Thursday November 23rd 2017

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What is drug detox and how does it work?

By Dr. Dean Drosnes, MD, FASAM and
David Rotenberg, MA, MBA, CAC Diplomate

Debunking the Myth That Detox Is Treatment

Our nation is entrenched in an epidemic of addiction, and we’ve seen heroic efforts from law enforcement, government agencies, the healthcare industry, and advocacy groups to get Americans into treatment. We applaud the steps outlined in the White House’s Office of National Drug Control Policy Commission Interim Report . Further, we are encouraged by President Trump’s national emergency declaration.

But with 142 people dying from a drug overdose each day, we are stuck in triage mode. Public policy focuses on getting people out of a life-threatening medical crisis and into detox. But what are the necessary next steps in the process? What is drug detox in relation to addiction treatment? And how does it work?

We aim to address those questions here. Then, we invite your feedback at the end. In fact, the folks at Addiction Blog try to answer your real-life questions personally and promptly. So, please leave us your comments in the section at the end!

Treatment goes far beyond detox

So, question number one: What is detox?

Detox is a medical process that stabilizes a patient who is facing drug dependence. During medical detox, doctors supervise drug withdrawal and offer both medical and emotional support.

Proper management of withdrawal begins with a comprehensive assessment of the patient’s state and recent drug use, along with a physical exam to corroborate the self-report. If a patient’s recent drug use is not accurately determined during this time, medications prescribed to manage withdrawal may be incorrect and the patient might find themselves suffering acute symptoms during treatment, resulting in a medical emergency. This can manifest as a psychological trauma that causes some people to be disenfranchised with the process of treatment.

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How does detox work?

While it’s been described as unbearable, some types of withdrawal are typically not medically dangerous. For example, it’s rare to see a seizure or another medical complication in the face of opioid withdrawal. This is opposed to alcohol or benzodiazepine withdrawal, which are much more fraught with medical complications.

Detox works to achieve three main goals:
1. Ease the discomfort of drug or alcohol withdrawal.
2. Help address any serious medical problems or complications during the process.
3. Provide emotional support immediately following the discontinuation of drugs or alcohol.

Once the patient is out of the woods medically, feeling better physically, and relieved of mental anguish, they are often either more motivated than ever to continue their path to recovery or feel they can forgo professional treatment. But what happens if a person detoxes and then wants to leave to go home? Addiction specialists know that this situation may require another mini-intervention.

When a patient wants to leave right after detox, family and treatment providers encourage them to accept addiction treatment help for a longer period, which must be part of an individualized treatment plan.

When a person goes through detox, they’ve only just become stabilized. The real work of addiction recovery must now begin.

Why is detox not “enough?”

While detox is a critical, necessary first step towards recovery, any medical professional who understands addiction knows patients must move into treatment after detox for the best chance of achieving recovery. People need to go to treatment after detox to learn new coping skills and living strategies, and then how to apply them to a live a sober, happy life.

In other words, the only way to decrease the number of Americans with active substance use disorders is to debunk the myth that detox alone is a viable solution to addiction. Instead, we need to work for higher patient retention rates in treatment.

A smooth transition from detox to treatment

Successful treatment looks different for everyone. At Caron, we individualize treatment for each patient. Time in detox is dictated largely by medical needs. People who are addressing long-term, or high dose substance use usually require more time in detox. Likewise, people who are multi-drug users may need more time to stabilize.

The crucial point comes after managed withdrawal is complete and the patient and their family need guidance to decide how best to move forward.

Generally, we work within a model that moves from detox directly into inpatient, and then to a highly-supervised outpatient program. Inpatient length of stay can last anywhere from 30 days on, depending on the individualized needs of the patient. However, there are myriad reasons someone might opt out of inpatient. One of the largest roadblocks can be insurance coverage, or, lack of support structure at home.

As addiction specialists, we need to understand why people might think they’re unable to continue from detox into treatment. A reputable rehab center will help you troubleshoot perceived challenges.

Some common barriers to getting addiction help include:

  • Wait times (often a week or more)
  • Difficulty financing treatment
  • Difficulty locating treatment, especially in rural areas

A full of continuum of care

After detox, addiction treatment begins. A reputable rehab will continue tracking a person’s progress the entire time: from detox to treatment to aftercare. In fact, patients need to be evaluated from every vantage point to best determine how they are advancing in their treatment. At Caron, once someone is inpatient, they’re supervised and supported. Counselors are observing their diet, mood, and medical needs around the clock.

This full commitment of the continuum of care comes in again after discharge. Addiction is a chronic disease, such as diabetes and heart disease. Therefore, relapse is always a possibility. However, Caron’s research shows that ongoing monitoring and support can make a significant difference in prevention. For example, Caron’s communication tool, My First Year, works with other continuing care components to maintain the team approach in early recovery. It involves family, the outpatient therapist, and other appropriate entities. It allows Caron to remain a constant source of support as the patient moves through different phases. In the five years since Caron launched the tool, 76.4% of alumni were abstinent at completion of the one-year program.1 When there was a relapse, the program’s high reengagement rate helped the alumni to get back on track with their recovery plan.

Looking out for post-acute withdrawal

While it’s not recognized as a scientific term, those of us in the field know that withdrawal can last into the weeks to months after an acute drug detox completes. This post-acute withdrawal phase is a real entity on the recovery trajectory. Post-acute withdrawal is the stage people typically progress to after initial withdrawal. The characteristics are cognitive.

People experiencing post-acute withdrawal:

  • aren’t thinking straight
  • experience emotional ups and downs
  • suffer from sleep disturbances
  • experience cravings
  • are hyper sensitive to stress

As with initial withdrawal, this is also best-managed in treatment. If a patient has left detox directly after initial withdrawal, it’s likely they’ll go through this phase alone and, sadly, become extremely vulnerable to relapse.

Facing the future

There is no magic pill for recovery. It’s a commitment that requires time, honesty, and motivation from people who want to get better. However, successful treatment also requires a comprehensive approach to treatment by a quality provider.

A few days in detox cannot compare to a full, individualized treatment plan.

Addiction is a family disease, and when individuals recover, families rebuild. Detox by definition does not involve families, and detox without treatment deprives them of that healing.

Our hope is the current attention on addiction will allow our government to allot more resources for this crisis. While acute care is essential, it’s only successful when working in tandem with access to longer-term treatment. With this approach, we can begin to prevent the tragedies that led the nation into this state of emergency.

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