Short for detoxification, a medical detox is usually the first stage of rehabilitation treatment option (depending on the level of addiction) that is carried out under the supervision of a medical professional to safely help patients overcome their physical and psychological dependence on illegal or controlled substances and alcohol. Medical detoxification is the process of the withdrawal management and deemed necessary to mitigate certain processes that occur as a result of chronically abusing and ceasing use of drugs or alcohol. The normal detoxification process is designed to remove the drug from the system and rid a patient’s body of accumulated waste products, foreign substances, and other materials (toxins).
While the body can detoxify itself naturally, this targeted intervention is vital for people with significant liver damage as a result of alcohol and drug abuse to improve and optimize the function of their body’s detoxification systems. In addition to synthesizing and secreting bile, the liver has over 500 important functions such as filtering toxins and bacteria in the blood to chemically neutralizes toxins and convert them into substances that can be eliminated by the kidneys, including the lungs, lymphatic system and skin.
The primary purpose of a detox is to support all these organs so that any toxins present in the body can be metabolized and excreted. The effects associated with drugs can vary from person to person, and different types of drugs affect the body in different ways depending on a variety of factors including a person’s health, age, the quality, amount and strength of the drug, etc. Regardless of factors, drug and alcohol use can have both short-term and long-term physical and psychological including dependency. Individuals who have an alcohol or drug problem develop what is known as a tolerance, where their body gets used to the substance, and they need more of it to get the same feeling. Drugs such as crystal meth and other amphetamines have been shown to change the user’s appearance significantly and make them feel less hungry, so they end up not eating and consequently appear unhealthy.
Some drugs can cause liver damage thus rendering the user’s body unable to fight off infection, makes their heart beat too fast, cause their body temperature to get so high enough to damage the brain and cause symptoms such as abdominal pain, itching, and a tendency to bruise and bleed as well as jaundice. Liver damage caused by drugs is termed as drug-induced liver injury (DILI), additionally, prolonged use of alcohol can also result in a condition known as alcoholic liver disease which can cause irreparable damage to the liver, causing various forms of liver disease.
Being the body’s largest internal organ, the liver and its many important such as digestion, metabolism, and protein synthesis, is a detoxifier. Each alcoholic drink is absorbed into the blood, one-third into the stomach and the other two-thirds ends up in the small intestine. The kidneys filter some alcohol out; the rest is sent to the liver where it is metabolized into a toxic chemical known as acetaldehyde, which damages liver cells. Excessive alcohol consumption or abuse can cause symptoms such as abdominal pain, fatigue, and weight loss lead to fatty liver disease which cannot be cured. Additionally, when the liver becomes inflamed, it cannot function properly and can also lead to a condition known as alcoholic hepatitis, which may be reversed but can cause adverse symptoms such as abdominal pain, bloating, nausea, vomiting, appetite loss, jaundice, fever, confusion, fatigue, male impotence and testicular shrinkage.
According to the Centers for Disease Control, over fifty people die every day from alcoholic liver disease. When the liver is unable to remove toxins from the blood, it can also lead to a fatal condition known as Hepatic encephalopathy where these toxins reach the brain to cause adverse symptoms such as extreme confusion, altered levels of consciousness, coma, and even death. Liver cirrhosis is yet another disease caused by excessive drinking, taking certain medications, including abuse of other drugs. Consequently, the liver cells become so damaged that they get replaced by lumpy and hard scar tissue.
Hepatocellular carcinoma (HCC) is the most common type of liver cancer associated with alcohol-caused cirrhosis, which accounts for over 70% of liver cancer-related diseases. While the liver is one of the most resilient and durable organs, it is important for individuals who are experiencing any symptoms of drug or alcohol-related liver disease to stop using these harmful substances right away. While this may prove a tad difficult for a functional or full-blown alcoholic, turning to a rehabilitation center can help them get the treatment they need to take control of their addiction and begin treating the damage drinking has caused to their liver.
Importance of Medical Detox
A person who habitually abuses drugs or alcohol has adjusted to having a specific level of the toxic substances in the system, and withdrawal symptoms such as stomach upset, trembling, anxiety, and other symptoms are aspects of physical dependence. Instead of stopping cold turkey, a medical detox intervention allows an individual to adjust to life without drugs or alcohol with the help of a healthcare professional. While alcohol withdrawal symptoms will often extinguish very quickly, some drug users need medical attention to prevent severe complications.
Being a depressant, the body begins to rely on alcohol over the course of months and years of drinking, consequently causing dependence. The severity of withdrawal symptoms is unique to every everyone depending on the severity of their alcohol use disorder. For example, symptoms of alcohol withdrawal may include fever, sweating, rapid heartbeat, confusion, hallucinations, etc. While some individuals will stop feeling these effects after a few days, some symptoms experienced during alcohol withdrawal can turn aggressive even cause extreme pain.
While rare, the most serious and life-threatening effect from alcohol withdrawal is delirium tremens, and due to its severity, it is advisable to detox under the care and supervision of medical professionals who can effectively manage the pain or discomfort with different medications. The initial symptoms of alcohol detox are mild but may become increasingly severe, and symptoms may involve disorientation, hand tremors, seizures, panic attacks within the first few days as the body rids alcohol from its system.
Additionally, some people will also experience post-acute withdrawal syndrome or PAWS long after the most serious withdrawal symptoms have diminished and may present symptoms such as anxiety, low energy, trouble sleeping and delayed reflexes, which may/can last from several months to a year. It is during or after a medical detox that patients can receive certain medications such as Benzodiazepines or disulfiram to calm the central nervous system and to mitigate unwanted effects such as facial flushing, nausea, headache, weakness, low blood pressure restlessness, insomnia, anxiety and muscle spasms
A person with an opioid drug abuse disorder for example with codeine, morphine, oxycodone, fentanyl, etc will experience withdrawal symptoms such as:
- Agitation
- Excessive sweating
- Anxiety
- Muscle aches
- Stomach upset
While Opioids are legitimately used for treating pain, they produce a sense of wellbeing or euphoria that many people develop tolerance or addiction to. Tolerance to the euphoric effect of opioids are known to develop fast, and while not life-threatening, the withdrawals can be extremely uncomfortable and last anywhere from 1-4 weeks during the first phase known as the acute withdrawal and up to two years during the second phase of post-acute withdrawal. A drug such as Fentanyl, which is a big part of the opioid epidemic is 50 to 100 times more potent than morphine and can cause an accidental overdose, however it can be reversed in hospital using intravenous drugs to safely manage the acute physical symptoms of withdrawal associated with stopping its use.
Stimulant use disorder is a fairly new diagnosis that captures a wide range of problems associated with the use of a variety of stimulant drugs including but not limited to Ritalin, amphetamines, cocaine, methamphetamines. While a stimulant such as Ritalin is often prescribed for treating ADHD, some people often take some of these drugs for recreational reasons, or to lose weight, to boost their energy or attention levels. Inadvertently, they end up developing a tolerance or addiction and consequently experience withdrawal when not using. An individual with stimulant intoxication can present various behavioral or psychological changes, which can prove problematic such as:
- Interpersonal sensitivity
- Auditory hallucinations
- Paranoid thoughts and repetitive movement
- Unexplained euphoria
- Hyper-vigilance
- Extreme anger
- Dilated pupils
- Elevated or lowered blood pressure
- Sweating or chills, nausea or vomiting
- Weight loss and muscle weakness
- Abnormally fast or slow heartbeat
Stimulant drugs are highly addictive, and users can develop dependence in as little as one week, and while considered mildly severe, withdrawal symptoms such as fatigue, vivid or unpleasant dreams, insomnia or hypersomnia, and abnormally slow heartbeat can manifest themselves within a few hours after stimulant use has ceased. A treatment plan for stimulant-related disorder involves individual counseling, non-confrontational behavioral counseling, setting up abstinence goals, attending group therapy, long-term support, and follow-up as well as medical detoxification if deemed necessary.
Cocaine is a drug that is considered “non-addictive” by some people. However, its withdrawal symptoms such as increased appetite, agitation, malaise, fatigue, sleep disturbances, etc. are what makes it difficult for those hooked on the substance to stop using on their own. Cocaine is a central nervous system stimulant that can either be snorted, injected or smoked and works by flooding the brain with dopamine or “feel good” neurotransmitter. Because it’s a drug that increases energy levels and keeps people awake while raising heart rate and blood pressure, it has become of the most abused substances that responsible for countless emergency room visit and cocaine-related overdose deaths.
Individuals going through a cocaine withdrawal experience what is known as psycho motor retardation or a physical slowing down that mostly brings psychological withdrawal symptoms.
Being a highly addictive drug that potentially changes the chemical makeup of the brain, consequently making it challenging to quit, it’s prudent to recognize some common warning signs of cocaine use and abuse in a loved one. The signs to look out for include:
- Unexplained needle marks
- White powder residue on the nose and mouth
- Burn marks on lips and hands
- Possession of drug paraphernalia such as syringes, pipes, burnt spoons, razor blades
- Financial troubles
- Social isolation
Cocaine users will also present certain physical changes such as:
- Dilated pupils that are sensitive to direct light
- Runny nose and frequent nose bleeding
- Overly talkative and excitable
- Changes in sleeping and eating patterns
- Weight loss
- Mood swings
- Increased risk-taking behavior
- Neglecting personal hygiene and appearance
A physician-assisted medical detox, in this case, followed by comprehensive inpatient addiction treatment is recommended because some of the most disconcerting cocaine withdrawal symptoms include intense depression and mood swings, including suicidal thoughts. Additionally, cocaine has a very short half-life, therefore withdrawals can start as soon as an hour after use and resolve after about 7-10 days depending on several factors such as:
- The length of use and buildup of the drug in the body
- The size of dose
- Comorbidity or poly drug dependence (2 or more drugs)
- Environmental factors that may complicate the psychological withdrawal process such as stress
- Co-occurring mental health disorder such as depression, anxiety, etc
Methamphetamine or meth is a very potent drug that is often used to treat attention-deficit hyperactivity disorder (ADHD). It is due to its extreme potential to stimulate the central nervous system that makes it easily abused and cessation is known to cause unpleasant withdrawal symptoms such as meth cravings, increased appetite, agitation, insomnia, paranoia, suicidal thoughts, and impaired coordination. Depending on how frequently a person uses methamphetamine, acute withdrawal and sub-acute withdrawals can last one to three weeks even up to a month or more.
According to the Center for Substance Abuse Research (CESAR), methamphetamine can become psychologically addictive where users go for days without food or sleep consequently rendering them irritable and paranoid enough to exhibit erratic behavior such as committing crimes and being violent. While it may not always easy to tell if someone has an opioid addiction, here are some of the telltale signs one can be on the lookout for:
- Mood and psychological changes – such as euphoria, improved or lowered self-esteem, psychosis, anxiety attacks, sudden depression or irritability.
- Behavioral changes – such as using large amounts of opioids than prescribed. Unsuccessfully trying to decrease the amount taken. Spending a lot of time trying to obtain said drugs. Abandoning important activities
- Physical changes – such as over-arousal and hypervigilance, constricted blood vessels, increased heart rate, increased sexual arousal, decreased appetite, increased energy levels, physical agitation, difficulty sleeping, increased sensitivity to sensory stimuli, etc
While there are currently no Food and Drug Administration (FDA) approved medications to help treat methamphetamine withdrawal, the use of antidepressants including detoxification can mitigate symptoms such as insomnia and help flush the drug out of a user’s system respectively.
Just like any drug, regular use of marijuana leads to a tolerance for it and chronic users have been known to experience various withdrawal symptoms such as loss of appetite, irritability, insomnia or anxiety. Marijuana presents both short-and long-term effects on the brain. Some of the long-term effects include:
- Impaired thinking and memory
- Altered senses for example of time
- Changes in mood
- Impaired body movement
- Difficulty with problem-solving
- Delusions
- Hallucinations
- Psychosis
- Increased heart rate and breathing problems
- Cannabinoid Hyperemesis Syndrome – severe nausea, vomiting, and dehydration
- Issues with child development during and after pregnancy
Marijuana use is more prevalent among the youth and has also been linked to various mental health problems, such as depression, anxiety, temporary paranoia, suicidal idealizations including worsening symptoms in patients with a severe mental disorder known as schizophrenia. Typical signs of marijuana use or abuse may include:
- Having marijuana paraphernalia such as pipes, bong, or rolling papers
- Red bloodshot eyes
- Unpredictable behavior such as laughing for no reason or having violent outbursts
- Being forgetful
- Increased appetite or lack thereof
- Delayed reaction times or abilities
- Panic or anxiety
- Liveliness or easily excitable
- Distorted senses
- Poor muscle and limb
Regular marijuana use can lead to the development of a substance use disorder and while there are currently no medications to treat its dependence, counseling and behavioral support has been shown to mitigate its psychological hold on patients who are trying to get clean and sober. In addition to exercising to help with unpleasant emotions, eating foods that are high in potassium, and hydrating, many recovery houses have been shown to use cranberry juice to purify and cleanse the body of marijuana toxins
Medical detox and withdrawal management process is a multifaceted approach that involves both medical and psychological interventions to help individuals who have developed a physical dependence on drugs or alcohol recover from their addiction and prevent relapses. A successful treatment program comprises of multiples services that a person seeking treatment may need to access to such as:
- Individual and group counseling, which focuses on helping a user reduce or stop substance use, including cognitive-behavioral therapy, skill building, adherence to a recovery plan, positive behavior reinforcement and much more
- Partial hospitalization or intensive outpatient treatment or inpatient or residential sessions that are mainly focused on medically managed withdrawal treatments as well as helping the patients change their behaviors in a highly structured setting
- Medication-assisted treatment (MAT) is used in combination with counseling and behavioral therapies mitigate cravings and other symptoms associated with withdrawals that come with using drugs or alcohol
- Recovery support services are non-clinical services used to support individuals in their recovery goals. Patients can receive support in various ways such as employment advice, education, mentoring, coaching, self-help groups, parenting education, spiritual support and much more
- A 12-step program such as Alcoholics Anonymous or Narcotics Anonymous provides a peer-to-peer support network to those who are working towards recovery
There is no one medical detox that is appropriate for everyone struggling with drug or alcohol use disorder and for a treatment to be successful it needs to be tailor made with an individual’s particular drug or alcohol problem including any associated medical and psychological needs in mind. Additionally, there are unexpected complications that can occur during a medical detox that has nothing to do with withdrawals. Therefore, a medical detox administrator can ensure the safety of a patient and prevent serious health consequences by ensuring that they first examine a patient’s medical history including their current state of mind and health before starting a detox.
Additionally, a typical detox procedure involves the use of specific medicine to taper off a substance safely and comfortably. It is, however, not uncommon to find patients who are sensitive to certain medications or are on other medication that may counteract with what they are prescribed during a detox program. It is advisable for patients to be open and honest first about their addiction and also let their attending physician know what other drugs or supplements they are on before they begin a detox program.
A long-term plan for recovery after the initial detox process is equally important. This not only involves psychological therapy, behavioral therapy, or peer-to-peer support, but it also involves nutritional support as well. Dehydration and nutrition imbalances are among the common side effect of prolonged drugs and alcohol use as a result of not eating enough throughout the day or eating foods that are low in essential nutrients. Proper nutrition and hydration are a crucial component to the substance abuse healing process because they both help restore physical and mental health and improve the chance of a patient’s recovery. Because Substance abuse is known to lead to vitamin and mineral deficiencies that threaten the user’s physical and mental health, damage their vital organs and the nervous system, a Medical nutrition therapy (MNT) and nutrition education should, in one way or the other:
- Encourage a patient’s self-care and a healthy lifestyle
- Heal and nourish the body damaged by alcohol or drug abuse
- Help with reducing craving
- Address any co-occurring medical conditions or those that are as a result of alcohol or substance abuse
- Stabilize a patient’s mood and reduce their stress