Detox as a Treatment
During addiction, you will have developed physical and psychological dependence on the substance and will experience withdrawal symptoms when you stop taking it. These symptoms can be unpleasant and, in the case of alcohol and some drugs, very dangerous. Withdrawal symptoms are often so negative, that without treatment people often resume using their abused substance just to ease them. The goal of detoxification is therefore both to remove of all traces of addictive and harmful substances from your body and to manage these withdrawal symptoms, keeping you safe and as comfortable as possible throughout the process.
Many individuals will need to undergo a medical detoxification—that undertaken under medical supervision. A medical detox is the first step of a stay in an inpatient rehab. It typically lasts between four and 10 days, depending on the individual, the substance they have been abusing and for how long and at what quantities and their overall health. Some symptoms of withdrawal can persist for weeks or months, however.
Detoxification only treats intoxication and immediate physical dependency on the drug. Once detoxification is complete, the patient must then begin the rest of the rehabilitation process, tackling the neurological and psychological roots of addiction.
Preparing for detox
Many people struggling with drug addiction are reluctant to stop using and seek treatment partly because they fear the experience of withdrawal and detoxification. But there are some preparations you can take in the early stages of withdrawal, and that medical staff at a rehabilitation facility or hospital can help you take, to make the process safe and comfortable.
Stop using drugs and alcohol
When you enter a facility and commit to rehabilitation, you’re committing to no longer consume addictive and harmful substances. Withdrawal will set within hours or days of stopping, depending on how much you have been using and how regularly and your degree of dependence. However, some drugs, such as benzodiazepines, are dangerous to withdraw from abruptly and people often must be weaned off them, taking progressively lower doses over a period of weeks. In the case of heroin abuse, you may be switched onto a substitute opiate, such as methadone or buprenorphine, for detox and rehabilitation.
Before withdrawal symptoms set it or early in their progression, you will be asked for information about your drug and alcohol use and it’s crucial for your safety that you’re honest about what you have been using and the quantities. If you’re primarily entering rehab for what you believe is a cocaine addiction but also drink heavily, you’ll need to disclose your alcohol use as well. You’ll typically also be required to submit blood and urine tests to show which substances are currently in your body and in what amounts. You should also receive a medical evaluation, which may include an ECG or blood tests. This information will be used to devise a specific detox plan for you. Your health will continue to be monitored at regular intervals as you undergo detoxification.
You may also meet with a mental health professional, to assess your mental state and help you psychologically prepare for detoxification and withdrawal. This is crucial because many of the most acute symptoms of withdrawal are psychological, including depression and anxiety.
Ultimately, the most important preparation you can for detoxification make is to commit—to yourself and to your loved ones— that you will stay clean from addictive substances and follow the treatment plan laid out for you.
Stages of the detox process
There are three broad stages of a detoxification programme.
- Evaluation: Patients are asked about their drug use and undergo blood and urine testing to see what substances are currently in their system. They’re also assessed for co-occurring disorders, including mental health issues, and their general health evaluated.
- Stabilisation: The patient undergoes withdrawal, under medical supervision and often with the use of medicine. While there is no medicine which can treat withdrawal, patients will frequently be prescribed medicine to alleviate the symptoms, which can include depression, anxiety, insomnia, nausea and vomiting. Withdrawal from some substances requires tapering and/or more intensive medical interventions. As withdrawal symptoms abate, a treatment plan will be devised, and the patient made away of the next steps.
- Into treatment: Once the patient has recovered acute withdrawal symptoms, they’re prepared to enter the rehabilitation phase of treatment, where they will receive intensive psychological therapy to combat their addiction. Detoxification usually ends with the patient committing to enter a rehabilitation programme.
What to expect during the detox process
Each individual will experience detox differently and even if you’ve been through detox before, your symptoms may be different this time.
You’ll often experience both physical and psychological withdrawal symptoms and may be given specific medicine to alleviate these.
Physical withdrawal symptoms
- tremors, shaking, shivering
- high temperatures, chills
- increased heart rate and blood pressure
- nausea, vomiting, diarrhoea
- abdominal cramping
- muscle aches
- vivid, unpleasant dreams
- runny nose
Psychological withdrawal symptoms
- difficulty concentrating
- mood swings
- intense cravings for the substance
If you’re undergoing detoxification in an in-patient rehab or hospital setting, you’ll likely be monitored throughout withdrawal, undergoing regular checks and medical evaluations by staff.
The detox process usually takes four to 10 days, depending on the person and the level of dependency. However, some patients may experience lingering withdrawal symptoms for weeks after cessation.
Alcohol withdrawal can be mild or life-threatening. Your particular experience will depend on your drinking history and habits and overall health.
Alcohol withdrawal usually sets in within eight hours of the last drink, although sometimes it begins days later. Symptoms peak between 24 and 72 hours following the last drink but can continue for weeks.
Symptoms of alcohol withdrawal include:
- heart palpitations
- shaking and tremors, especially of the hands
- mood swings
- clammy skin
- loss of appetite
- rapid heart rate
- nausea and vomiting
About one in every 20 people detoxing from alcohol will experience a serious and life-threatening withdrawal symptom called delirium tremens, or DTs. Delirium tremens is most common in those who are severely addicted to alcohol - including those who have consumed large quantities of alcohol every day for several months or have abused alcohol for more than a decade—and those who have experienced withdrawal in the past. Most symptoms of delirium tremens begin within two to three days of the last drink, but seizures typically occur within the first 24 hours. Delirium tremens can be life-threatening so it’s important to seek out emergency medical care.
Symptoms of delirium tremens include:
- emotional distress
- hypersensitivity to sound, touch, and light
- intense agitation or irritability
- intense confusion
In cases of extreme withdrawal, including delirium tremens, patients may be prescribed medicine, such as chloridiazepoxide, diazepam, lorazepam or oxazepam, to alleviate symptoms.
The symptoms of withdrawal from drugs and the treatment options available during detox will depend on the drug itself and how much the patient has been consuming and for how long.
Heroin and opioid
Withdrawal symptoms: nausea and vomiting, diarrhoea, aches and pains, fever, sweating, shaking, muscle spasms, agitation, cravings for heroin. The physical symptoms usually last for five to seven days.
Treatment: Those undergoing heroin and opioid detoxification often need professional medical care. Withdrawal from and addiction to these substances can be managed with substitutes, such as methadone and buprenorphine.
Withdrawal symptoms: strong cravings for cocaine, fatigue, irritability, agitation, paranoia, depressed mood, lack of pleasure, increased appetite, sleeplessness, vivid or unpleasant dreams. Depression, including suicidal thoughts, and cravings for the drug can last for weeks and months after discontinuing use.
Treatment: There are no substitutes for cocaine, but patients can be prescribed drugs to alleviate withdrawal symptoms. Patients can also receive psychological therapies to help them tackle the depression that particularly characterises cocaine withdrawal.