January 13, 2021 Treatment

Detox is the 1st Step in Treatment

Around 400 B.C., Ancient Greek Physician Hippocrates observed alcohol withdrawal in patients, writing  “from drinking he has trembling hands.” Despite recognizing withdrawal symptoms by medical forefathers, historians believe the first medically supervised “detoxification” program, commonly referred to as detox, was opened in New York state in 1864, during the Civil War.

“Detoxification” is a term used to describe the process of safely clearing toxins from the body. Detox is most commonly recommended when substances like alcohol, opioids, or sedatives were abused.  The detoxification process requires appropriate medical interventions to ease acute withdrawal symptoms. For some, it is the first step in the treatment process.  Supervised detox is necessary to manage potentially life-threatening complications that might occur without treatment.

How do you know if you require detox?

Typically, a medical assessment is required to evaluate withdrawal symptoms. Several medical assessment tools can be used to determine the severity of withdrawal and therefore determine the need for detoxification services:

CIWA or “Clinical Institute Withdrawal Assessment” for alcohol is a 10-item scale that measures withdrawal symptoms and severity to determine if medications are required during the detox process.

COWS or “Clinical Opiate Withdrawal Score” is used to identify the presence of withdrawal symptoms as the result of ceasing opioid use.

Among these clinical measures, other assessments are typically conducted to help providers determine the likelihood of withdrawal symptoms requiring medical intervention. Measures such as physical examination, blood, and urine testing

Do all substances require detoxification services?

There is no easy answer to this question. The reality is that any substance can cause medical complications. These can require supervision to safely remove the substance from the body.  However, particular substances are more dangerous than others to suddenly stop cold-turkey.

Alcohol is one of the most dangerous substances to stop cold-turkey. Even reducing alcohol intake for some can be life-threatening.  In fact, complications can result in death for severe drinkers. Complications include seizures, gastric bleeding, hallucinations, and delirium tremens. For individuals with comorbid medical conditions, the risk for complications is more significant.

Benzodiazepines are a class of sedatives that can be viewed as the “pill form of alcohol”. These include medications such as alprazolam, clonazepam, lorazepam, and diazepam. Unlike alcohol, it can take several days, or even a week before developing withdrawal symptoms. All depending on the type of benzodiazepine taken regularly.  Complications from benzodiazepine withdrawal include seizure and detachment from reality.  For individuals with other medical conditions, the risk of complications is higher.

Other substances such as opioids produce a severe withdrawal that can be treated in detoxification programs. These drugs include heroin and other pain-killers. It is essential to recognize that individuals using substances often are not just using one drug. In several studies, it has been found that cocaine use, and developing a cocaine use disorder, is associated with simultaneous heroin, cannabis, tobacco, and alcohol use (Kedia et al., 2007; Roy et al., 2013; John and Wu, 2017). It is essential to look at the “big picture” when determining if detoxification is warranted.

What Happens in Detox?

Outpatient detox programs exist, but are not typically recommended for individuals struggling with long-term substance use, health complications, and limited support.

Inpatient detox programs range in length, determined by the evaluation conducted at the beginning of the admission process. The type of substance, length of time used, frequency, quantity, presence of health conditions and co-occurring disorders, and other factors must be considered. Typically, one can expect to successfully stabilize within 5-14 days.

Once admitted to a detoxification program, most patients will receive a “taper” or medications used to ease withdrawal symptoms. These medications are prescribed by a physician. Signs are monitored to ensure comfort and safety, with tapers being adjusted as necessary.

Risks will vary by individual, but detoxification is a medical process that can significantly affect your body if not properly managed.

At Indiana Center for Recovery, you can expect to be comfortable, supported, and relaxed in an environment suitable for your needs.

Is Detox Enough?

The detoxification process addresses immediate medical acuity caused by withdrawal symptoms.  The National Institute of Drug Abuse (NIDA) recommends detox as a part of a treatment program. The American Society of Addiction Medicine, (ASAM) “Detoxification does not constitute substance use disorder treatment but is one part of a continuum of care” (2020). Continuing treatment beyond detox is best to address long-standing mental health or trauma issues that may lead back to use, develop relapse prevention plans, and find support in a community of individuals with similar concerns.