Dependency detox

Medical detox: why you need it and what to expect

Withdrawal symptoms can be severe for certain drugs and alcohol, even life-threatening. If you have developed a dependence on a substance, you may need to go through a detoxification process under medical supervision before entering an addiction treatment programme. Here are answers to common questions about medical detox so you have a better understanding of the process and what to expect. South Africa is home to a burgeoning population of recovering addicts, counsellors, and specialists, making it an excellent setting for drug rehabilitation centres. Get in touch with us for more information on our South Africa treatment centre.

Medical detox: why you need it and what to expect

What is medical detox?

Medical detoxification – or detox – involves treatment under medical supervision to help you safely withdraw from drugs or alcohol. Medical detox is done in a clinical environment under the supervision of an addiction care team. If required, medicine is used to help alleviate painful or uncomfortable symptoms while your body gets rid of the substance. Medical detox is the first step in treating substance use disorder and should be followed by inpatient or outpatient psychotherapy to continue the healing processes.

Why do you need medical detox?

If you have developed substance use disorder – an addiction – from heavy and long-term use of drugs or alcohol, quitting ‘cold turkey’ is extremely hard and dangerous. Cold turkey is a term used when someone stops using drugs or alcohol too quickly. Drug and alcohol withdrawal symptoms range from mild flu-like symptoms to severe sweating, hallucinations and seizures. Acute withdrawal symptoms can cause a variety of medical complications that are life-threatening, even fatal. For this reason, drug and alcohol withdrawal should be managed under medical supervision in a clinical environment.

What are the dangers of alcohol withdrawal?

Acute alcohol withdrawal is associated with certain medical complications that are life-threatening.

Delirium tremens

Delirium tremens is commonly known as the DTs and is a severe form of alcohol withdrawal. Delirium tremens occurs when you stop drinking alcohol after a period of heavy drinking, especially if you don’t eat proper food during that time. DTs may also be caused by a head injury, infection or illness if you have a history of alcohol abuse.

DTs involve sudden and severe changes to the nervous system and brain. Symptoms occur 48 to 96 hours after your last drink but they may only appear 7 to 10 days later. Delirium tremens can be life-threatening, even fatal.

  • body tremors
  • changes in mental function
  • agitation or irritability
  • confusion or disorientation
  • decreased attention span
  • deep sleep that lasts for several days
  • delirium
  • excitement
  • fear
  • hallucinations
  • increased activity
  • quick mood changes
  • restlessness
  • sensitivity to light, sound or touch
  • sleepiness or fatigue
  • seizures

Dehydration

Dehydration is a common and life-threatening side effect of alcohol withdrawal. It can cause dangerous electrolyte imbalance in your body that can result in the following symptoms:

  • nausea
  • diarrhoea
  • mental confusion
  • depression
  • anxiety
  • disruptions to your central nervous system
  • hallucinations
  • seizures

Thiamine deficiency

According to the National Institute of Alcohol Abuse and Alcoholism (NIAAA), up to 80 percent of people living with alcohol addiction suffer from a thiamine deficiency. This deficiency can cause an individual to develop Wernicke’s encephalopathy, a disorder that can lead to significant mental confusion, loss of eye movement control and poor motor coordination.

Wernicke’s encephalopathy develops into the debilitating Korsakoff syndrome about 80 percent of the time, and this syndrome requires specialised medical treatment.

What are the dangers of drug withdrawal?

Quitting certain drugs suddenly and abruptly can result in acute withdrawal symptoms. In some cases, sudden withdrawal from high-risk drugs such as opioids and benzo can be life-threatening. Going ‘cold turkey’ is dangerous because of the way your nervous system adapts to its dependence on the drug.

The risk associated with drug withdrawal depends on the type of drug and the severity of the addiction. Common symptoms of withdrawal

Benzos (Benzodiazepines)

Medical detox is recommended for benzo withdrawal because withdrawal symptoms can be painful, uncomfortable and even life-threatening. The risk of grand mal seizures from benzo withdrawal is higher than with other drugs and alcohol withdrawal. Withdrawal seizures are life-threatening.

Benzo withdrawal can also cause significant psychological symptoms that can lead to suicidal thoughts or attempts. According to Psychiatric Annals, the psychological symptoms of benzo withdrawals can take up to two years to settle down.

Physical symptoms of benzo withdrawal symptoms include:

  • double or blurry vision
  • headache
  • nausea and vomiting
  • diarrhoea
  • body pain
  • restlessness
  • sweating
  • disorientation
  • dizziness
  • dry mouth
  • fever or chills
  • reduced muscular control
  • shortness of breath
  • hallucinations
  • seizures

The psychological symptoms of benzo withdrawal include:

  • depression
  • anxiety
  • panic attacks
  • irritability
  • confusion
  • disconnection from reality

Opioids

Opioid withdrawal is extremely unpleasant but the symptoms are not typically life-threatening. However, don’t underestimate the risk of opioid withdrawal because people have died from the side effects of symptoms, such as severe dehydration, hypernatraemia (elevated blood sodium level) and heart failure.

Medical detox is recommended for opioid withdrawal because it not only helps to manage painful and uncomfortable symptoms, it also reduces the risk of fatal complications.

Common physical symptoms of opioid withdrawal include:

  • muscle aches
  • tearing and dilated pupils
  • runny nose
  • persistent vomiting and diarrhoea
  • excessive sweating
  • insomnia
  • yawning
  • goosebumps
  • rapid heartbeat and high blood pressure
  • dysphoria
  • pupillary dilation
  • piloerection
  • lacrimation
  • rhinorrhea

Common psychological symptoms of opioid withdrawal include:

  • irritability
  • anxiety
  • depression
  • insomnia

Stimulants

Stimulant withdrawal is not life-threatening but can be extremely unpleasant, depending on the type of stimulant drug and the length of time the drug has been abused.

What is a concern is the psychological withdrawal from stimulants. Symptoms can be severe, including suicidal thoughts or attempts and violence. If you have an addiction to a stimulant drug, you need to seek professional medical help to stop using stimulant drugs and avoid a relapse.

Common symptoms of stimulant withdrawal include:

  • depression
  • anxiety
  • disrupted sleep patterns
  • overeating or loss of appetite
  • brain fog
  • poor movement control
  • clammy and pale skin

Cannabis/marijuana

People often underestimate cannabis withdrawal and try to stop on their own. Yes, it’s true that marijuana withdrawal is not life-threatening but it can cause mood and behavioural symptoms that need to be monitored by an addiction care specialist.

The severity of marijuana withdrawal symptoms depends on your tolerance to marijuana, the amount you’ve been using and how long you’ve been using the drug. Long-term marijuana use can cause cannabis withdrawal syndrome (CWS) and result in intense cravings and relapse.

Common symptoms of cannabis/marijuana withdrawal include:

  • insomnia
  • fatigue
  • loss of appetite
  • headache
  • body pain
  • hypertension
  • depression
  • anxiety
  • nausea and vomiting
  • night sweats
  • nightmares
Medical detox: why you need it and what to expect
Medical detox: why you need it and what to expect
Medical detox: why you need it and what to expect

What medication is used for drug and alcohol detox?

Medication is usually prescribed in the acute withdrawal phase to help you cope with debilitating and frightening symptoms as well as decrease cravings for the substance. This phase of medical detox is overseen by a medical professional who specialises in addiction treatment and is done in a hospital or addiction clinic.

Medication that is commonly used during detox includes:

Methadone

Methadone is a synthetic, narcotic analgesic that is used in opioid addiction treatment. It is most effective for treating heroin withdrawal and cravings. Methadone shares the same chemical characteristics as morphine but the drug action is gradual. This means you don’t get as intoxicated or high.

Methadone can be extremely addictive and the risk is you may swop one addiction for another. You will be monitored carefully during medical detox and the drug will be reduced gradually to prevent tolerance to methadone from developing.

Naltrexone

Naltrexone is used for the treatment of opioid and alcohol use disorders. It is a long-acting opioid blocking agent and is highly effective at preventing opioid withdrawal symptoms. For alcohol use disorder, it helps to block feelings of euphoria. If you are on naltrexone and attempt to use opioids or alcohol, you won’t feel the same effect of the substance. Naltrexone also reduces cravings for opioids and alcohol.

Vivitrol

Vivitrol is an injectable form of naltrexone and a single injection can last for one month. The oral form of naltrexone can be taken daily but the injection is far more effective in treating symptoms of opioid and alcohol withdrawal and reducing cravings.

Buprenorphine

Buprenorphine shares similar characteristics to morphine but the main difference is buprenorphine is a partial opioid antagonist. This means the drug is much weaker than a full agonist opioid and the potential for abuse and addiction is less than methadone.

Buprenorphine works the same way as methadone by taking up space in the opioids receptors to decrease the withdrawal symptoms. The drug blocks the euphoric effects of opioids for up to 24 hours. There is a risk that you can become dependent on buprenorphine which is why the drug needs to be closely monitored when used as part of an addiction treatment programme. The goal is to taper off the use of buprenorphine gradually.

Suboxone

Suboxone is used as an alternative to methadone for the treatment of opioid use disorder. The active ingredient in suboxone – buprenorphine – is a partial activator of the opioid receptor and it carries less risk of addiction and overdose compared to methadone.

Sublocade

Sublocade is a new addition to the treatment of opioid and alcohol use disorder. It is a long-acting injectable form of buprenorphine and has a lower risk of addiction compared to methadone. Sublocade is only administered if you have received a stable dose of the transmucosal form of Suboxone for a minimum of seven days.

What happens after medical detox?

Medical detox is not a ‘cure’ for an addiction. It’s the first step in an integrated addiction treatment programme to help you purge drugs or alcohol out of your system in a safe and controlled manner.
For long-term recovery and to avoid relapse, medical detox should be followed by inpatient or outpatient psychotherapy, a nutrition and exercise plan, and an aftercare programme.

Relapse is common after a drug or alcohol treatment programme because addiction is a complex brain disease, and it changes how your brain works. Relapse after medical detox can be deadly if you start again with the same amount of the substance you took before you went to the hospital for treatment. Drug or alcohol overdose is a real threat and can be fatal.

Continued treatment after medical detox involves:
Counselling and psychotherapy. Talk therapy is used as part of an inpatient or outpatient treatment programme to help you define your social, emotional and environmental triggers and provide you with tools to avoid relapse and destructive behaviour once you complete the addiction treatment programme.

Medical detox: why you need it and what to expect

Nutrition and exercise plan

A healthy diet and regular exercise helps heal the mind, body and soul. Good nutrition and exercise helps to improve the tone and condition of your body, promotes heart and lung health, reduces stress, and improves your overall well-being.

Medical detox: why you need it and what to expect

Aftercare support

Aftercare support is vital to prevent you from relapsing when you go back to your daily life and routine. Before you complete your addiction treatment programme, your counsellor will draw up an aftercare plan for you. The goal of an aftercare programme is to support you in your early recovery, prevent relapse and help you work towards your life goals.

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