Treatment: Types of Detox

Detox is moving from your regular drug use to no drug use, with the help of various medications.

There are different types of detox. The types of substances having been abused as well as the withdrawal symptoms experienced will influence which type of detox is appropriate.

Detoxification can be done on both an outpatient basis (at mental health centers, addiction clinics or private clinics) or inpatient (at a hospital or residential treatment center). Inpatient detoxification allows you to be closely monitored, prevents use of the substance of abuse, and can speed up the process of detoxification. Outpatient detoxification has the advantage of being less disruptive to your life and less expensive. The choice of setting depends on many factors such as the drug of abuse, amount and length of history of abuse, psychosocial issues, patient’s age, and co-existing medical and/or psychiatric conditions among others.

Opioid Detox

Opioid detox is a bit different from detox options frequently provided for other substances of abuse and addiction. There are medications that have been approved solely to treat opioid addiction. Whether heroin or prescription painkillers are the opioid of choice, inpatient care or medication is often recommended for optimum comfort and safety.

Medications (such as buprenorphine and methadone) used to manage opioid dependence can help to alleviate the unpleasant withdrawal symptoms associated with opioids. These two medications – which are partial and full opioid agonists, respectively – are administered to stabilize your condition. Then they’re gradually tapered off so you don’t experience withdrawal symptoms.

The duration of withdrawal symptoms strongly depends on whether the opioid is long acting or short acting. Heroin is relatively short acting. Withdrawal symptoms will appear within hours after the last dose and may dissipate within a few days, while longer-acting opioid painkillers may not elicit withdrawal symptoms until a few days after the last dose, possibly lasting for weeks.

Alcohol Detox

Cessation of heavy alcohol abuse can lead to distressing and potentially life-threatening withdrawal symptoms. Some non-fatal withdrawal symptoms include:

  • Sweating
  • Shivering
  • Anxiety
  • Slow movements and thoughts
  • Nausea or vomiting
  • Insomnia

Delirium tremens is a severe form of alcohol withdrawal that’s most commonly associated with heavy and prolonged use. It’s a medical emergency and can result in death if it goes untreated, though it occurs in no more than 10% of those experiencing alcohol withdrawal symptoms. Some symptoms of this condition include:

  • Hallucinations
  • Seizures
  • Confusion or disorientation (delirium).
  • Agitation
  • Changes in mental function.
  • Deep sleep that lasts for one or more days.

This severe alcohol withdrawal syndrome requires medical attention immediately. It’s always recommended that someone who has a severe addiction to alcohol receive medically supervised detoxification in order to safely remove the substance from the body.

Methods of Drug Detox

Depending upon the drug, people might have different options in drug detox methods. No one method is right for everyone. Rather, the drug of choice, the dose taken at the time the patient starts detox, how long the person has been using that drug, and whether the patient is using other drugs will determine the most appropriate type of detox. Different detox approaches include cold-turkey detox or medicated detox.

A “cold turkey” detox means stopping use of all drugs and substances with nothing more than medical supervision to aid you in case of an emergency. There’s no pharmacological assistance, and you experience the full brunt of the withdrawal symptoms for as long they last. For some drugs, these can be quite intense and last for a couple of weeks or longer. For other drugs, cold turkey detox isn’t as physically difficult.

If you opt for medical detox you stop taking all substances. Medical Detoxification is a process that systematically and safely withdraws people from addicting drugs, usually under the care of a physician. The detoxification process is designed to treat the immediate bodily effects of stopping drug use and to remove toxins left in the body as a result of the chemicals found in drugs and/or alcohol.

Detox alone might help you to stop abusing drugs and alcohol in the short term, but without follow-up care and therapy, the risk of relapse into problematic use increases greatly.

Medications can be extremely effective in helping you to safely stop abusing drugs and alcohol. They might address the changes in the brain that occur due to chronic drug abuse or help to mitigate cravings. In some cases, they might even mimic the action of the addictive drug in the brain and help patients to avoid the bulk of withdrawal symptoms.

Agonist-assisted detox

Both methadone and buprenorphine are used in agonist-assisted detox, this approach aims to prevent / minimise withdrawals and cravings. By temporarily replacing your normal drug with a pharmaceutical-grade opioid, you should gradually be able to reduce your dose until you are no longer taking opioids at all.

Buprenorphine detoxification can be completed in 1 or 2 weeks, whereas methadone detoxification can take longer depending on the starting dose and the rate of reduction.

What to expect

If you have been using heroin or other non-prescribed opioids, you will first be switched to buprenorphine or methadone before beginning your dose reduction. The longer you take to reduce your dose, the more time your body has to adapt to functioning without opioids. However, if you have been using heroin/opioids for a long time, then the long-term changes to your brain can also take a long time to reverse, and you can still expect to experience withdrawal discomfort or cravings for some time after completing the detox. If withdrawal symptoms are severe or you decide that you are not ready to attempt abstinence, you can easily reverse the process and move towards maintenance therapy. If this happens, don’t take it as a failure. It may be your body’s way of telling you it is not ready to work properly without opioids, and if it means you get what you need, then this may be the best outcome for you at this point in your journey towards recovery.

Symptomatic medications

Symptomatic medications can help alleviate some of the withdrawal symptoms if you wish to avoid taking opioids (not the cause). Although you are likely to still feel cravings, some people find they are easier to deal with when the physical symptoms of withdrawal aren’t so “in your face”.

What’s next?

All kinds of things can trigger cravings even years after your last use of heroin/opioids. If you feel you need medication to stay abstinent, you can consider using naltrexone, a medication that blocks the effects of opioid use to prevent relapse, or maintenance therapy to eliminate cravings and give you the time to make changes you feel you need in your life.