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Detoxification, “detox” for short, is the process of purging the body of drugs and alcohol while trying to manage and minimize the effects of withdrawal. Detox is always conducted under medical supervision and within 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, depending on the substance being eliminated: complete and immediate cessation of use (stopping 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 of controversy.
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. And as with all detoxification, the patient is then referred to a drug treatment facility for further therapy.
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 either administering drugs that either mimic the effects of the original but are not addicting, or drugs considered less dangerous and more easily managed. Among the substances addressed in this method of detoxification are barbiturates, prescription painkillers and anti-depressants, and some opiate derivatives.
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 stage blocks the body’s opioid receptors, thereby blocking the reaction to opioids. Then, a second medication blocks the opioids themselves. The entire process takes less than 48 hours. At the conclusion, the patient is prescribed Naltrexone, a drug that blocks the opioid receptors, thereby preventing their effects. This treatment continues for one year. Rapid detox is controversial, with advocates and opposers equally divided. Because it hasn’t been in use for very long, the main objections focus on a lack of studies to determine its long-range effectiveness.
Detoxification is of little use all 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 30 or 90-day (or longer) inpatient therapy focus on those conditions and circumstances that contribute to the patient’s decision to use drugs or alcohol.