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Detoxification
Detoxification, or detox, is the process of purging the body of drugs and alcohol, while trying to manage and minimize the effects of withdrawal. It is always conducted under medical supervision, in a hospital setting. As abstinence is the first step in any drug and alcohol rehabilitation program, detoxification must take place before any further treatment plan can be implemented.
Methods of detoxification
Detoxification takes place one of three ways, complete and immediate cessation of use (cold turkey), gradual detoxification, or rapid detoxification. The first two processes are the long-standing methods of detox, and have the greatest amount of research and data regarding their efficacy. The third, rapid detox, is in its infancy as a treatment procedure, and has found itself the subject to controversy. The procedure prescribed for any patient depends on the substance being eliminated.
Cessation
Cold turkey detoxification is recommended for patients who do not face life-threatening consequences from stopping use of the drug in question, most commonly alcohol, amphetamines, and some opiates. While the patient will experience withdrawal, and the symptoms may be intense and painful, the physical consequences are not fatal. The patient is closely monitored and cared for during the process. As with all detoxification, the patient is then referred to a drug treatment facility for further therapy.
Gradual Detoxification
When the consequences of withdrawal can result in the death of the patient, immediate cessation is not feasible, and a gradual withdrawal procedure is recommended. Gradual withdrawal involves one of two procedures. In one, the amount of the drug is slowly reduced until the physical cravings have been eliminated, and the patient is not in danger. In the other, detoxification is accomplished by administering drugs that mimic the effects of the original but are not addicting, or by replacing the original with another drug that is considered less dangerous and more easily managed. Among the substances that are addressed in this method of detoxification are barbiturates, prescription painkillers and anti-depressants, and some opiate derivatives.
Rapid Detoxification
Rapid detoxification is administered to certain individuals with an addiction to various opiates. In the procedure, the individual is administered medication in two stages. The first blocks the bodies opioid receptors, thereby blocking the reaction to opioids. The second medication blocks the opioids themselves. The entire process takes less than forty-eight hours. At the conclusion, the patient is prescribed naltrexone, which blocks the opioid receptors thereby preventing their effects. This treatment continues for one year.
This treatment has its controversy, with advocates and detractors equally divided. Because it has not been in use for very long, the main objections focus on a lack of studies to determine its long-range effectiveness.
Detox follow-up
Detoxification is of little use by itself. Since it addresses only the physical presence of the substance in the body, and is not concerned with circumstances or conditions that contribute to abuse, relapse is probable unless an effective addiction program is implemented. Drug and alcohol treatment programs, ranging from outpatient therapy, to thirty- or ninety-day (or longer) inpatient therapy, focus on those conditions and circumstances that contribute to the patient’s decision to use drugs or alcohol.