Detoxification
From Drug Rehab Wiki
Detoxification is the process in which a person who is dependent upon substances undergoes withdrawal from substance use. It is a medical protocol used during the acute withdrawal phase from substance(s). Detoxification transitions an individual from intoxication to substance-free medical stability.
Goals of Detoxification
Goals of substance detoxification are:
• completion of withdrawal
• medical stabilization
• preparation for continued substance treatment
In addiction treatment, “detox” is often the initial phase of treatment during which the substance is discontinued and withdrawal is completed. Following detox in addiction treatment other aspects of treatment, such as counseling and participation in self-help groups, address the behavioral, emotional, psychological and social aspects of addiction.
Withdrawal
Withdrawal begins with the cessation of substances and is completed when the body has stabilized after withdrawal. Symptoms of withdrawal occur in the detoxification process and are managed medically by supervised detoxification protocols. Detoxification from certain substances requires medical supervision for safe withdrawal in order to prevent complications such as seizures, hypertensive crisis, coma and, in some cases, death. Acute withdrawal occurs during the first few days or weeks of detox and is the period during which the symptoms are most severe and usually require medical supervision. Protracted withdrawal describes symptoms that occur after the initial period of detox, and sometimes take weeks or months to resolve.
Detoxification Protocols
Medical detoxification protocols are specific to the class of substance upon which an individual is dependent. Substance cessation in a substance dependent individual results in withdrawal during which cravings and other symptoms specific to the substances involved occur. There are distinct medical protocols for withdrawal from specific classes of substances such as:
• Opioids • Sedatives and hypnotics • Alcohol • Stimulants
Abstinence or Withdrawal Syndrome
The withdrawal process has varying times of onset, specific symptomology, varying severity, varying persistence and varying potential for medical risks that are specific to the substance(s) involved. An individual’s overall health, including psychiatric health, can affect all variables of the withdrawal process. Various substances in a designated class of drug will typically have similar withdrawal effects but may vary in the intensity and length of withdrawal time. The clinical signs and symptoms of withdrawal from a substance are clustered into an Abstinence Syndrome or Withdrawal Syndrome specific to the substance involved.
Initiation of Detoxification
The detoxification process is typically preceded by a multi-leveled evaluation that assesses the following:
• evaluation of the specific substance(s) used
• evaluation of substance concentrations in the body
• identification of co-existing clinical issues including physiological and psychiatric co-occurring conditions
• evaluation of stressors and resources related to substance use and available for recovery efforts
• determination of the appropriate setting for detoxification
• recommendations for post-detoxification treatment interventions to maintain abstinence
Aspects of Detoxification Medical Protocol
Medical detoxification protocol for all classes of substances involves:
• use of medication to manage withdrawal symptoms
• psychological support
• palliative care
• education about detoxification
• preparation for further stages of substance treatment
Detoxification Settings
Various settings are available for detoxification. Detoxification settings are recommended by clinicians to accommodate an individual’s specific need for medical supervision and support. The American Society of Addiction Medicine (ASAM) has established assessment criteria for determining the appropriate detoxification treatment setting for each substance dependent individual. Assessment criteria include considerations of whether an individual has:
• acute intoxication or acute withdrawal potential
• biomedical conditions and/or complications
• emotional, behavioral or cognitive conditions or complications
• readiness to change
• relapse, continued use or continued problem potential
• recovery supportive living environment
Each detoxification setting provides a specific level of medical supervision. The degree of medical supervision varies across these detoxification settings:
• outpatient settings such as a physician’s office
• urgent or emergency medical care settings
• substance treatment facilities
• mental health treatment facilities
• acute care inpatient medical settings
While the levels of care available in each of these settings vary in the availability and intensity of medical care and other supports for detoxification, costs also vary greatly. Roughly, the more restrictive the detoxification setting, and the more available medical supervision and supports are, the more costly that method of detoxification is.
Use of outpatient settings for detoxification are typically less expensive and require that an individual be ambulatory, have adequate supports and a living environment conducive to a successful participation in and completion of the detoxification process. More restrictive settings of care for detoxification are usually indicated for:
• those with medical and psychiatric distress from acute withdrawal
• pregnant women
• those with co-existing medical and psychiatric conditions that can be complicated by withdrawal
• those who have no supports in place for successful abstinence
• those who are not ambulatory
Detoxification and Co-Existing Medical and Psychiatric Conditions
Behavioral changes during detoxification can pose a potential for harm to self or others through severe disorganization, suicidality or aggression. Other signs and symptoms of withdrawal that require immediate medical attention may occur during a detoxification process. These can indicate a life-threatening situation and can include:
• severe anxiety
• fever
• seizure
• vomiting
• confusion
• delirium
• hallucinations
• tachycardia
• blood pressure changes
• decreased heart rate
• psychosis
• unresponsiveness
• depression
Concurrent Disorders
Individuals with a co-existing psychiatric condition may experience intensified symptoms of that condition during detoxification and are often treated in a medical setting with psychiatric services.
Individuals with a co-existing physical condition that constitutes serious risk if exacerbated may be treated within a medical facility equipped to monitor and treat any complications of that condition that arise during detoxification.
Protracted Withdrawal
Some substances such as benzodiazepines can cause persisting symptoms of withdrawal after detoxification known as a Protracted Withdrawal Syndrome or Post Acute Withdrawal Syndrome (PAWS). Symptoms such as the following can persist after detoxification:
• insomnia
• anxiety
• irritability
• tremulousness
• depression
• gastrointestinal disturbances
• neuropathy
• slowed thinking
Nutrition, exercise, relaxation, self-help groups, meditation and supportive counseling are among the various modalities used in treating a Protracted Withdrawal Syndrome or Post Acute Withdrawal Syndrome (PAWS).
Rapid Detoxification
Rapid Detoxification is a process in which an opioid or opiate dependent individual undergoes an intensive medical procedure to rapidly detoxify. Rapid detoxification processes require anesthesia and treatment in an acute medical inpatient setting under the care of a physician and medical support staff. These detoxification procedures are widely available but considered by some healthcare professionals to be controversial.
