Medical Detox Guide

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Your Complete Guide to Medical Detox

Detox is the first step in your recovery path, and it is often the hardest step for people who live with substance use disorders. The process aims to eliminate drugs and alcohol from the body when a person has become physically or psychologically dependent on the substance.

Chronic, long-term substance use makes the body adjust to the presence of the drug to function. When the drug is no longer available, your body goes through a series of withdrawal symptoms, indicating that it is adjusting to the absence of the substance. Additionally, if you have a psychological dependence on the drug, emotions and mental health disorders may arise that were previously masked by the substance. Despite the challenges, detox is necessary for your recovery and has many benefits.

Taking the First Step

Many people with substance use disorders attempt to quit on their own, a process known as “going cold turkey.” For some, the withdrawal symptoms are too overwhelming, and they continue using as a way to self-medicate and ease the physical and emotional discomfort. This initial experience stays in their thoughts and prevents them from attempting to quit. Depending on the substance, withdrawal symptoms can range from mild to severe, and certain substances can make drug detox a life-threatening option without the proper management.

Once the drug is eliminated from the body, though, a person is able to start the physical and emotional healing and recovery. Detox is not considered a part of treatment, but it is necessary to help a person follow a healthy and safe process of abuse and addiction treatment.

Detox & Withdrawal May Delay Treatment

Going through detox and withdrawal clears drugs and alcohol from your body. It allows your body to start healing, and it also gives you a clear mind to start the recovery process. Unfortunately, most people do not successfully complete the detox and withdrawal process.

Depending on the substance, the drug withdrawal time ranges from a few days to several weeks. During this time, the person may experience difficult physical and psychological symptoms that delay treatment, such as:
• Irritability
• Problems eating and sleeping
• Headaches
• Chills and fever
• Severe depression
• Hallucinations
• Suicidal thoughts
• Rapid heartbeat
• High blood pressure
• Cramps and muscle spasms
• Stomach pain
• Nausea, diarrhea, and vomiting
• Tremors and shaking

What Is Medical Detox?

Detox is performed using two distinctive models. Social models for detox rely on providing a person with a support system while the symptoms of withdrawal emerge. Medically supervised detox is based upon the administration of specific medications that ease the withdrawal symptoms. The medications are coupled with oversight by clinicians and counselors to help the person successfully complete detox.

Is Medically Managed Detox Safe?

Medically managed detox is considered a safer and more effective way to eliminate drugs and alcohol from your body, both on a short-term and long-term basis. From a short-term perspective, you are carefully monitored for any signs that your body is not managing the detox process well. A counselor is also available to help you manage any difficult emotions.

On a long-term basis, medically managed detox is much more effective than trying to quit on your own. People are less likely to relapse because they successfully navigate the discomfort of detox, and this sets them up for greater success on their paths to recovery.

Why Detox Under Medical Supervision Is Better

Detox under medical supervision is a better option than the social models because it validates what the person is experiencing. Additionally, clinical and mental health staff can monitor for any life-threatening situations, such as suicidal thoughts, heart rate issues, dangerously high blood pressure, and the potential for strokes. If the person has any underlying chronic conditions, such as hypertension or diabetes, these can be effectively managed by the clinicians as well.

Substances That Require Medically Managed Detox

Not all substances manifest a level of withdrawal symptoms that requires clinical and mental health oversight, but most do require this degree of supervision. The following provides a closer look at what to expect when detoxing from certain substances.

Symptoms of Alcohol Withdrawal

Alcohol affects the central nervous system of the body, which helps regulate blood pressure, heart rate, motor skills, and other functions. When a person who is addicted to alcohol stops drinking, the body goes through a period of adjustment, and the physiological changes can be severe. A person going through alcohol withdrawal during detox may have a dangerously high heart rate, high temperature or fever, tremors, and elevated blood pressure. The person may also experience psychological symptoms such as angry outbursts, depression, and anxiety.

Symptoms of Withdrawal From Benzodiazepines

Benzodiazepines include prescription medications for seizures, anxiety, and other conditions. They work much the same way as alcohol. When a person is addicted to “benzos,” withdrawal symptoms can be severe and life-threatening.

Withdrawal From Opioids

Addiction to opioids causes the body’s natural endorphin production to stop, and the person is completely dependent on the drug. Opioid withdrawal ranges from moderate to severe, and heroin withdrawal can be extremely difficult. For moderate cases, withdrawal makes a person feel like they have the flu. They may have nausea, fever, vomiting, diarrhea, and muscle aches. In more severe cases, the person may have opioid withdrawal syndrome, which can be life threatening. Due to the challenges with opioid withdrawal, medically supervised detox is always recommended.

Symptoms of Withdrawal From Prescription Drugs

Prescription drugs that affect the central nervous symptoms, such as those for sleep disorders and chronic pain, can be addictive. Someone who is addicted to these types of drugs is likely to have some withdrawal symptoms, as well as symptoms of the underlying medical condition. A clinician and counselor can help the person navigate the detox process.

Withdrawal From Stimulants

In addition to physical withdrawal symptoms such as nausea, sweating, and fatigue, meth, cocaine, and other stimulants cause various psychological withdrawal symptoms. A person can experience severe depression, and this may lead to thoughts of self-harm and suicide. Some may also have hallucinations and paranoia. Having a clinician and counselor available ensures that the person can successfully complete detox.

Withdrawal From Synthetic Drugs

Due to the various substances that are used for synthetic drugs, such as fentanyl and bath salts, detox can be a highly variable and unpredictable experience. Detoxing from these drugs under medical supervision ensures that any physical and psychological symptoms are addressed in a timely and safe manner.

What to Expect From Medically Supervised Detox

The U.S. Substance Abuse and Mental Health Services Administration (SAMHSA) developed a guide for clinicians and counselors that outlines the best approach to medically supervised detox. According to SAMHSA, the drug detox process should include evaluation and stabilization.

Evaluation as Part of Medically Supervised Detox

Blood tests are performed to determine what substances are in your body. This helps the clinician anticipate symptoms of your withdrawal and create an appropriate plan of care. The plan of care will include both medical and emotional support.

A physical exam and history are also performed to check your overall health and identify any underlying chronic medical conditions, such as hypertension, heart disease, and diabetes. A counselor meets with you as well to identify any mental health conditions that may exist. The information that is gathered during the evaluation is also used as part of your substance use treatment plan after detox.

Stabilization During Medically Supervised Detox

Once you define a detox plan of care with a clinician and counselor, the detox process begins. Staff monitor how you are feeling physically and emotionally. It is important to discuss any issues openly and candidly. You may be given medications to ease the symptoms. Your team also ensures that you eat, sleep, and stay hydrated. Detoxing from substances can take time, so your counselor is available to encourage and support you.

Medications Used for Medically Managed Detox

Not everyone needs medications as part of a medically managed detox program. Based on your medical history and symptoms, your clinician and counselor may opt to provide medications as a way to ease the elimination of drugs from your body. This is a highly individualized decision that will be discussed with you. Medications are most often recommended during the detox process for alcohol and opioids.

How Long Does Medically Managed Detox Take?

The drug withdrawal timeline varies for each person. In addition to the type of substance, the timeline also depends on:
• Individual metabolic rate
• Underlying medical conditions
• Degree of physical dependence
• Ability to practice self-care during detox

Metabolic Rate

Everyone’s body processes substances at a different rate, whether it’s food or drugs and alcohol. Having a slower metabolic rate may mean that it will take more time for the drugs and alcohol to be eliminated from your body.

Underlying Medical Conditions

Certain medical conditions, such as diabetes and hypothyroidism, may affect how quickly your body is able to rid itself of drugs and alcohol. Your clinician can explain how these conditions may affect the timeline for your detox.

Degree of Physical Dependence

Your body stores drugs and alcohol in much the same way as it stores nutrients. If you use a high quantity of drugs and alcohol or use substances frequently, there will be more that needs to be eliminated compared to someone who uses less often.

Ability to Practice Self-Care During Detox

Self-care is paramount during medically supervised detox. Your counselor and clinician will encourage you to eat properly, sleep as much as possible, and stay hydrated. These three areas have a significant impact on how well your body works during detox.

Hydration also boosts your body’s ability to remove toxins, such as drugs and alcohol, from your system. Whenever possible, spend time during detox doing things that you enjoy, such as taking walks, reading, sketching, and keeping a journal. This helps to keep you healthy on an emotional level.

What Happens After Medically Managed Detox

After completing medically supervised detox, many people notice an improvement in the way they feel physically and emotionally. At first, you may feel strange because you are experiencing physical and emotional sensations that were masked during the time that you relied on drugs and alcohol. These sensations can be positive or challenging, but you have a team of experts available to support you.

Treatment Begins After Detox

The same clinicians and counselors that helped you through detox become part of an integral team that supports you along a path to recovery from addiction. The information that was gathered during your detox evaluation serves as a foundation for your recovery plan. The plan is updated with the next steps, such as individual and group counseling. This is also the time when your options are discussed. The recommendation may include inpatient treatment or outpatient treatment.

Once you reach this point in overcoming your addiction, it is important to maintain the same level of commitment. If inpatient treatment is best for you, dedicate the time needed to overcome the past and to learn new ways to live a healthier life.

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Reviewed By:

Dr. John Elgin Wilkaitis

Dr. John Elgin Wilkaitis completed medical school at The University of Mississippi Medical Center and residency in general psychiatry in 2003. He completed a fellowship in Child and Adolescent Psychiatry at Cincinnati Children’s Hospital in 2005. Following this, he served as Chief Medical Officer for 10 years of Brentwood Behavioral Healthcare a private health system including a 105-bed hospital, residential treatment, and intensive outpatient services.

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