Detox Substance Abuse Treatment
Substance use disorder (SUD) is defined as a chronic medical condition that involves uncontrolled use of addictive substances despite the harmful consequences.1 The data collected through the National Survey on Drug Abuse and Health in 2017 show that 19.7 million people in the U.S. were struggling with an SUD. Out of this number, 14.5 million people suffered from alcohol issues and 7.5 million had an illicit drug disorder. The latter category includes both illegal drugs such as heroin, but also prescription medications that can be diverted and abused.2
The severity of the disorder may vary, but what all cases of substance abuse have in common is that people with SUDs put themselves at very serious health and safety risks, and are unable to stop substance use. This happens because substance use has disturbed the biochemical balance in the body and the person is no longer able to function normally without using the drug. The person experiences intense cravings and unpleasant physical symptoms between two doses of drugs or alcohol, which is referred to as dependence and withdrawal.1
Despite being rather complex, substance abuse disorder is a treatable condition, regardless of whether the disorder is severe or milder.1 There are many treatment modalities and options, but the first step in any treatment program is detoxification, also often referred to as detox substance abuse treatment. The purpose of this process is to remove the toxins from the body of the person who is suffering from substance dependence or is intoxicated.3
When Is Medical Detox Substance Abuse Treatment Necessary?
In general, the more severe a person’s dependence condition is, the more likely it is that they will need medical support during detoxification. There are several risk factors that can influence one’s drug dependence.4
- Amount and duration of drug use: High dosages and frequency of drug abuse can increase dependence levels.
- Method of abuse: Injecting, snorting, or smoking drugs may lead to stronger dependence more quickly than ingesting or swallowing them.
- Age at first use: Using drugs before the brain is fully developed can increase the odds for later problematic drug use.
- Biological factors: Metabolism, gender, and co-occurring medical or mental health disorders can affect dependence.
- Type of drug abused: Different drugs induce dependence at different levels.
- Environmental factors: High levels of stress, exposure to trauma, and a lack of a stable home and good support system can result in higher levels of dependency.
- Polydrug abuse: If a person abuses multiple substances, dependency is more significant.
- Family history of drug dependence and addiction: Genetics plays a role in vulnerability to addiction.5
An additional relevant factor that qualifies a person for a medically supervised substance abuse treatment is the existence of a co-occurring disorder such as depression, anxiety, or PTSD. According to the estimates from 2019, this is not a small number of people who are struggling with substance abuse—9.5 million people in the U.S. suffer from co-occurring disorders.6
When both a mental health or medical condition are present in someone who is battling addiction, medical detox is needed to safely manage all potential medical and mental health issues that can arise during withdrawal. Co-occurring disorders can complicate and exacerbate each other, and they should be carefully monitored and managed with specialized care.3
What Are Detoxification Withdrawal Symptoms?
Medical detox is the most comprehensive form of detox that provides safety and security in a controlled environment. During detox substance abuse treatment that is medically supervised, a person’s vital signs can be continuously monitored, and medical care can be delivered as needed.3
Common physical withdrawal symptoms include:7
- Irregular heart rate and blood pressure levels.
- Breathing issues.
- Sleep difficulties.
- Muscle aches and tension.
- Nausea, vomiting, diarrhea.
- Appetite fluctuations and possible anorexia or weight loss.
- Sweating and changes in body temperature.
Emotional side effects of withdrawal can be significant and include:8
- Irritability, edginess, agitation, restlessness.
- Trouble thinking clearly.
- Concentration and memory difficulties.
- Intense cravings.
One of the most dramatic forms of withdrawal is called delirium tremens (DTs): a condition that involves seizures, fever, significant confusion, and psychosis. It usually occurs in cases of alcohol and sometimes benzodiazepine abuse. About 3-5% of people battling alcohol withdrawal may suffer from DTs.9 DT is especially dangerous as it may begin later than normal withdrawal, i.e. a few days after stopping drinking.10
Medical detox can protect the person from these potentially even life-threatening conditions.3 Treatment facilities provide physical stabilization through medical means, while mental health support is provided by trained professionals to keep the patient psychologically stable.
How Does Medical Detox Substance Abuse Treatment Work?
Medical detox is in principle the initial stage of an addiction treatment program.11 The process of detox substance abuse treatment consists of three essential components:3
- Evaluation: The patient is tested and screened for the presence of a substance and physical or mental health conditions.
- Stabilization: The patient is assisted both medically and psychosocially through withdrawal to become substance-free. Sometimes in addition to treatment professionals, this process also involves the patient’s family or other significant people.
- Leading to further treatment: It needs to be clear to the patient that the treatment process does not end with detox and that in order to recover from addiction it is necessary to engage in further steps in substance abuse treatment and care.
Medical detox is not a standalone treatment for drug abuse and addiction. Instead, it should be viewed as an important first step. After a detox program, individuals should enter directly into an addiction treatment program that can continue to build on relapse prevention tools, healthy habits, coping mechanisms, medication management, and more.11
What Are Possible Settings for Detox Substance Abuse Treatment?
There are several possible settings, i.e. levels of intensity of care that the patient receives during detox substance abuse treatment.3
- Level 1: Facilities that provide outpatient treatment services without extended onsite monitoring; for example, visiting a physician’s office.
- Level 2: Ambulatory detoxification with extended onsite monitoring; for example, day hospital service.
- Level 3: Clinically managed residential detoxification; e.g. residential treatment services that involve peer support groups that may in some cases involve 24-hour medical supervision.
- Level 4: Medically managed intensive inpatient detoxification; for instance, inpatient treatment centers that provide 24-hour medical care in most severe cases.
Which Medications Are Used in Detox Substance Abuse Treatment?
There are several categories of medications used in detox substance abuse treatment.
Medications that belong to the category of benzodiazepines counteract the side effects of withdrawal from alcohol and central nervous system depressant drugs. Long-acting benzodiazepines, such as diazepam (Valium) and chlordiazepoxide (Librium), can stabilize brain chemistry to minimize the rebound effect of the brain’s neurotransmitters. These long-acting benzodiazepines can be slowly tapered off in a controlled manner on a set schedule until they are no longer necessary.8
Opioid agonists and partial agonists
These medications are used in treatment programs for opioid use disorders. Short-acting opioid drugs like heroin and fentanyl are often replaced with the longer-acting full opioid agonist methadone (Methadose, Diskets, Dolophine). Methadone can be distributed once daily to keep withdrawal symptoms and cravings at bay. The dosage can then be weaned off over a set period of time.12
Partial agonists containing buprenorphine (Subutex, Buprenex, Butrans) work in a similar fashion. However, they have less potential for abuse as they do not create the same “high” as full opioid agonists. They also have a plateau feature where they stop working after a certain dosage is taken.12
Antidepressants are mood-stabilizing drugs that can be very helpful during medical detox, and medications such as desipramine (Norpramin) can aid in minimizing some of the emotional side effects of withdrawal.13
Some over-the-counter medications are also used for alleviating withdrawal symptoms. These are drugs used against symptoms such as nausea, fever, muscle pain, or insomnia.14
In addition to medications used in detox substance abuse treatment, providers often introduce vitamins, supplements, and a nutritious meal plan to counteract the malnutrition that accompanies drug abuse and addiction. Fluids may need to be given intravenously during medical detox, as individuals are often significantly dehydrated when entering detox.8
What Are Rapid and Ultra-Rapid Detox?
Rapid detoxification lasts for one to five days, while ultra-rapid detoxification lasts for 24 hours. Rapid detoxification involves sedation, whereas ultra-rapid detoxification involves either heavy sedation or general anesthesia. These are both risky procedures and must be supported by highly competent medical professionals. Moreover, patients with certain conditions such as liver or cardiac diseases are typically not eligible for this treatment due to potentially adverse effects.15
Frequently Asked Questions
- There is no universal answer to this question, as this highly depends on the type of substance and the condition of the patient. The exact plan and timeline for detox substance abuse treatment should be individually tailored to meet the specific needs of the patient.3
- Whether a specific detox substance abuse treatment program is covered by insurance should be checked by contacting the treatment facility. However, it is important to keep in mind that all health insurers are legally obliged to provide the same level of benefits for substance abuse issues as for other medical conditions.16
- Treatments during medical detox are aimed at gaining stability so a person can safely enter into a drug addiction treatment program directly following withdrawal. Emotional support and encouragement to remain abstinent as well as brief interventions and behavioral therapies, like cognitive behavioral therapy (CBT), work to sustain abstinence during detox.11CBT can help to uncover potential triggers to relapse and teach coping mechanisms for dealing with them. Relapse prevention is especially important, as the brain and tolerance levels will begin to reset after stopping drug use.11
- Although in many cases withdrawal symptoms are not life-threatening, it may still be difficult to manage them without medication. The use of medications in detox substance abuse treatment is advised in situations when people are dependent on prescription opioids and heroin, benzodiazepines, and in some cases alcohol.17
1. American Psychiatric Association. (2020). What Is Substance Use Disorder?
2. Substance Abuse and Mental Health Service Administration. (2018). Key Substance Use and Mental Health Indicators in the United States: Results from the 2017 National Survey on Drug Use and Health.
3. Substance Abuse and Mental Health Service Administration. (2006). Detoxification and Substance Abuse Treatment. Treatment Improvement Protocol (TIP) Series, No. 45.
4. National Institute on Drug Abuse. (2020). Drug Misuse and Addiction.
5. Nestler, E. (2002). The Genetic Basis of Addiction. Psychiatric Times, 19(2).
6. Substance Abuse and Mental Health Service Administration. (2019). National Survey on Drug Use and Health.
7. Kosten, T. R., & Baxter, L. E. (2019). Review article: Effective management of opioid withdrawal symptoms: A gateway to opioid dependence treatment. The American journal on addictions, 28(2), 55–62.
8. UK Department of Health Care Quality Commission. (2020). Brief guide: substance misuse services – detoxification and withdrawal from drugs and alcohol.
9. Schuckit, M. (2014). Recognition and Management of Withdrawal Delirium (Delirium Tremens). The New England Journal of Medicine, 371, 2109–2113.
10. WebMD. How Long Does It Take to Detox From Alcohol?
11. National Institute on Drug Abuse. (2018). Principles of Effective Treatment.
12. Substance Abuse and Mental Health Service Administration. (2020). MAT Medications, Counseling, and Related Conditions.
13. Diaper, A. M., Law, F. D., & Melichar, J. K. (2014). Pharmacological strategies for detoxification. British Journal of Clinical Pharmacology,77(2), 302–314.
13. Providers’ Clinical Support System. Training for Medication Assisted Treatment, Module 4: Special Aspects of the Treatment of Substance Use Disorders.
14.Centre for Alcohol and Other Drugs. (2011). Rapid Opioid Detoxification – Guidelines.
15. Substance Abuse and Mental Health Service Administration. (2019). Understanding the cost of treatment.
16. WebMD. (2020). Which Substance Abuse Issues May Require Medically Assisted Detox?