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Medical Detox Explained: What Is It?

Although many private addiction treatment centers still employ the term “medical detox,” it is not used by professional organizations like the American Association of Addiction Medicine (ASAM), the largest organization of addiction medicine physicians in the United States, and the World Health Organization (WHO). Both have published statements explaining why this term is no longer used and why the term “withdrawal management” or “physician-assisted withdrawal management” is preferred. All these terms refer to the same process.

Detoxification and Withdrawal

Detoxification is an ongoing physical process that is performed by a person’s system to rid itself of waste products and toxins. The primary organ systems involved in detoxification are the liver and the excretory system; however, a small percentage of drugs that people use are also excreted through the skin and lungs.

Because the body can only metabolize and eliminate substances at a certain rate, individuals who abuse substances will often have very high levels of these substances in their bodies. Over time, the person’s body will adjust to the presence of these substances, and the person will find they have to use more of a substance to get the effects they once achieved at a lower amount (tolerance).

Developing tolerance is relatively common for any type of substance that a person takes on a regular basis. Substance abusers who develop a tolerance often begin to take increasingly larger amounts of the drug, leading to the development of even greater tolerance and the need for very high amounts of the drug to get the effects they desire.

woman on bed

After significant tolerance has developed, and an individual continues to take increasingly high amounts of the drug, their system adjusts to high levels of the drug being continually present. The adjustment is designed to offset the effects of the drug, which is the reason people develop a tolerance for the drug. However, the body continues to engage in natural detoxification.

If the person stops using the substance for a sufficient length of time, which can be only a few hours in people with very high tolerance levels, the levels of the substance in the system will decline. The person may begin to experience adverse symptoms associated with this state of imbalance. The set of negative symptoms is referred to as withdrawal syndrome.

When an individual begins to experience withdrawal symptoms after they have stopped using a drug, they have developed a physical dependence on the drug.

Drug abusers are not usually under the care of a physician, and their withdrawal symptoms are typically intense and overwhelming due to the high level of tolerance they have developed. These individuals may find themselves driven to continue to use their substance of choice simply to avoid the withdrawal symptoms they may experience and not for the high that the drugs once produced. This observation is well described by the incentive-sensitization theory of substance abuse.

Medical Detox or Withdrawal Management

Many people will attempt to beat the cycle of addiction on their own by going through the withdrawal process with a cold-turkey approach or using some other method, but most of these individuals will relapse. The potential for relapse is extremely high in individuals who are experiencing active withdrawal symptoms because they can merely alleviate their withdrawal symptoms by taking their drug of choice.

Mental health treatment professionals who address problems with addiction have long recognized this issue and developed a process to help individuals get past the period of withdrawal with as little discomfort as possible. This process is what is often referred to as medical detox or withdrawal management.

According to ASAM, during the withdrawal management process, the person in recovery is placed under the care of a physician who will administer medications that can alleviate the withdrawal symptoms they may experience. This reduces the risk of relapse in the early stages of recovery and allows the person to begin to develop their long-term recovery program.

Medications used in this process may eliminate or significantly reduce the withdrawal symptoms for a specific drug, or they may be general medications that reduce generalized symptoms, such as headaches, nausea, jitteriness, and other common symptoms. 

  • Suboxone (buprenorphine and naloxone) and methadone are opioid replacement medications commonly used to eliminate the withdrawal symptoms associated with the use of opiate drugs.
  • Benzodiazepines like Valium (diazepam) are commonly used to address the specific withdrawal symptoms associated with alcohol and to reduce the risk of dangerous seizures. However, they are also useful in addressing withdrawal symptoms from other drugs such as other benzodiazepines, stimulants, and other substances.
  • Mild stimulant medications like Provigil (modafinil) will often be used to address problems with lethargy and sleepiness that occur during many types of withdrawal.
  • Headaches, nausea, gastrointestinal issues, and other physical issues can be addressed with prescription drugs or over-the-counter drugs.
  • Cravings to use one substance of choice are very common during withdrawal, and many medications can reduce these kinds of cravings such as ReVia (naltrexone).

Drugs that directly address various withdrawal syndromes like opiate replacement drugs (Suboxone and methadone) or benzodiazepines can also produce physical dependence. These drugs are typically administered on a tapering schedule in which the physician begins with the dosage that controls the individual’s withdrawal symptoms. Over time, they slowly cut down on the dosage at planned intervals to wean the person off the drug. This allows the person to slowly get through the detoxification process and avoid potentially dangerous or distressing withdrawal symptoms. 

Medical Detox Is Not a Cure

Many individuals are still under the false impression that getting through the withdrawal process is sufficient and essentially a cure for their addictive behavior. Nothing could be further from the truth.

In fact, simply going through detox without getting involved in a comprehensive treatment and aftercare program will inevitably result in relapse. Every major organization that researches addictive behaviors recognizes that individuals must become involved in ongoing treatment and aftercare following the medical detox process.

There is no cure for addiction, but the disorder can be successfully managed on an ongoing basis.


Sources

(2013). The ASAM Criteria: Treatment for Addictive, Substance-related, and Co-occurring Conditions. American Association of Addiction Medicine. from

(2009). Clinical guidelines for withdrawal management and treatment of drug dependence in closed settings. World Health Organization. Retrieved December 2018 from http://www.wpro.who.int/publications/docs/ClinicalGuidelines_forweb.pdf

(March 2018). The Role of the Liver in Detoxification. Enzymedica. Retrieved December 2018 from https://enzymedica.com/blogs/naturaldigestivehealth/the-role-of-the-liver-in-detoxification

(April 1993). The Psychology and Neurobiology of Addiction: An incentive–sensitization View. Addiction. Retrieved December 2018 from https://deepblue.lib.umich.edu/bitstream/handle/2027.42/30601/0000238.pdf?sequence=1

(January 2018). Types of Treatment Programs. National Institute on Drug Abuse. Retrieved December 2018 from https://www.drugabuse.gov/publications/principles-drug-addiction-treatment-research-based-guide-third-edition/drug-addiction-treatment-in-united-states/types-treatment-programs

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