To get off any substance of abuse, individuals must go through the detox process. This withdrawal process is often what makes many people fearful of quitting, but it doesn’t have to be an uncomfortable experience. With modern technology and advancements in the medical field in recent decades, detox has come a long way.
In most instances, detox requires professional help. While some people can quit certain substances cold turkey, such as marijuana, and deal with withdrawal symptoms until they subside, this isn’t the case across the board. In fact, the success rate for quitting opiates cold turkey is a dismal 5 percent, according to Wired Magazine. Certain drugs, like opiates and benzodiazepines, require a tapering process during detox.
The medical detox process isn’t the same across the board. Someone who is dependent on benzodiazepines will have an entirely different experience than someone who has been abusing alcohol or prescription opioids. The time that it takes to detox varies from one substance to the next, and from one person to the next.
It can be difficult to cut the body off from the substances that have been fueling it, even when they’re ultimately not good for the body. This is due to both physical and psychological dependency. The physical component is the reason withdrawal symptoms, like seizures, nausea, and headaches develop. As the last dose of a drug wears off, the body needs more to keep operating the way that it has been. Psychologically, addiction manipulates the mind into thinking it can’t cope without the substance. This psychological dependence motivates the individual to keep taking the substance regardless of the negative consequences such use brings.
Withdrawal symptoms lead many to relapse during the detox process. Withdrawal symptoms can be lessened if the person is tapered off the substance rather than quitting it altogether. This is the typical process for detoxing from:
- Prescription opioid pain relievers
The general population often underestimates the difficulty of quitting drug and alcohol abuse. It’s a whole lot harder than just putting the bottle down and walking away. Environmental triggers can be removed, but the factors that have influenced an addiction for so long remain after withdrawal. Cravings cause many to relapse, which 40-60 percent of people in recovery do, per NPR
Medical detox should be part of any comprehensive substance abuse treatment program. The effects of withdrawal can be scary, abrupt, and even life-threatening. At-home or DIY methods of detox are the most dangerous, especially among those who are detoxing from alcohol and at risk of developing delirium tremens, a condition that kills as many as 35 percent of people who experience it and are not treated, as reported in Discovering the Cause and the Cure for America’s Health Care Crisis. Under medical supervision, controlled doses of medications can be rendered, and side effects can be observed and treated accordingly, helping to keep detoxing individuals safe.
Currently, there is no steadfast medical treatment for withdrawal from benzodiazepines. Symptoms during detox range from flu-like symptoms and insomnia to paranoia and depressed moods.
Most cases of benzodiazepine abuse include the abuse of other substances, which can further complicate the detox process. Prescription opioid painkillers, like oxycodone and hydrocodone, are the most commonly abused alongside benzos. In 2000, 5,032 people were admitted to treatment citing abuse of both of these drugs, and by 2010, the admission rate had reached 33,701 – a 569.7 percent increase, the Substance Abuse and Mental Health Services Administration reports.
Benzodiazepine detox requires a tapering schedule. The time that this takes to complete varies from person to person. Individuals who are abusing other drugs will generally take longer to reach sobriety. Benzos calm the mind by boosting GABA levels. When the drug is removed from the equation, GABA levels often have a difficult time regulating on their own, and as a result, withdrawal ensues. Individuals who have been abusing short-acting benzos like Xanax will start experiencing withdrawal symptoms within 48 hours, while those who have been abusing long-acting benzos may not feel anything until as many as 10 days after the last dose.
Tapering schedules for benzos should be mapped out across a number of months. The initial dose should be similar to what the person has been abusing. From there, the dose should be cut down by 25 percent for every quarter of the time it will take to detox, until the medication is no longer needed at all. For example, someone who is to taper off within 12 weeks would cut the dose down by 25 percent every three weeks. In some cases, generally those where a short-acting benzo has been abused, it may be recommended that the person switch to a long-acting benzo for the purpose of tapering. This is a routine procedure in the treatment world and benefits the client by keep the amount of the drug in the bloodstream more stable.
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Another sedative hypnotic, barbiturates also work by ramping up GABA production, thereby relaxing and even shutting down certain parts of the brain. Although they aren’t abused at the rate benzodiazepines are, they are dangerous drugs. In a year’s time, they were responsible for 396 deaths in America, In the Know Zone reports.
Due to how barbiturates can heavily sedate someone, breathing assistance is sometimes required until the drug is fully removed from the body. Withdrawal symptoms, like tremors, anxiety, and hallucinations, start to set in around 8-16 hours after the last dose. The most severe symptoms, like delirium and seizures, generally present in the beginning and wane as the withdrawal progresses toward completion around day 15 for most. Often, an individual will be given phenobarbital in lieu of the abused substance and then guided in tapering off that in increments of 10 percent dose reductions every day, according to the Family Practice Notebook. Medical detox and inpatient treatment are recommended for barbiturate detox.
Opioid Maintenance Therapy
Both methadone and buprenorphine are tapering methods of detox. People who abuse heroin and prescription opioid pain relievers are given regular doses of these treatment drugs as replacements for the illicit substances they have been abusing. Around 9 percent of Americans abuse an opioid drug at some point during their lives, according to Medline Plus.
Opioid maintenance is typically the longest withdrawal period anyone who abuses drugs or alcohol can go through.
Since opioid addiction is so intense and the likelihood of relapse is so high, there is good reason to warrant a minimum of one year in treatment for opioid maintenance therapy.
Withdrawal from heroin and prescription painkillers typically sets in around 12 hours after the last use. By supplementing with buprenorphine or methadone, symptoms of diarrhea, agitation, and extreme fatigue, among others, are often eliminated entirely. The rate at which dosages are decreased is much slower, given that the detox period is so much lengthier. Thus, a decrease in the treatment drug dose is very individualized and up to the treating physician’s discretion.