You’ve probably heard this term on multiple occasions but are still wondering what medical detox is. The term medical detox refers to the process of removing alcohol or drugs from the body. Medical detox relies on certain pharmacotherapies that work to alleviate withdrawal syndrome.
The alcohol or drug withdrawal syndrome is a cluster of symptoms a person experiences when they stop taking the substance. These withdrawal symptoms range in intensity from mild and moderate to severe. Since medical detox is the first step in addiction recovery, it’s important to focus on all its aspects, and that’s exactly what we’re going to do below.
Quitting Cold Turkey
The term “quit cold turkey” is a practice where a person stops taking alcohol or drugs all at once rather than gradually reducing the use. This approach is the fastest way to overcome dependence or addiction. However, various withdrawal symptoms may occur, and it can be difficult to handle them when a person is doing it on their own.
This often results in a relapse. Although a common belief is that relapse is the end of the recovery process – it is not. With proper approach and support, a person can stay on the right track and continue their journey toward sobriety.
Support matters a lot in recovery from addiction, even when you’re trying to quit cold turkey. For example, only 3 to 5% of people who quit smoking cold turkey stay off cigarettes long-term. This goes to show that a strong support system comprised of family, friends, and professionals at a treatment center works best for successful treatment.
Factors That Influence Withdrawal Symptoms
Addiction to alcohol and other substances has a major impact on the body, especially a person’s brain. Cessation of substance abuse marks the beginning of a medical detox process.
As the body faces a major change (no more stimulation from the substance), withdrawal symptoms occur. These symptoms range in intensity from mild to moderate and severe.
Every person is different, and they experience withdrawal differently. That happens because several factors determine the intensity of symptoms a person can experience. These factors include:
- Length of use – withdrawal symptoms are less intense and go away faster in people who abuse a certain substance for a shorter period of time. On the flip side, people who abuse a substance for a long time tend to have longer, more serious symptoms.
- Quantity of substance abused – the amount of alcohol or drug ingested also determines the duration and intensity of withdrawal symptoms. Men and women who abuse large amounts of a certain substance experience more intense withdrawal symptoms compared to their counterparts who take lower doses.
- Environment – environmental factors can intensify cravings for a certain substance. These factors include relationship problems, hanging out with people who use drugs or alcohol, work troubles, and other issues that increase stress, anxiety, and depression. In other words, a person’s overall environment and quality of life may influence the severity of symptoms of withdrawal.
- Other mental health or medical illnesses – withdrawal from drugs or alcohol can be more complex in persons who suffer from co-occurring conditions such as cardiovascular diseases, anxiety, depression, personality disorders, and eating disorders.
- Dependence on other substances – it’s not uncommon for people to use two or more drugs or substances at a time. In that situation, they may experience withdrawal symptoms associated with both drugs. As a result, symptoms can be more intense and may last longer.
- Type of substance – some substances stay in the body longer than others. The withdrawal process and timeline aren’t the same for every substance, as you’re going to see below.
Alcohol Use Disorder Withdrawal Symptoms
Long-term consumption of alcohol wreaks havoc on our health. Alcohol consumption is an important risk factor for illness, disability, and mortality. Some of these health problems include:
- Degeneration of nervous system
- Alcoholic fatty liver disease
- Cirrhosis of liver
- Infectious diseases
- Neuropsychiatric diseases
- Cardiovascular disease
- Unintentional and intentional injury
When a person with alcohol use disorder suddenly stops drinking, withdrawal symptoms may occur. You see, for most people, alcohol is a “tool” to relax and decrease anxiety. Alcohol provides these effects by amplifying the effects of GABA neurotransmitter, which regulates feelings of calm and euphoria.
Additionally, alcohol lowers glutamate, which creates excitability. Heavy drinking makes it more difficult to increase GABA and decrease glutamate. As a result, a person needs to drink more to achieve the same outcome. Gradually, dependence and addiction develop.
Alcohol use disorder is a serious problem that requires adequate treatment at the best medical detox for alcoholism in Texas.
Sudden cessation of alcohol drinking means you are no longer impacting these two neurotransmitters. That being said, the body still continues to produce glutamate while under-producing GABA. As a result, you experience withdrawal symptoms. We can divide alcohol addiction-related withdrawal symptoms into several categories, as presented in the table below.
Persons with alcohol dependence may also experience the following withdrawal symptoms:
- Difficulty sleeping
- Loss of appetite
- Pale skin
- Extreme confusion
How long does medical detox for alcoholism last, you wonder? The exact timeline for alcohol withdrawal symptoms may vary from one person to another due to the factors mentioned above in this post. But generally, it looks like this:
- 6-12 hours after the last drink: mild symptoms of withdrawal occur, such as headache, mild anxiety, insomnia, mild tremors, and stomach upset
- 24 hours after the last drink: visual, auditory, and tactile hallucinations
- 24-72 hours after the last drink: many symptoms peak or resolve. Seizures may appear in 24 -48 hours after the last drink, while delirium tremens in 48-72 hours
Delirium tremens is a severe and potentially fatal presentation of alcohol withdrawal. It may include serious symptoms such as:
- Delirium (severe confusion)
- Body tremors
- Sudden mood changes
- Heightened fear and/or excitement
Opioid Use Disorder Withdrawal Symptoms
Opioids, also referred to as narcotics, are medications doctors prescribe to treat severe and persistent pain. The misuse and dependence on these drugs pave the way to addiction. Some of the most common opioids include pain relievers such as fentanyl, hydrocodone, oxycodone, and tramadol. Additionally, the illegal drug heroin is also an opioid.
Opioids have a number of side effects, including drowsiness, mental fog, constipation, nausea, slowed breathing, and a high risk of overdose.
Medical detox and withdrawal from opioids are not pleasant, but in most cases, it is not life-threatening. As opioids leave the body, the system withdrawal symptoms may ensue. These symptoms depend on the factors described above in this post. Your overall health, the severity of the addiction, and a type of substance matter a lot in severity and duration of withdrawal syndrome.
In the early stages of withdrawal, a person may experience symptoms such as:
- Excessive sweating
- Body aches
- Muscle pain
- Trouble sleeping (insomnia)
- Restless legs
- Eyes tearing (lacrimation)
Later stages of withdrawal may induce the following symptoms:
- Stomach pain
- Abdominal cramping
- Dilated pupils
- High blood pressure
- Rapid heart rate
The timeline for onset and duration of withdrawal symptoms in opioid dependence detox varies based on the type of drug. Check the table below to learn more, or you can get informed if you contact medical detox for opioid addiction near me.
IMPORTANT: Although not opioids, it’s worth mentioning benzodiazepines (e.g., Xanax, Valium), which are tranquilizers, and may also be addictive. Withdrawal symptoms in benzos detox begin within one to four days of the last dose and peak in severity in the first two weeks.
Cocaine and Other Stimulants Withdrawal Symptoms
Cocaine is a highly addictive stimulant drug. Other stimulant drugs include methamphetamine, ecstasy, and prescription drugs such as Adderall and Ritalin. Stimulant drugs speed up mental and physical processes. They increase the release of dopamine and contribute to short-term pleasurable effects, euphoria, and the “high” feeling.
Cocaine abuse has a wide range of health consequences that can be life-threatening. Some of these adverse effects include acute myocardial infarction, acute rupture of the aorta, cardiac arrhythmia, and sudden death. Moreover, cocaine has multisystem toxicity involving psychiatric, neurologic, pulmonary, obstetric, dermatologic, and gastrointestinal systems.
Considering the addictive potential of cocaine, a person in treatment may experience a wide spectrum of withdrawal symptoms. Some of the most common symptoms of cocaine withdrawal include:
- Slowing of activity
- Depressed mood
- Unpleasant and vivid dreams
- Increased appetite
- A general feeling of discomfort
In one study, the most prevalent symptoms were transient craving, hyperactivity, insomnia, slight tremor, and apprehension (anxiety or fear that something bad will happen).
A person who is in the recovery from cocaine, during the initial stage (detox), may also experience symptoms such as:
- Low sex drive
- Inability to feel pleasure
- Suicidal thoughts and/or tendencies
- Muscle aches
- Nerve pain
Cocaine has a relatively short half-life of cocaine withdrawal symptoms can occur quite fast e.g., 90 minutes after the last dose. The cocaine withdrawal process develops in three phases:
Nicotine Withdrawal Symptoms
The scope of nicotine addiction is addressed further in the article. This segment gives a deeper insight into nicotine and withdrawal symptoms people may experience.
Nicotine is both a sedative and stimulant drug and the main psychoactive ingredient in tobacco products. In fact, nicotine is what makes smoking and cigarettes so addictive. A person experiences a “kick” when exposed to nicotine. This happens because nicotine stimulates the adrenal glands, thus inducing the release of adrenaline. The spike in adrenaline levels stimulates the body.
A chain of reactions ensures such as the immediate release of glucose, increased heart rate, breathing activity, and blood pressure. Indirectly, nicotine promotes the release of dopamine in the motivation and pleasure areas of the brain. A person then experiences a pleasurable sensation, which also happens during ingestion of other drugs.
The use of nicotine can increase the risk of cancer, especially lung cancer, but it also elevates the likelihood of developing cardiovascular, respiratory, and gastrointestinal disorders. Evidence confirms nicotine affects cell proliferation, promotes oxidative stress, apoptosis, DNA mutation through various mechanisms. Nicotine can also contribute to skin aging.
Since nicotine is highly addictive, a person who strives to quit may experience withdrawal symptoms. Studies show seven primary symptoms of nicotine withdrawal are:
- Depressed mood
- Difficulty concentrating
- Increased appetite
Nicotine withdrawal syndrome may also include dizziness, constipation, nightmares, nausea, and sore throat.
For practical purposes, health professionals classify nicotine withdrawal symptoms into these categories:
- Affective symptoms: anxiety, anhedonia (loss of interest), depression, dysphoria (generalized dissatisfaction with life), hyperalgesia (abnormally increased sensitivity to pain), and irritability
- Somatic symptoms: tremors, bradycardia (slower than normal heart rate), gastrointestinal discomfort, and increased appetite
- Cognitive symptoms: difficulty concentrating, impaired memory
Each person experiences nicotine withdrawal differently. In people, the above-mentioned symptoms are more intense than in others. Generally speaking, nicotine withdrawal symptoms occur between four and 24 hours after a person has smoked the last cigarette. Symptoms typically peak on the third day and gradually subside over the next three to four weeks.
For some people, the strongest aspect of nicotine withdrawal is craving. Familiar places, other people, and even some situations may trigger cravings. An important aspect of nicotine addiction recovery is identifying these triggers to reduce exposure to them.
Medical Detox from Alcohol Use Disorder
According to the National Institute on Alcohol Abuse and Alcoholism, in 2019, about 25.8% of people ages 18 or older reported engaging in binge drinking past month. About 6.3% engaged in binge alcohol use past month. The same report shows 14.1 million adults in the U.S. had alcohol use disorder (AUD). Of these, 8.9 million were men and 5.2 million women.
Medical detox from alcohol abuse may involve medications such as:
- Benzodiazepines – to prevent seizures and manage certain withdrawal symptoms.
- Disulfiram – FDA-approved for alcohol use disorder. It changes the way the body breaks down alcohol. It works by creating a negative association with alcohol in the brain. If a person drinks, they feel sick and experience other unpleasant effects such as headache, vomiting, weakness, and nausea.
- Naltrexone – to ward off cravings.
- Acamprosate – to ease withdrawal symptoms such as anxiety, restlessness, insomnia.
A person on alcohol addiction withdrawal may need to take antipsychotic medications, antiepileptic agents, anesthetic agents. They may also need to take vitamins and other nutrients depleted by chronic and heavy alcohol use.
Medical Detox from Opioid Use Disorder
The misuse of opioids has become widespread in the United States. According to the National Institute on Drug Abuse, about 21 to 29% of patients prescribed opioids for chronic pain misuse them. Moreover, between 8 and 12% of those patients develop opioid use disorder. About 4 to 6% of people who misuse opioids transition to heroin. A staggering 80% of people who use heroin misused prescription opioids.
The CDC reports that over 750,000 people have died from drug overdose since 1999. Opioids account for two out of three drug overdose deaths.
Opioid use disorder is a serious problem, but it’s possible to achieve a successful recovery. Medical detox is the first step of that process.
Pharmacotherapies used for a medical detox in opioid use disorder include:
- Methadone – helps relieve withdrawal symptoms and may be prescribed for long-term maintenance of abstinence in persons with opioid dependence. After a period of maintenance, the dosage is gradually lowered.
- Buprenorphine (Subutex) – addresses withdrawal symptoms and may shorten detox time. Like Methadone, this drug can also serve to support long-term maintenance. It may be combined with Naloxone to prevent misuse and dependence.
- Clonidine – used to alleviate anxiety, agitation, sweating, muscle aches, and cramps. It may also reduce blood pressure.
- Naltrexone – helps prevent relapse, available in the form of injections and pills.
- Naloxone – to reverse and treat heroin overdose.
In cases of methadone addiction, the doctor may still prescribe Methadone during withdrawal. However, they will lower the dosage overtime to prevent dependence, as mentioned above.
Starting dose of Methadone is 10mg oral or intravenous (IV). Generally speaking, Methadone is given every four to six hours if withdrawal persists. The total dose of Methadone in 24 hours equals the dose for the next day. Rare are the cases when a patient needs more than 40mg in 24 hours.
On the other hand, buprenorphine is administered in doses of 4mg to 12mg. It is in sublingual form and can be given instead of Methadone and tapered over a five- to 10-day period.
Medical Detox from Cocaine and Other Stimulants
According to a report from 2016, last year for which data is available on National Institute on Drug Abuse, there were about 1.5 million current cocaine users in the U.S. Cocaine use is most prevalent among young adults (18-25 years).
At this point, there is no specific medication protocol approved by the FDA for medical detox from cocaine. That being said, a person may still get medications that work to decrease the intensity of withdrawal symptoms. These may include:
- Beta-blockers – drugs such as Propranolol are prescribed to treat high blood pressure, irregular heart rate, anxiety, and tremors. Studies show Propranolol may decrease symptoms of autonomic arousal associated with early cocaine abstinence and improve treatment outcomes.
- Anticonvulsant drugs – drugs such as Topiramate are generally used to treat seizures associated with epilepsy. They may be useful for relapse prevention based on the impact on GABA and glutamate neurotransmission. Gamma-aminobutyric acid (GABA) is an inhibitory neurotransmitter because it blocks (or inhibits) certain brain signals and lowers the activity of the nervous system. When it attaches to GABA receptors, GABA produces a calming effect. On the other hand, glutamate is the most abundant neurotransmitter in the brain and central nervous system. This neurotransmitter is involved in every excitatory brain function. Anticonvulsants such as Topiramate may increase cerebral levels of GABA and facilitate its neurotransmission, but also inhibit neurotransmission of glutamate through a blockade of AMPA/kainite receptors. Blockade of AMPA receptors prevented reinstatement of cocaine self-administration in a study published in the Journal of Neuroscience.
- Antidepressants – in persons who are going through cocaine withdrawal, these drugs are used to address severe symptoms of depression as well as suicidal thoughts and tendencies. A study from the Journal of Psychopharmacology found that antidepressant Mirtazapine may have the potential to reduce anxiety- and depression-like behavior during cocaine withdrawal.
- Disulfiram – a medication used for the treatment of alcohol dependence. It may help with cocaine withdrawal as well. One study revealed Disulfiram could be an effective pharmacotherapy for cocaine abuse among methadone-maintained opioid addicts and even in persons without comorbid alcohol abuse.
Other pharmacotherapies associated with cocaine withdrawal include Baclofen to reduce cravings, tiagabine to improve cocaine abstinence, modafinil, which may block euphoric effects of cocaine and prevent relapse; and TA-CD vaccine to stimulate the production of cocaine-specific antibodies that bind to cocaine molecules and prevent them from crossing the blood-brain barrier.
A person on medical detox from cocaine may get sleep aids and pain relievers.
IMPORTANT: Again, no medication protocol is approved for the treatment of cocaine and stimulant addiction. The above-mentioned pharmacotherapies have been investigated in the studies for their efficacy.
The exact course of medical detox for cocaine/stimulant addiction is determined by the doctor involved in a specific treatment regimen. It depends on the severity of addiction and other factors such as addiction to other substances, the quantity of substance abused, etc.
Medical Detox from Nicotine
Medical detox is usually associated with addiction or dependence on alcohol, opioids, and cocaine, and other stimulants. But other types of addiction exist as well. Addiction to nicotine is one of them, and medical detox could aid recovery.
According to the CDC, tobacco use is the leading cause of preventable disease, disability, and death in the United States. In fact, cigarette smoking accounts for 480,000 deaths every year. More precisely, one in five deaths occurs due to tobacco use.
About 40 million adults in this country smoke cigarettes. The fact that 4.7 million middle and high school students use at least one tobacco product speaks volumes about the severity of this problem. Over 16 million Americans live with a smoking-related illness. Smoking is more common in men. About 15 in 100 adult men are smokers compared to 13 out of 100 women.
Prevention of tobacco use and initiation of addiction is vital to a long-range reduction in morbidity and mortality. However, only dramatically increased cessation rates can overturn health disasters on a national or global level because major benefits of prevention are delayed by several decades.
A paper from the Pharmacology and Therapeutics explains most smoking cessation efforts fail to sustain abstinence. That being said, intervention with evidence-based pharmacotherapy roughly doubles or triples the rate of successful long-term cessation.
Quitting smoking is difficult for most people for several reasons, which include:
- Easy access to cigarettes and other nicotine products
- The common belief that nicotine is harmless or, at least, not as dangerous as other substances
- Strong cravings that make a person give up
Medical detox could help persons with nicotine addiction overcome this problem. For that purpose, a wide range of medications is approved by the FDA and/or other major medicines regulatory authorities worldwide to aid smoking cessation by treatment of dependence and withdrawal. We can divide those medications into two categories:
- Nicotine replacement therapies include gums, lozenges, patches, inhalators, nasal sprays. Gums and lozenges work for acute dosing useful to alleviate acute craving and withdrawal. The patch is a sustained dosing formulation useful for reducing background craving. Inhalator and spray are available with a prescription only. The use of inhalators and sprays is limited. For instance, they are meant to be used up to 12 weeks of the initial treatment.
- Non-nicotine-based pharmacotherapies such as bupropion (Zyban) and varenicline (Chantix). Both drugs are issued with a prescription, and although they don’t deliver or replace nicotine, they help with withdrawal and cravings.
Several other medications are considered effective as potential second-line pharmacotherapies for smoking cessation. These are the antidepressant nortriptyline and the antihypertensive clonidine. Under certain dosing conditions, naltrexone shows promise in combination with transdermal nicotine. Whether or not these medications would be approved for smoking cessation remains to be seen.
Is It Safe To Do Medical Detox At Home?
The idea of an at-home medical detox may seem convenient and simple. It’s not uncommon for people to look for a way to detox at home. In theory, at-home detox allows a person with substance abuse disorder to start a recovery process in the comfort of their home, where they feel safe and protected.
This approach is not recommended due to a number of health complications that may occur. Detox involves withdrawal symptoms that can be unpredictable. The severity of these symptoms varies from one person to another based on factors mentioned above in this post.
Moreover, when a person enters the recovery process at home, they do not have access to medical care and support. Should complications or severe withdrawal symptoms arise, that person doesn’t get help in a timely manner. This doesn’t happen with detox in treatment centers where patients are under medical supervision.
The high risk of relapse is yet another reason to avoid at-home detox. First of all, detox is not enough to recover from drugs or alcohol. Instead, it’s just the first stage of the recovery process. After detox, it’s easy to think the journey is over, but without other approaches such as therapy, it’s difficult to adopt necessary mechanisms for life without substance abuse. Additionally, withdrawal symptoms may make a person give up and start using a specific substance again.
Without supervision, a person is more likely to abuse the medical detox prescriptions and overdose. The risk of self-harm and suicide is also high, but the success rate of at-home detox is low.
In other words, at-home detox treatments have more risks than advantages. Stay safe and undergo medical detox under supervision to get support with withdrawal symptoms.
Medical detox marks the first step toward recovery from drug or alcohol abuse, but detox is not the only step. To achieve successful recovery, a person needs to go through behavioral therapy and other types of therapies to adopt coping mechanisms that will help them stay clean after the treatment.
Rehab centers provide inpatient or outpatient care to patients, a stable environment, support, and other tools necessary for the new chapter ahead.
John Eckelbarger is a Business Development Representative for Stonegate Center. With a BSA in Chemistry from the University of Texas at Austin, he has an interest in the neurobiology of addiction as well as the pharmacology of drugs. He hopes to bolster Stonegate Center’s status at the forefront of addiction medicine through bold, innovative content creation. He is currently pursuing his MBA in Finance from Texas Christian University.