This is not meant to be discouraging, but instead focus on how crucial addiction recovery is for looking forward to your future.
Even if it is the hardest thing you will ever undertake, choosing to overcome your addiction by seeking out the treatment necessary for full recovery may also be one of the best decisions you will ever make. This guide is designed to give you the tools you need to make that decision in the first place, and to stick to it.
One of the first steps on the road to recovery is drug or alcohol detox (or detoxification), which is essentially your body working toward ridding your physiological systems from the detrimental effects of and residue from the substance. Detoxification is often considered one of the most difficult aspects of recovery, both because it is one of the first stages in recovering from alcohol or drug addiction and because it creates uncomfortable symptoms of agitation in your body and mind.
These symptoms can be difficult, though not impossible, to manage. Arguably one of the best ways to prepare for drug or alcohol detox is to learn about the process and what it entails - what the withdrawal symptoms look like, what the dangers are, what treatment is available, and what detox means for your recovery process in the long-term.
Building a healthy set of expectations for detox and withdrawal can be enormously helpful in making the symptoms of detox more manageable. Whether you struggle with issues and behaviors related to addiction to alcohol, prescription medication, opioids, heroin, cocaine or methamphetamine, detoxification will be part of your recovery process. This guide is designed to give you the knowledge and expectations necessary for successfully getting through the detox stage, withdrawal symptoms and all, enabling you to move on down the road to recovery.
The page is here to serve as your comprehensive guide to drug and alcohol detox, including the symptoms of withdrawal for each type of drug (including alcohol). With this in mind, the guide on this page addresses the following questions:
While recovery as a whole is certainly difficult, perhaps the hardest part of the recovery process is the first stage - detoxification, otherwise known just as detox. A quick Google search reveals that the term detox itself is relatively general, and can refer to anything from a body cleanse to a part of recovery from drug or alcohol addiction. So what is actually meant by detox in terms of addiction recovery, and what does detox involve?
Clearly it is more than just choosing a raw or all juice diet - that is not the kind of detoxification we talk about here. Instead, detoxification from drug or alcohol addiction is the necessary physiological process for removing toxic substances - such as alcohol or drugs - from your system.
Detox can be defined as:
For someone who has been assessed as an addict, all three of these definitions of detox are accurate. Both alcohol and drugs can have an extremely detrimental impact on your body with prolonged use. This is why detox requires the recovery from its effects, complete removal of the toxic properties, and a medical process for managing the symptoms associated with withdrawal. Since many of the symptoms, dangers and misunderstandings regarding the detox from various drugs look largely the same, this guide addresses detox and withdrawal both by individual drug type and overall signs and symptoms.
This comprehensive guide will address the detoxification process for each of the major drug types (including alcohol), but it is first necessary to establish what medical alcohol and drug detox looks like across all drugs and addictions.
"Medical detoxification safely manages the acute physical symptoms of withdrawal associated with stopping drug use. However, medical detoxification is only the first stage of addiction treatment and by itself does little to change long-term drug use. Although detoxification alone is rarely sufficient to help addicts achieve long-term abstinence, for some individuals it is a strongly indicated precursor to effective drug addiction treatment."
~ "Understanding Drug Abuse and Addiction" from the National Institute on Drug Abuse
Just as with drug detox, alcohol detox is a crucial aspect of the recovery from and management of alcoholism. While detox can be as simple (if not easy) as quitting alcohol cold turkey, medical alcohol detox is a medically supervised period of alcohol withdrawal. Medical management of this detoxification process provides a safer way of starting the move toward sobriety and complete abstinence, giving someone struggling with alcohol addiction the tools and medical attention necessary for this initial, arduous step of recovery.
Medical detoxification is often required for those who are alcohol dependent - which means not only that you have a strong desire to drink alcohol, but also that your body has become accustomed to large amounts of alcohol. With this level of alcoholism, you can start feeling withdrawal symptoms just a few hours after your last drink. As a response and management strategy for these symptoms, alcoholics tend to drink more, worsening the condition.
This is where medical alcohol detox comes in. The medical approach to detox involves careful monitoring and management of withdrawal symptoms, intervening when necessary. As a report from medical doctors Hugh Myrick and Raymond F. Anton states, "Appropriate treatment of alcohol withdrawal can relieve the patients discomfort, prevent the development of more serious symptoms, and forestall cumulative effects that might worsen future withdrawals." More than that, the doctors note that "Hospital admission provides the safest setting from the treatment of alcohol withdrawal, although many patients with mild to moderate symptoms can be treated successfully on an outpatient basis."
In this way, medical detoxification can take place in a variety of environments, including hospitals, medical clinics, residential rehab programs, and intensive outpatient treatment programs.
Just as with alcohol detox, medical drug detox is the first, physical step toward whole treatment for drug addiction. It is important to know that addiction is not only physical, but psychological, which means that those struggling with addiction should follow up on detoxification with other psychological and therapeutic treatment options. However, medical drug detox is the first thing that those with drug addictions must undergo on their road to recovery.
According to Medline Plus, medical drug detoxification is "the withdrawal of the substance abruptly in an environment where there is good support. Detoxification can be done on an inpatient or outpatient basis." The description may sound simple enough, but medical drug detox is associated with physical, emotional and mental symptoms of withdrawal, which can make drug detox an overwhelming experience for many. Again, this is why detox as a medical process is so important - having a monitoring physician or nurse is crucial to ensure that the withdrawal symptoms do not become too severe.
The specific withdrawal symptoms for each kind of drug is covered below; for now, there are three main takeaway points for medical detox:
1) Medical detoxification is often preferable (and sometimes indispensable) to simply quitting alcohol or drug use without supervision.
2) Medical detoxification is just one, physical step toward recovery, and does not represent whole recovery.
3) Medical detoxification can take place in a variety of settings, but no matter the environment involves uncomfortable and even painful physical and psychological symptoms of withdrawal.
As mentioned above, one of the key insights from this guide is that while detoxification is a necessary and difficult part of addiction recovery and treatment, it is not tantamount nor does it guarantee long-term success in recovery. Again, this is not meant to be discouraging but instead set realistic expectations for what detox is, what is involved in it, and what it does for addiction recovery as a whole. Another way to set these expectations is to learn the specific symptoms, dangers, and available treatment options for detoxification from specific types of drugs.
Addictive substances can be broken down into five specific types of drugs:
While there are more specific drugs within these categories (such as over-the-count drugs, steroids, and hallucinogens) as well as more generalized categorizations (such as depressants and stimulants) overall these five categories cover the majority of addictive drugs, including alcohol. If you struggle with addiction to a specific kind of drug, you can find the symptoms of withdrawal, the dangers of detox, the types of treatment available, and what you should know regarding detoxification from that drug.
The guide is designed to be a starting point for those looking to understand the withdrawal symptoms of detoxification from addiction. If you would like to find out more about any specific drug, you can find more information from government resources like the National Institute on Alcohol Abuse and Alcoholism, the National Institute on Drug Abuse, the Substance Abuse and Mental Health Services Administration, and the U.S. Department of Health and Human Services.
"Detoxification is a set of interventions aimed at managing acute intoxication and withdrawal. It denotes a clearing of toxins from the body of the patient who is acutely intoxicated and/or dependent on substances of abuse. Detoxification seeks to minimize the physical harm caused by the abuse of substances."
~ "Detoxification and Substance Abuse Treatment", U.S. Department of Health and Human Services
Alcohol acts just like any other drug in the way it debilitates motor function and cognitive ability. These impairments are only amplified when alcohol is abused, leading to lasting physical damage and cognitive impairments. When abused over a long period of time, alcohol can be extremely difficult to give up since the body learns to adapt to the dependence to the substance. Withdrawal symptoms from alcohol begin once you have dependence on alcohol, which can be identified by the following symptoms:
Because of these precursors, many professionals note that the more regularly you drink, the more likely it is that you will experience withdrawal symptoms when you stop drinking altogether. It can be difficult to know if you are dependent on alcohol until you start experiencing these withdrawal symptoms.
Medline Plus notes that "alcohol withdrawal symptoms usually occur within 8 hours after the last drink, but can occur days later. Symptoms usually peak by 24 to 72 hours, but may go on for weeks." The same page also identifies eighteen common symptoms of withdrawal from alcohol addiction:
More extreme symptoms, caused by a severe form of alcohol withdrawal known as delirium tremens, include agitation, confusion, decreased attention span, deep sleep, delirium, fear and even hallucinations. As Medline Plus goes on to note: "Delirium tremens can occur when you stop drinking alcohol after a period of heavy drinking, especially if you do not eat enough food. It is most common in people who have a history of alcohol withdrawal." This form of withdrawal is especially common for those who drink a substantial amount of alcohol for several months (such as one pint of hard alcohol every day) or for those who have abused alcohol for more than a decade.
Clearly, the symptoms of withdrawal from alcohol can range from mild to quite severe. The danger of withdrawal caused by alcohol detoxification lies in these more severe symptoms. Also known as acute alcohol withdrawal, this complication in detox can cause significant illness and even death if not properly managed.
This is when physicians consider using medication to manage the severity of these withdrawal symptoms, and supports the use of medical detox from alcohol rather than simply quitting cold turkey. One report from the NIAAA, appropriately called "Introduction to Alcohol Withdrawal" summarizes the symptoms as well as the dangers of alcohol withdrawal:
"Heavy drinkers who suddenly decrease their alcohol consumption or abstain completely may experience alcohol withdrawal. Signs and symptoms of alcohol withdrawal can include, among others, mild to moderate tremors, irritability, anxiety, or agitation. The most severe manifestations of withdrawal include hallucinations and seizures. These manifestations result from alcohol-induced imbalances in the brain chemistry that cause excessive neuronal activity if the alcohol is withheld. Management of alcohol withdrawal includes thorough assessment of the severity of the patients symptoms and of any complicating conditions as well as treatment of the withdrawal symptoms with pharmacological and nonpharmacological approaches. Recognition and treatment of withdrawal can represent a first step in the patients recovery process."
~ Richard Saitz, M.D.
As mentioned above, alcohol detox can take place either in a residential rehabilitation facility (inpatient program) or an intensive outpatient treatment program. Where alcohol detox takes place depends on the severity of the withdrawal. If you have experienced withdrawal before, or have sustained alcohol abuse for a significant amount of time, the best option may be to attend an inpatient rehabilitation program, or at the very least undergo detoxification in a medical facility. The withdrawal symptoms in these cases may be severe enough to require medical attention, and it is always better to play it safe in this regard. If you do not expect the severe symptoms described above, committing to either an outpatient program or at the very least a support group will be beneficial for the detox, as well as the rehabilitation process as a whole.
In extreme cases, some medications are available for alcohol detox. These include prescription drugs such as diazepam, chloridiazepoxide, lorazepam, and oxazepam. These do not decrease alcohol dependence, but instead mitigate the symptoms of withdrawal for the duration of detoxification: "Such medications can help control the shakiness, anxiety, and confusion associated with alcohol withdrawal and reduce the risk of withdrawal seizures and DTs." Because these are prescribed medication, undergoing medical detox can be the best option for recovery from extreme cases of alcohol dependence.
A specific form of opiate, heroin is a synthesized form of morphine, which occurs naturally from the Asian opium poppy plan. Heroin usually takes the form of a white or brown powder, or as a black substance known as black tar heroin. Despite its adaptation from the medically accepted pain reliever morphine, heroin represents a significant danger to those taking it, since the drug is often cut with either other drugs or substances. Because of the strength and quantity of the drug is unknown, heroin poses a significant threat of overdose and relatively severe symptoms of withdrawal in the detoxification stage.
Just as with any drug, continued use of heroin changes the entire physical structure of the brain, which creates an imbalance in the neuronal and hormonal systems of the body's physiology. This essentially means long-term imbalances in the chemical makeup of the brain, which are not easily reversed. The long-term effects of continued heroin use include the following:
Clearly, addiction to heroin is associated not only with detrimental effects in the short-term, but also potent addictive powers in the long-term. Centers for Disease Control report that heroin use more than doubled among young adults ages 18-25 from 2002-2013, that more than ninety percent of people who use heroin also use at least one other drug, and close to half of people who use heroin are also addicted to prescription opioid painkillers. There is no question, then, that heroin is a highly addictive drug that can result in overdose, powerful withdrawal symptoms, and the use of other drugs and alcohol.
Because of its highly addictive nature, detoxification from heroin can be a difficult process and involves many withdrawal symptoms over the course of several days. That said, detoxification from heroin use is not the same for everyone struggling with addiction. The severity of the withdrawal symptoms from heroin depend on how long the drug has been used, to what degree it was abused, and what amount was taken. The withdrawal symptoms of heroin include:
More severe symptoms of withdrawal from heroin addiction include vomiting, anxiety, rapid heart rate, hypertension, difficulty in feeling pleasure, impaired respiration, insomnia and muscle spasms.
"Symptoms of withdrawal include restlessness, muscle and bone pain, insomnia, diarrhea, vomiting, cold flashes with goose bumps, and leg movements. Major withdrawal symptoms peak between 24-48 hours after the last dose of heroin and subside after about a week. However, some people have shown persistent withdrawal signs for many months."
~ "What are the long-term effects of heroin use?" National Institute on Drug Abuse
Withdrawal from heroin is usually associated with more severe symptoms than that of alcohol withdrawal, and therefore requires medical detox in nearly every case. Without medical support through the detoxification process, it can be unbearable to experience the withdrawal symptoms of heroin detox. In fact, heroin withdrawal can even be fatal to a fetus, which is why pregnant women looking to sobriety and recovery keep up a dose of methadone in order to prevent heroin withdrawal symptoms. But what are the treatment and support options for detox from heroin?
Managing the withdrawal symptoms from heroin addiction involve both behavior therapies and pharmacological interventions - or, in other words, medications designed to help patients stop using heroin altogether and return to stable and productive lives. Behavioral therapy can be delivered in both outpatient and inpatient settings. More specifically, cognitive-behavioral therapy has been shown by the National Institute on Drug Abuse to help "modify the patients expectations and behaviors related to drug use and to increase skills in coping with various life stressors."
In addition to the therapeutic approaches to treatment in heroin detox, effective medication for managing withdrawal symptoms include methadone, buprenorphine, and maltrexone. All three of these medications are prescribed, and therefore require medical detox involving physician intervention.
Even if heroin is highly addictive, it does not represent the same problem in the United States as opiates in the form of prescription medication. Just two years ago, less than half a million people used heroin in the United States, while just over four million people took narcotic pain relievers not prescribed to them. This means people are more than eight times more likely to abuse prescription medication than they are to even take heroin or other illegal substances. These narcotic pain relievers include the following medications:
Addiction to these prescription medications is just as real as any other form of opioid addiction. For both painkillers and antidepressant medication, the use of the drugs often transcend the prescribed use: "The medications may provide relief for symptoms in the short term, but they do not cure anxiety or depression, and there may be underlying causes of depression and anxiety to explore."
Because of this slow growth of dependency, detox from prescription drugs can be associated with many of the same withdrawal symptoms as other drugs. The withdrawal symptoms for prescription drugs include the following:
Given these symptoms of withdrawal, the dangers of detox for prescription drugs are largely the same as for other forms of drugs. More specifically, those looking to overcome addiction to prescription opioids or benzodiazepines face the possibility of acute withdrawal, which is "the initial emergence of symptoms after suddenly discontinuing the use of a substance. These symptoms tend to be opposite of the effects of the substance." Acute withdrawal symptoms may develop into protracted withdrawal symptoms, which require medical intervention in order to avoid the severe effects of withdrawal from prescription medications.
"For someone with an established narcotic addiction, a list of symptoms doesn't capture the agony of opioid withdrawal. The syndrome is intensely unpleasant, and people will do almost anything to avoid it. Opioid withdrawal lasts from hours to several days - and sometimes weeks - depending on how long and how much a person has used their drug of choice. After the intense initial symptoms subside, some physical and mental discomfort may persist for weeks."
Just as with other forms of drug addiction, overcoming addiction to prescription medication often requires medical detox from the opioid, sedative, or anti-anxiety medication. As the Mayo Clinic states, "Withdrawal can be dangerous and should e done under a doctors care." This is the role of medical detox for prescription medication withdrawal.
Medical detox from prescription medication requires the gradual decrease of the dose of medication to the point where it is no longer used at all. In some cases, other forms of medications can be used to manage more extreme severe withdrawal symptoms. This is why medical detox, and even medically assisted treatment, can be so beneficial for recovery from addiction to prescription opioids and other forms of medication.
"Addiction to prescription opioids can be treated with medications including buprenorphine, methadone, and naltrexone. These drugs can counter the effects of opioids on the brain or relieve withdrawal symptoms and cravings, helping the patient avoid relapse. Medications for the treatment of addiction are administered in combination with psychosocial supports or behavioral treatments, known as medication-assisted treatment."
~ "How can prescription drug addiction be treated?", National Institute on Drug Abuse
Cocaine addiction is a health issue that ties in closely with other forms of drug addiction and substance abuse. In 2013, cocaine accounted for just over five percent of admissions to drug abuse treatment programs - however, as the National Institute on Drug Abuse reports, more than two thirds of those who seek treatment for cocaine use more than just one substance. Because of this polydrug association, cocaine addiction is associated with significant withdrawal symptoms once discontinued, and the signs of addiction are quite clear.
"Cocaine withdrawal occurs when someone who has used a lot of cocaine cuts down or quits taking the drug. Symptoms of withdrawal can occur even if the user is not completely off cocaine and still has some of the drug in their blood. When cocaine is stopped or when a binge ends, a crash follows almost immediately. The cocaine user has a strong craving for more cocaine during a crash."
~ U.S. National Library of Medicine
Unlike withdrawal from alcohol, heroin and other opiates, withdrawal symptoms from cocaine rarely include physical manifestations, such as vomiting and shaking. That said, the symptoms of withdrawal from cocaine should not be underestimated, since the internal withdrawal symptoms can be just as strong as or even stronger than those of other substances. Symptoms of withdrawal from cocaine involve the following:
As mentioned above, these withdrawal symptoms may have a much more detrimental internal impact than can be seen from the outside. This is where the danger of detox from cocaine lies. For instance, the craving for cocaine and depression associated with detox from the drug can last for weeks and months after discontinuing cocaine use. Because of the long-term effects of withdrawal, the symptoms are sometimes associated with thoughts of suicide in some individuals. The all time high offered by cocaine is directly contrasted by the all time low seen in withdrawal and detoxification from the drug.
Just as with other drug detox processes, withdrawal from cocaine can be managed according to both behavioral therapy and pharmacological approaches. For a pharmacological approach, it is crucial that the medications used to mitigate withdrawal symptoms for cocaine are not simply replacement substances (such as alcohol, sedatives, or anti-anxiety medications). Instead, it is crucial that prescription drug use in response to cocaine withdrawal is "monitored carefully in patients who abuse substances."
Behavioral approaches and interventions are the primary way cocaine withdrawal symptoms can be managed, and have proven effective in both inpatient and outpatient program environments. For instance, cognitive-behavioral therapy has proven to be an effective approach for preventing relapse, giving clients the tools they need to recognize where cocaine use is likely, avoid these environments, and cope more holistically with the effects of the addiction. Altogether, it is the integration of both pharmacological and behavioral approaches that have proven most effective in recovery from cocaine addiction, including the management of withdrawal symptoms.
"Research indicates that people who are committed to abstinence, engage in self-help behaviors, and believe that they have the ability to refrain from using cocaine (self-efficacy) are more likely to abstain. Aftercare serves to reinforce these traits and address problems that may increase vulnerability to relapse, including depression and declining self-efficacy."
~ "How is cocaine addiction treated?", The National Institute on Drug Abuse
Sustained methamphetamine use results in many detrimental consequences, not the least of which is addiction itself. Because methamphetamine users develop a tolerance to the pleasurable effects of the drug over the course of supposedly casual use, abusers of the drug more often than not need higher or more frequent does of meth in order to sustain the desired pleasurable effect. This continued and increasing use of the drug is what feeds addiction, what makes the long-term effects of the drug so detrimental, and what makes withdrawal from methamphetamine much more difficult. Long-term effects of methamphetamine include a lack of feeling, increased anxiety and confusion, insomnia, mood swings, and even violent behavior.
The withdrawal symptoms from addiction to methamphetamine include the following:
"The consequences of methamphetamine abuse are terrible for the individual - psychologically, medically, and socially. Abusing the drug can cause memory loss, aggression, psychotic behavior, damage to the cardiovascular system, malnutrition, and severe dental problems. Methamphetamine abuse has also been shown to contribute to increased transmission of infectious diseases, such as hepatitis and HIV/AIDS."
~ "What Is Methamphetamine?", National institute on Drug Abuse
The main danger in withdrawal from methamphetamine (such as crystal meth) is psychological. Because sustained use of the drug can create unparalleled dependence, quitting methamphetamine cold turkey can almost immediately result in depression and even suicidal thoughts. Coming off of the drug often results in feelings of anxiety and social isolation, which only feeds the likelihood of relapse in recovery. Because of the dangers associated with withdrawal from methamphetamine, it is important to consider a combined treatment option.
Managing withdrawal from methamphetamine often requires medical detox. There are currently no medications that block the effects of amphetamines, but treatment programs often utilize behavior change techniques, designed for giving a healthy understanding of the drug, its addictive powers, and the effect it has on daily life. More specifically, the most effective behavioral treatment for methamphetamine addiction has been shown to be cognitive-behavioral and contingency-management interventions.
This treatment approach can be accomplished either in an intensive outpatient treatment program, or a residential rehab center where health and safety can be monitored on a daily basis. Both of these settings give clients the opportunity to not only make it through the initial detox phase, but overcome their addiction altogether by helping them understand their behaviors and why they use amphetamines.
If you are ready to take the first step toward recovery from your addiction, do not hesitate to reach out to us. We can help you find the best drug and alcohol rehab for your needs and get you the help you need. You do not have to go through detox and withdrawal alone. You can find our contact information here.
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