What is Medical Detox and When You Need It
By Deborah Rasso, LMHC, CAP, ICADC, LPC, NCC, QS, CH
When you finally make the decision to stop using mind and mood altering substances, many questions may go through your mind. Do I need detox treatment or should I look for a less intensive level of care? What do I do first? Am I going to be sick while withdrawing? How do I prepare? What should I expect and look for in a detox program? All of those questions (and some you didn’t think of) are about to be answered.
Alcohol and Benzodiazepines Detox Treatment
A medical detox treatment program is the highest level of care in addiction treatment. People who drink heavily or use benzodiazepines should always participate in the safety of a medically monitored detoxification program. One of the possible side effects of un-medicated detox from these substances is a seizure. Seizures can be fatal. Therefore, if your drug of choice is alcohol or if you have been taking benzodiazepines regularly or in large doses, then you should admit to a 24/7 medically monitored detox program.
Once in the program, you will be put on a protocol using Librium or Ativan for four to five days (longer if needed). “People who are older, heavier drinkers and still have healthy livers are usually given Librium,” explained Jacob Strachan, RN, Charge Nurse at The Palm Beach Institute. “If the patient has an unhealthy liver, or is younger, they are more likely to be given an Ativan detox protocol”.
The length of the time you are in “detox treatment” and taking medications will depend on your symptoms. Patients are usually offered Librium for four days. The first two days they are given 50 mg every eight hours if needed. The third day it is lowered to 25 mg every eight hours and on the fourth day, they are given 10 mg every eight hours for a total of 30 mg.
Patients have to meet criteria before they are given medications. The criteria are both subjective and objective. Some of the symptoms that the medical team will assess are nausea, anxiety, sweats, tactile disturbances (itching, numbness), visual disturbances (sensitivity to light), headaches, auditory disturbances (disturbing sounds), disorientation, agitation, and tremors. A patient’s score on the assessment, known as Clinical Alcohol Withdrawal Assessment (CIWA), performed by the medical staff, will determine whether the patient requires medication. They will also check the patient’s vital signs on each assessment (blood pressure, heart rate, temperature, etc.).
The patient will be asked questions regarding their cravings, pain levels, sleep, and appetite. Once the medical protocol has been completed, patients will continue to need to be aware of their symptoms due to the fact that seizure activity peaks at 10 days to two weeks after stopping alcohol and drug use. If a patient has any history of seizure for any reason, they are usually put on a medication called “Keppra” for five days which will lower the likelihood of a seizure.
Opiate and Heroin Detox Treatment
If your drug of choice was prescription opiates or heroin, medical detox is not always required, but it is still recommended. The symptoms of withdrawal from opiates are nausea, vomiting, chills, sweating, restless legs, diarrhea, body aches to name just a few. It is extremely difficult to go through these symptoms without medical monitoring and medications. A person entering treatment to detox from opiates will be given either Suboxone or Subutex.
Suboxone is a partial opioid agonist. In other words, Suboxone will attach to the opioid receptors in the brain similarly to how the opiate did. This will block the withdrawal symptoms. The Suboxone will be tapered down allowing the body to adjust to the change. Suboxone contains Buprenorphine and Naloxone. Some people who are allergic to Naloxone may be given Subutex instead because does not contain Naloxone. The Suboxone protocol usually will last up to seven days.
Patients on a Suboxone protocol are usually given 8 mg the first day, 4 mg to start and then 2 mg every eight hours. On the second and third day, they can take 2 mg every eight hours as needed. On the fourth and fifth day, they will be given 2 mg every 12 hours and on the last two days, they will get 2 mg one time per day as needed.
They will also need to meet criteria to be given the medication. The assessment for this type of medication is called a Clinical Opiate Withdrawal Scale (COWS). Symptoms assessed include:
- pulse rate
- pupil size
- bone or joint aches
- runny nose
- gastrointestinal upset
- and gooseflesh (goosebumps) on the skin.
Depending on the score, the medications will be given or withheld until the criteria is reached.
Detoxing from opiates at home is difficult due to the tendency for an addict to abuse their Suboxone by taking too much or by selling the Suboxone to get their drug of choice. Additionally, there is the risk of dehydration if the client has severe withdrawal symptoms. Though dehydration can be fatal, medical staff can quickly assess if a patient is becoming dehydrated and take the necessary steps to prevent serious consequences.
Methadone Detox Treatment
Detoxing from Methadone is more complicated than from opiates. A methadone detox treatment will usually begin with four days of Hycodan syrup. The will be tapered slowly off the syrup before beginning the Suboxone protocol. The COWS score is very important before beginning Suboxone. The patient does not want to begin Suboxone if they still have Methadone in their system or they may experience uncomfortable withdrawal symptoms.
The goal for the patient is to try to take as little medication as possible because they can also experience withdrawal from the medications if taken it is in too high of a dose or taken for too long. Suboxone has a half-life of approximately 30 hours. This means that Suboxone continues to have an effect in the body for 30 hours after taking the last dose. Therefore, withdrawal symptoms sometimes recur mildly approximately two days after the protocol is complete. The symptoms that may return can be medicated with what Nurse Strachan refers to as “comfort medications.”
Comfort medications are available for most patients going through medical detox treatment from any substance. They may include:
- Tigan for nausea,
- Robaxin for muscle and joint pain,
- Vistaril for anxiety,
- Clonidine for high blood pressure and anxiety,
- Imodium for diarrhea,
- Melatonin for sleep.
None of the comfort medications offered have any addictive properties and cannot be abused.
The nursing staff will check on the clients frequently to ensure that they are responding well to their medications. The medical team will also make sure to educate the patient on every medication they are taking including what it is, how long it will last, what the side effects may be, and when they should return for their next dose.
Most detox programs will offer clinical support from therapists and behavioral health technicians while patients are in treatment. You should attempt to attend any groups that are offered during the day so you can understand the disease of addiction and begin working on new coping skills. In-house AA meetings will introduce you to a support system that is available to everyone in the community.
Handling Detox Treatment
Contact with family and friends is likely to be limited while you go through detox so that you can focus on yourself and the healing process. To prepare for detox remember that you should rely on the staff to help determine what you need. This will require complete honesty about your symptoms. Don’t be a martyr and try to suffer through discomfort, but also, don’t ask for medications if you don’t need them. You are trying to get out of that habit!
By the end of your week in detox, you will be feeling better and will be stabilized. Keep in mind that even if your body has adjusted to not having drugs in your system every day, your mind has not adjusted. Addiction is a disease of the reward system of the brain. The only way to repair the thought process is to continue to work on identifying your triggers for use and developing new coping skills. The brain can take up to two years to repair and change the thought patterns. Therefore, don’t be in a rush to return home. Further treatment is recommended to continue making progress against this disease.
Start on the Road to Recovery Today
If you need detox treatment from a harmful addictive substance, you’re not alone. There are hundreds of thousands of people across the country across the country who are taking that first step toward recovery, and recovery starts with detox. Call us at 844-899-5777 to let our experienced professionals help you get into a detox treatment program that’s right for you.