaluate the condition of every patient before subjecting them to a treatment process. However, the detoxification process generally includes three main steps: Evaluation, Stabilization, and Transition.

  • Evaluation:

Evaluation is the first step that is carried out before any further treatment is started. There are many facets that are taken into consideration. An initial history includes the details as for how long the person has been using the drugs, what type of drugs, the frequency, and duration. The staff and medical professionals work with each person to gather such information. Some other assessments that come under the initial evaluation are:

  • Blood Tests
  • Screening for other co-occurring conditions
  • Psychological assessment
  • Medical assessment
  • Risk assessment
  • Social Assessment
  • Stabilization:

The basic purpose of detoxification is to medically stabilize the person and rule-out any medical risks. The duration of this phase varies for each individual and it is considered as the most difficult phase of the detoxification. To monitor the withdrawal symptoms and reduce the drug cravings, a team of professional people continuously supervise the patient and provide some controlled therapies. Some other options that are provided during the Stabilization phase include:

  • Healthy and nutritious meal
  • Medicines

The stabilization or the detoxification phase can be carried out either in an outpatient or an inpatient treatment facility.

  • Outpatient Detox: During the outpatient detox process, the patient visits the doctor in the office rather than living in a specially designed detox facility. The doctor supervises the detox and prescribes any medicines that will be needed by the person to curtail the withdrawal symptoms. The person stays at home and pays a regular visit to the doctor. As the person is not under a medical supervision throughout the day, the doctor has to be very cautious while prescribing medicines. The outpatient detox is slow and can take weeks or months. This option is not suitable for everyone. It is mostly used for the patients with a milder addiction and a strong supportive background.
  • Inpatient Detox: During inpatient detox, the patient is admitted to a specially designed detox facility where he has to stay for certain duration of time that may vary depending upon his condition and progress. The patient is under medical supervision 24 hours a day. At the medical facility, drugs are administered to control the withdrawal symptoms. Any sudden problem can be handled instantly at an inpatient medical facility because a thorough medical care is provided round the clock. There are greater chances of success when an inpatient detox program is availed.  Also, it takes less time duration. Usually, the process gets completed within one to two weeks. Once it gets completed, a patient is ready to enroll in further treatment programs.
  • Transition: It is the third step of the Detoxification process. Addiction is considered as a mental illness and a continuous treatment is needed to overcome it. The treatment doesn’t end with the removal of drug remains from the body. The purpose is to treat the underlying reasons of addiction. So after a person has undergone a successful detox, he is subjected to further treatment depending upon his condition.  The treatment options include inpatient rehab, outpatient rehab, counseling programs, behavioral therapies, and stress-management skills that will enable a person to live a sober life.

Levels of Detoxification:

According to the ASAM criteria, there are five main levels of detoxification that can be used for a particular patient. The level best suited is selected after carefully evaluating the patient’s history, physical, and psychological condition.

  • First Level: The first step or level is the ambulatory detoxification. There is a scheduled medical supervision, evaluation, detox, and referrals. These take place in the outpatient setting and the aim is to make a comfortable transition of the patient to other treatment options.
  • Second Level:The second is almost a similar level; however, the nurses monitor the patient for a couple of hours and provide the necessary treatment.
  • Third Level:The third level involves a proper supervision, assistance, and continuous observation of the patients. Some facilities allow the patients self-administration of the medicines. If the patient demands some specific treatment, staff members of the facility can arrange to provide him or take him to some other suitable facility.
  • Fourth Level:The fourth level is the 24 hours medical monitoring of the inpatient detoxification. There is a team of nurses and doctors to utilize the approved procedures and policies to help the patients overcome those intense withdrawal symptoms.
  • Fifth Level:The fifth level is an intensive inpatient detox procedure. It provides round-the-clock medical directed evaluation for the withdrawal management. This level is for unstable and critical patients. The treatment is usually offered in the hospitals, which are equipped with all the life-support techniques.

Alcohol and drug Detoxification:

Drug Detox:

The clinicians use several drug detoxification programs to relieve or reduce the withdrawal symptoms and help an addict adjust to a normal life without using the drug. Detoxification is not aimed to cure the addiction but it lays the foundation for the path of recovery. The detoxification can be carried out without the use of medicines or they can be used to ease the withdrawal symptoms. However, medically assisted treatment is a relatively advanced approach.

Effects of detox:

There are many withdrawal symptoms associated with the quitting of various drugs. These occur when the body and brain become deprived of the drug. It happens after a person has become physically and psychologically dependent on the drug. When a person’s body becomes dependent, a continuous supply of the drug is necessary to let the body function normally.

The symptoms vary from one drug to the others. However, many of the addictive drugs target the same neurophysiologic processes to initiate a high so the symptoms are somewhat similar too. These symptoms are further dependent on a number of factors, such as

  • The type of drug abused.
  • The length of addiction.
  • The consumed doses of the drug
  • Any mental health conditions
  • Family History

The withdrawal symptoms have different forms or categories. Broadly, we can divide it into three forms, physical, psychological, and life-threatening symptoms.

Physical Symptoms:

  • Sweating
  • Tremors
  • Insomnia
  • Nausea/vomiting
  • Muscle tension
  • Difficult breathing

Psychological Symptoms:

  • Irritability
  • Depression
  • Mood Swings
  • Lack of concentration
  • Intense Cravings

Life-threatening Symptoms:

  • Seizures
  • Delirium Tremens
  • Stroke
  • Extreme Confusion
  • Severe Trembling
  • Hallucination

Medicines used to treat withdrawal symptoms:

A number of medicines are used to reduce the symptoms that emerge during the detox.

  • Anti-anxiety drugs: Benzodiazepines are prescribed for short-term use for the treatment of certain withdrawal symptoms such as restlessness, anxiety, and muscle spasms. Benzodiazepines are also addictive; therefore, a proper prescription and monitoring is mandatory.
  • Clonidine: It is used for the treatment of withdrawal symptoms such as sweating, agitation, anxiety, cramping and runny nose.
  • OTC Medicines: Pain killers, antiemetics, and antidiarrheals are also given to alleviate the general symptoms of withdrawal.

Drugs for opioids abuse: There are many drugs that are used for the treatment the opioid addiction.

  • Methadone: It is an opioid agonist. The medicine slowly reaches the brain and acts to dampen the euphoric effects of opioids. Methadone is in wide-use and is an excellent treatment option for opioid addiction. It was first manufactured in 1930 for the treatment of mild to moderate pain. The primary use of Methadone is the treatment of opioid dependence. Like the other opiates, it binds to the opioid receptors in the brain. So it tends to reduce the intensity of withdrawal symptoms. It interferes and blocks the pleasurable sensations, therefore, it is used as an opioid replacement therapy for promoting abstinence from opioids.

Methadone is available in the market in different formulations like oral tablets, oral solutions, and injectable solutions. It has a half-life of about 15-60 hours or 10-40 hours, which depends upon the specific formulation used. The regularly prescribed doses range from 30 -120 mg. The exact dose depends on the extent of abuse and the tolerance developed to Methadone.

  • Buprenorphine: It is a partial agonist of opioid receptors. Buprenorphine reduces the drug cravings. It was first synthesized in 1960’s. FDA approved the drug for the management of opioid dependence. Currently, the drug comes in a popular formulation of Suboxone, which is a combination of Naloxone and Buprenorphine. Naloxone acts as the opioid agonist that is added to avoid any fatal reactions. Suboxone is available in the sublingual formulation.

Buprenorphine has a potential for abuse and addiction. Therefore, it should be used for a short term and strictly in accordance with the prescribed doses. On first treatment day, 8 mg sublingual tablet is given. The dose is then increased in 2-4 mg increments to control the withdrawal symptoms and cravings. The half-life of Buprenorphine ranges from 24-60 hours.

  • Naltrexone:It acts as an opioid antagonist. Naltrexone works to block the effects of opioids. It is neither sedative nor addictive. The drug was first manufactured in 1963 to treat the cases of opioid dependence. In 1984, it got approved by the FDA for treating the patients with opioid addiction. The clinical studies have confirmed that Naltrexone can effectively discourage the alcohol consumption. It does so by blocking the opioid receptors, which are associated with the pleasurable effects.

Naltrexone acts as the competitive antagonist of δ, k, and mc receptors at the central nervous system. It has the highest affinity for u receptors. By binding to these receptors, the effects of opioids get blocked. All the objective and subjective effects such as miosis, euphoria, respiratory depression, and drug cravings become diminished. Naltrexone has a half-life of about 13 hours after the oral intake. In adults, 50 mg daily is the recommended dose. Rarely, it is increased up to 100mg or 150 mg.

The metabolization of Naltrexone takes place in the liver so there are high chances of hepatic toxicity. Therefore, the doses must be reduced if a person has some hepatic problem.

Alcohol Detox:

Alcoholism can completely ruin a person’s life. Though the person becomes aware of the negative consequences, the fear and intense discomfort associated with stoppage act as a subconscious compulsive force to make the person keep abusing Alcohol. The detoxification is mandatory to treat the Alcohol addiction.

Alcohol detoxification involves the processes by which a person’s habituated system is brought back to a normal state. Severe alcohol addiction can lead to the down-regulation of GABA receptors. A sudden withdrawal from the long-term addiction can even be fatal. Following the detoxification, an alcoholic becomes ready to enter the rehabilitation centers and learn the techniques for a sober living. Detoxification is, however, a natural body process but a constant or frequent use of alcohol makes the body incapable of carrying out its normal function.

Alcohol Withdrawal symptoms:

Intense withdrawal symptoms arise when a person stops the consumption of Alcohol. They also occur when the patient undergoes the detoxification. These symptoms include interrupted sleep, hand tremors, anxiety, stress, headache, sweating, heart palpitations, foggy thinking’s, headache, irritability, seizures, mental confusion, hypertension, and Delirium Tremens. The severity of these symptoms is based on the duration of Alcohol abuse.

Risks of Alcohol Detox:

There are a number of risks associated with the alcohol detoxification like delirium tremens and dehydration. The excess vomiting, sweating and diarrhea can make a person severely dehydrated and hypotensive. Severe dehydration can cause seizures, which can be life-threatening if not properly controlled. Delirium Tremens can cause respiratory failure and cardiac arrhythmia.

Medicines used to treat Alcohol withdrawal symptoms:

The withdrawal symptoms are very agonizing and painful for the patient. They can be sometimes fatal if not promptly treated. When the detoxification process is carried out under a professional supervision; the symptoms are controlled with the help of certain medicines. These are many approved medicines that can be given for treating these symptoms.

Some important general measures include:

  • Correction of fluid and electrolyte imbalances.
  • Thiamine and folic acid.
  • Short-acting Benzodiazepines.

Some of the specific medicines for treating Alcohol addiction are:

  • Disulfiram: Disulfiram was first manufactured in 1920’s and got approved by FDA in 1947. It was the first drug used to treat alcoholism. It is known as the oldest detox medicine used for managing Alcohol addiction. An exaggerated sensitivity to alcohol develops and even the small doses result in the hangover symptoms. As a result, the person stops the use of Alcohol.

Disulfiram discourages the abuse of alcohol by blocking the metabolism of alcohol and cause severe side-effects such as breathing problems, facial flushing, sweating, irregular heartbeat, fainting, weakness, seizures, and dizziness by the consumption of an even minor amount of Alcohol. These effects are so strong that a person automatically develops an aversion to Alcohol.

The active ingredient of Disulfiram is tetraethylthiuram disulfide. It is available in the formulation of oral tablets. In the early stages, a dose of 500 mg/daily is administered. It is then tapered down to the maintenance dose of about 250 mg daily. Disulfiram has a half-life of about 60-120 hours. The drug should be consumed under a strict medical supervision. The misuse of the drug is associated with liver damage, nerve pain, memory loss, psychosis, and seizures.

  • Acamprosate: It treats the long-term symptoms such as insomnia, anxiety, and restlessness. The medicine is used for managing the patients suffering from a long-term and severe alcohol addiction. It is also used for the treatment of Benzodiazepines addiction. The sedatives like Alprazolam, Clonazepam, and Diazepam are included in the class of Benzodiazepines for which Acamprosate can be given.

Acamprosate works by regulating the normal amount of neurotransmitters, especially gamma-aminobutyric acid in a brain damaged by the alcohol abuse. Acamprosate helps to relieve the anxiety, sleeplessness, and anxiety. It restores the healthy brain functions.

The half-life of Acamprosate is about 20-33 hours. As the drug gets cleared through the renal system, it is not given to people with an impaired kidney function. Severe adverse effects can occur in people, who have a kidney dysfunction and take Acamprosate.

  • Naltrexone: It blocks the opioid receptors that are located in the reward centers. This helps to reduce the Alcohol cravings and the relapse.

Duration of Detoxification:

The process of detoxification can last for three days to a couple of weeks. It is determined based on the type of drug, dosages consumed, and the severity of addiction. Though detoxification can last for a couple of weeks, some of the withdrawal symptoms can continue for more days. Another thing to consider is that first attempt of detox is not successful in many individuals. Multiple attempts are required for many people to achieve the better results.