For those who struggle with physical and mental withdrawal symptoms when without their substances of choice, detox is the first step to recovery. The specifics of the experience (e.g., the type of withdrawal symptoms, how long those symptoms will last, etc.) will vary from person to person, depending on:
- The drug of choice
- Other drugs of abuse used regularly
- The existence of co-occurring mental health disorders
- Underlying physical ailments
- The length of addictive use of the drug
- The “normal” daily dose at the time of detox
Though a critical part of recovery, detox is just the first part of a comprehensive treatment program. Physical and mental stabilization is the goal, and when followed by long-term therapeutic treatment, detox can jumpstart a powerful journey in recovery.
- Is medical detox necessary?
- What does medical detox offer?
- What medications are used?
- Are medications prescribe for withdrawal?
- Should our family doctor be involved in the process?
- What is the level of supervision and monitoring?
- What happens if a medical emergency occurs?
- How long does a detox program last?
- Does health insurance cover the cost?
- What should happen after the process is complete?
Is medical detox necessary?
Detox is only a necessary part of treatment when the individual experiences withdrawal symptoms, and in these cases, medications may be a useful part of recovery, though they are often not necessary. There are those who opt to quit their drug of choice “cold turkey.” That is, rather than use medications to manage any aspect of the detox process, they prefer to get through the symptoms as well as they can with medical care on standby if necessary. For those who struggle with mild to moderate withdrawal symptoms or are breaking free from a low-dose addiction, this may be the best choice.
However, if cold-turkey detox is not preferred, depending upon the substance of choice, there may be the option of choosing a “medicated detox.” For example, those who struggle with opiate addiction may choose to undergo a long-term detox that essentially replaces heroin or opiate painkillers with another substance that binds to the opiate receptors in the brain and blocks the symptoms of withdrawal. The dose of the medication is slowly lowered over time, allowing for the person to methodically become completely drug-free over the course of months rather than experiencing an onslaught of uncomfortable symptoms during detox.
In some cases, a medicated detox option is not available, nor is there a medication approved for the purpose of managing cravings for that specific drug. There are still, however, a number of medications that can be useful for the purposes of managing specific symptoms. For example, if insomnia is an issue, then a nonaddictive sleep aid may be helpful. Additionally, medications to manage extreme anxiety, depression, nausea, and bone and muscle pain can help clients to more effectively navigate the detox process.
What does medical detox offer that can’t be found with an at-home detox?
At-home detox is never recommended for someone who experiences withdrawal symptoms of any kind when without the drug of choice. It is both unsafe and ineffective. Few people see the physical and mental withdrawal symptoms that define detox through to the end, knowing that a single dose of the drug of choice will allow them to feel better. Unfortunately, during the brief period of sobriety, the body recalibrates and the “normal” dose of the drug of choice may be an “overdose,” triggering extreme medical emergency that may be fatal.
By contrast, medical detox offers:
- Immediate medical stabilization, if necessary
- A complete physical to identify all issues that may complicate detox
- The 24-hour care of medical staff members
- Medications that can ease the withdrawal symptoms
- Psychological support of professional substance abuse treatment specialists
- Initial treatment for co-occurring mental health symptoms and underlying medical issues
- Support of peers in residence
- Supported transition into treatment
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What medications are used at a medical detox program?
Medications are chosen based on the person’s symptoms, past experience with attempted detox and treatment, and underlying issues. There are a number of medications that can have a positive impact under the right circumstances.
For example, in the case of alcohol detox, benzodiazepines including lorazepam and Ativan are commonly used to manage the tremors, anxiety, and confusion that often define the experience. Conversely, the anticonvulsant carbamazepine has a lower potential for abuse as compared to benzos and may be preferred for use among clients with less severe withdrawal symptoms. Additionally, it may also be appropriate to take:
- Clonidine: This blood pressure medication can help to decrease problems associated with elevated heart rate and high blood pressure during alcohol detox.
- Beta blockers: These, too, will help to manage increased heart rate and blood pressure triggered by alcohol withdrawal.
- Dilantin: This medication can help to manage seizures in clients who have an underlying seizure disorder.
- Antipsychotics: If hallucinations and agitation are issues, antipsychotics can help.
Are detox centers allowed to prescribe withdrawal medications?
Some medications have unique requirements that allow only those who are certified in the prescription of those drugs to hand out the substance to clients in a detox setting. For example, only doctors who are certified in the prescription of buprenorphine are allowed to prescribe the drug to clients struggling with opiate detox. Similarly, methadone is highly restricted and must be administered by a certified substance abuse treatment professional daily in an approved setting.
Other medications that are effective in helping a client to manage specific withdrawal symptoms are nonaddictive, and therefore do not have the same restrictions placed upon their use. It is important that clients check and double-check that the detox program they choose has all state and federal permits in place and that all staff members have the proper certification and expertise to perform within their scope of practice.
Should our family doctor be involved in the process?
If clients would like to include their family physicians in the process of detox, it may be possible to work with them if their schedules permit. In some cases, a family physician who has worked with the client for years will have valuable insight to offer.
However, because detox is an area of medical specialty, a family physician may prefer to be kept in the loop and be available to assist if necessary but defer to the substance abuse treatment professionals on the details of developing and adjusting the treatment plan.
What level of supervision and monitoring should be expected?
The level of supervision and monitoring should be determined based on the need of the individual. For example, in cases where a client is living with a severe mental health disorder or was admitted in the midst of serious medical emergency, continuous monitoring and supervision in a medical setting for 24-72 hours may be required.
In other cases, when a client struggles with cravings and/or mild physical withdrawal symptoms, access to medical care should be accessible if an unexpected complication arises, but the client may be able to live with other residents and begin the process of therapeutic treatment.
What happens if a serious medical emergency occurs during the detox process?
Every effort will be made to prevent any medical issues from arising during detox and addiction treatment. Clients undergo a full physical and a medical history is taken upon arrival to identify all underlying medical conditions and to assess the potential impact on the client during the detox process. Stabilization and treatment for all physical conditions will begin immediately during detox, and if there is any risk of medical emergency, close supervision and 24-hour care are made available.
If despite these precautions, a serious medical emergency arises at any time during detox or addiction treatment, immediate medical care followed by ongoing treatment and continuous follow-up care are available.
How long does a detox program last?
Like everything in recovery, the details must be determined on a case-by-case basis in order to ensure that the client has the most comprehensive care possible. The type and intensity of withdrawal symptoms will depend upon the type of drug the client is using and the dose taken at the time of cessation of use. Clients are advised to remain in residence at a detox program until they have stabilized in recovery and the bulk of the withdrawal symptoms have passed, and then to turn their attention to the process of healing through therapy and holistic addiction treatments.
When physical withdrawal symptoms are a significant part of the detox process, it often occurs in stages. For example, in the first 12-72 hours after the last dose of the drug of choice, withdrawal symptoms usually start slowly and then slowly build in intensity over the next couple of days and reach their peak. The intensity level often stays at this point for up to a week or more, and then slowly starts to subside. Medications can significantly improve this process, in some cases shortening the length of detox and enabling the client to more swiftly stabilize and focus on other aspects of recovery.
Does health insurance cover the cost of detox?
The Affordable Care Act requires that all health insurance companies cover the cost of care for substance abuse and addiction as well as mental health disorders. However, it does not specify which services or medications specifically should be covered or in what amount. Depending upon the specifics of the policy, the nature of the symptoms experienced, and the history of detox attempts, an insurance provider may require that the client first attempt outpatient care, avoid expensive medications, or otherwise prove that inpatient or medicated detox is medically necessary.
What should happen after the detox process is complete?
Detox often continues to some degree for months or even years after heavy drug use; however, the intense withdrawal symptoms experienced in the first days and weeks of recovery will soon give way to a sense of balance and mental clarity. It is a freeing experience to finally be able to focus on something other than the maintenance of an ongoing addiction. It is at this time that treatment can begin in earnest.
Though detox is essential in recovery and the unavoidable first step, it is not an entire treatment unto itself. Rather, intensive therapy is recommended, a unique combination of traditional, alternative, and holistic therapies that serve to address the specific challenges facing the individual person. Long-term engagement with a therapeutic treatment plan that is adjusted to accommodate new treatment goals, personal goals, and changing needs should continue through the first year or more of recovery. Slowly, tapering down the schedule can accommodate growing responsibilities in the community and allow for full integration into independent sober living.