Detox | Detoxification

detox

Detox, or detoxification, is the process of removing a drug from someone’s system and allowing normal body chemistry to return. It also includes the short-term withdrawal symptoms that happen as the body reacts to not having the addictive substance.

This use of the word is somewhat different than the common use of ‘cleansing’ although it is related.

Medical detoxification is a three step procedure specifically related to drugs of abuse:

Evaluation
The first step consists of evaluating the patient and includes testing for drug-blood levels, obtaining a history and performing a physical and mental examination. A patient’s overall physical condition is important when deciding which type of detox they will be able to handle and what problems are likely to crop up.
Stabilization
Stabilization is a period where the patient is allowed to recover from the acute effects of the drug and undergo withdrawal. In a medical setting, it is common to give medications that help with the major withdrawal symptoms along with psychological support. Getting them past the worst phases of withdrawal is the goal.
Follow-up care
The final step in detoxification is arranging for follow-up care and gaining a commitment from the patient that they will continue treatment. In some facilities, this simply means staying in a program for which detox was a part. In other cases, a referral is necessary.

Other types of detox

Ultra or Rapid detoxification is used in two circumstances. The first is an emergency response to an overdose. For narcotics, the injectable drug, Naloxone can be given to almost immediately stop the effects of opioid (heroin, hydrocodone, etc.) overdose.

In non-emergency cases, patients are first anesthetized and then administered Naloxone (or allowed to withdraw if the addiction is to a non-opiate). This accomplishes an almost immediate onset of withdrawal symptoms, but the patient is unconscious and doesn’t have to suffer.

Rapid and Ultra Detox has not been shown to improve overall abstinence rates. It has been proposed that patients are more likely to maintain sobriety when they have experienced withdrawal because they may fear having to undergo it again.

Vitamin Therapy is sometimes used during detox as either a replacement for poor nutrition while actively abusing or, in some programs, as a direct treatment. While various claims have been made (usually for proprietary formulations) no direct studies have shown vitamins to be effective in reducing major withdrawal symptoms.

Adjunct medications – it is common during detox to prescribe medications that help patients with known withdrawal symptoms. Sleep aids and other drugs are commonly given in the first few days.

Detox time frames

Detox varies somewhat depending on the amount and frequency of abuse by the addict. Generally, the detoxification process is considered complete once major withdrawal symptoms have disappeared and there is no measurable drug in the body. Note that ‘major withdrawal symptoms’ does not mean all symptoms. Detox primarily refers to the first phase where the drug is cleared from the body, not the entire healing process.

Approximate detox time frames for selected drugs

  • Heroin (and other opiates, non-rapid detox) – 5 days, up to two weeks to feel “normal”.
  • Alcohol – 3 to 5 days acute, symptoms clear at about 3 weeks.
  • Benzodiazepines (Xanax, Ativan, others) – one to two weeks because of the danger of stopping abruptly. The drug can clear faster, but the dose is reduced gradually for patient safety.
  • Marijuana – this is an exception because the drug is detectable in the body for a month or more after quitting. However, the effects of the last dose are gone within a day at the most. Detox for marijuana (to clear the body) is then a matter of time abstinent rather than an acute procedure.
  • Cocaine/crack – 5 to 14 days, generally the drug is cleared within 5 days but major symptoms can persist much longer.
  • Methamphetamine – 7 to 10 days with low level symptoms persisting much longer. The drug is actually cleared from the system within 2 days, but 90% of patients develop a withdrawal syndrome which accounts for the longer averages.

photo by Wong Mei Teng

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