Detox may conjure up ideas of juice cleanses and or facial scrubs for some people but medical detox is no cucumber on the eyes. When you become dependent on a psychoactive drug, withdrawal comes with a range of uncomfortable symptoms, some of which can be medically dangerous.
Medical detox is the process of helping a person through withdrawal with a team of medical professionals and any necessary medication. People in detox are in the highest level of care available in addiction treatment with, according to the American Society of Addiction Medicine, 24-7 medical management, and monitoring.
It may seem counterintuitive to use chemical substances during the process in which you are trying to remove chemical substances from your body. However, with medical supervision, certain medications can be a helpful tool in the detox process. The withdrawal symptoms you might experience in detox depend on the drug you become dependent on, the existence of other medical or mental disorders, and the length of time you were in active addiction.
Some symptoms can be extremely uncomfortable, whether they are felt physically or emotionally. Withdrawal can cause anxiety and depression, muscle aches, and nausea, all which can sometimes be mitigated by medications.
In some cases, it can be dangerous to quit certain drugs abruptly. Central nervous system depressants dull the activity of your nerves and when they are suddenly stopped, your nervous system can go into overdrive. This reaction can cause dangerous symptoms like panic, seizures, delirium, and catatonia. In such cases, it may be necessary to wean you off of the drug with medications.
Medications can also be used to ease specific symptoms that are typical of certain types of withdrawal. For instance, nausea is common in opioid withdrawal, so you may be given medicine to counteract upset stomach, vomiting, or diarrhea. Addiction withdrawal is often an uncomfortable process but you don’t have to go through it alone. Medical detox is centered on helping you safeguard your sobriety and making the process of becoming free from drugs as painless as possible.
There is a variety of medication and pharmacotherapies used to treat withdrawal symptoms that are approved by the U.S. Food and Drug Administration. Everything from Tylenol to opioids is used in the treatment of addiction and it’s symptoms. Sometimes medications are used to address the effects of addiction itself, while others are used to mitigate symptoms of withdrawal.
Different medications can be used to treat different forms of addiction and withdrawal, and the appropriate medications often depend on the specific set of symptoms you encounter. However, some symptoms like insomnia, headaches, and nausea are fairly common and they can be treated with mild medications like anti-inflammatories, mild sedatives, Immodium, and other common symptom relievers.
The following are common symptoms of drug withdrawal that are commonly treated in detox and the medications that are used for each:
Opioids are the driving force behind the United States’ current addiction epidemic and withdrawal can come with some extremely uncomfortable symptoms including:
Opioid withdrawal symptoms are often compared to the flu because they share some similar symptoms. While symptoms can be all but unbearable, withdrawal is not typically thought of to be potentially deadly. However, in some cases, medical complications can lead to life-threatening medical situations. For instance, sweating, vomiting, and diarrhea can lead to dehydration. If you are on your own when this occurs, it can be potentially deadly.
Methadone is a long-acting opioid that’s often used to treat opioid addiction. It is sometimes used to wean users off of opioid addiction in a treatment called methadone tapering. The drug has a half-life of 15 to 55 hours which gives it a much longer duration of action than other opioids like heroin. This allows detox patients to experience relief from cravings and withdrawal symptoms for up to two days. In detox, administration of the drug is strictly regulated. More commonly, methadone is used as a maintenance drug, which is when harmful illicit drugs are replaced with regulated alternatives without the goal of achieving complete abstinence. This type of treatment is controversial.
Methadone itself can cause intense withdrawal symptoms that include the flu-like symptoms of other opioids as well as tachycardia, hyperventilation, tremors, and hypertension. Because of this, weaning is done very carefully and the drug is used as a last resort.
Buprenorphine is another opioid that is sometimes used to treat opioid addiction. Unlike morphine and heroin, buprenorphine is only a partial agonist of the opioid receptor. That means it doesn’t produce as profound effects as other full-agonist opioids. It doesn’t cause the euphoric sensations that prescription opioids do. Instead, it staves off withdrawal symptoms, including drug cravings for up to 24 hours. However, like methadone, buprenorphine can be addictive, causing withdrawal symptoms of its own.
Naltrexone is an opioid receptor antagonist that blocks the binding of opioids and stops them from having an effect in the body. As an antagonist, it binds to opioids but doesn’t activate them. Naltrexone is commonly used to treat overdose and it can even be purchased over the counter in some states.
As an addiction treatment, it is used to stop the euphoric effects of opioids. Theoretically, this is said to gradually reduce cravings. However, if addiction has roots in unresolved mental or emotional issues, this may just redirect the problem to another unhealthy addictive behavior. Plus, naltrexone should only be used as a therapy after medical detox because the drug can actually send opioid users into immediate withdrawal.
Where opioid addiction is concerned, medications should not take the place of treatment. If used, they should be used with behavioral therapies and other interventions that get to the root of the problem. In detox, symptoms can be managed without the use of other opioids.
Central nervous system depressants like alcohol, benzodiazepines, and barbiturates come with some of the most dangerous withdrawal symptoms. When you become dependent on alcohol or other depressants, your brain has gotten used to the increased activity of a neurotransmitter called gamma-Aminobutyric acid (GABA) which is an inhibitory chemical that lowers the excitability of the nervous system. Your brain may start to increase the production of excitatory effects to counteract these effects and return brain chemistry to normal.
When you abruptly stop drinking alcohol or taking benzos, the GABA effects are also abruptly stopped. The chemicals in your brain that counteract the effects of depressants continue to work, sending your nervous system into overdrive.
Benzodiazepines are often used to wean people off of alcohol or other benzos. This helps to avoid serious withdrawal symptoms by helping your brain chemistry slowly return to normal levels. However, therapeutic use of benzos needs to be carefully administered by a medical professional and this kind of treatment should also be accompanied with or followed up with counseling or behavior therapy.
Acamprosate is a medication used to treat alcohol withdrawal symptoms during detox. It works on the same GABA receptors that are affected by alcohol and benzodiazepines, however, the exact method by which the chemical helps to balance brain chemistry is not fully understood. Generally, it is thought to modulate the GABA receptor and agonize the NMDA receptor, which plays a role in the functioning of neurons. However, depression and suicidal thoughts are side effects of the drug and it should be used with caution.
Disulfiram, sold under the brand name Antabuse, is a drug that interferes with the breakdown of alcohol in your system and causes an unpleasant reaction when you drink alcohol. Reactions can include nausea, flushing, and palpitations. The theory behind this is that the negative effects of drinking alcohol while on disulfiram will rewrite the processing of alcohol in your reward center. However, only highly motivated clients tend to opt to take disulfiram and it’s generally thought to be ineffective because clients and patients rarely choose the drug.
Stimulants have a unique range of symptoms during withdrawal. Generally, they work by flooding the synapses in the brain with dopamine, a feel-good chemical that is largely responsible for the regulation of mood and emotions. During withdrawal, the majority of the symptoms will be psychological and emotional. Symptoms include:
Since muscle aches and pains are common, most physical symptoms can be treated with anti-inflammatories like ibuprofen. However, psychological symptoms can be extreme. Meth, especially, can limit a person’s ability to feel pleasure by damaging dopamine receptors in the brain. This can result in deep depression and suicidal thoughts. During detox and treatment, these symptoms can be treated with a variety of medications and clinical therapy.
Modafinil is a mild dopamine reuptake inhibitor, which means it works in the brain in a similar way to cocaine, although much less powerful. This can increase wakefulness and treat sleep issues like narcolepsy and hypersomnia. It can help ease some of the symptoms of stimulant withdrawal.
For patients with particularly bad tremors or shaking symptoms, anticonvulsants like vigabatrin and topiramate may be prescribed. They are primarily used to treat epilepsy and seizures.