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.
- Muscle tension
- Difficult breathing
- Mood Swings
- Lack of concentration
- Intense Cravings
- Delirium Tremens
- Extreme Confusion
- Severe Trembling
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.
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.