Illicit drug use is a common issue in this country. The CDC estimated that in 2012, 9.2 percent of people over age 12 abused drugs in the previous month. There is also a massive treatment gap with only 2.3 million of the 21.6 million people over age 12 in 2011 needing treatment for substance abuse actually receiving it, according to the National Institute on Drug Abuse.
Often the first step down the road to recovery is purging these unhealthy substances through detox. The process of removing toxic or harmful substances from your body is called detox, which is short for detoxification. Substance abuse can lead to both a physical and emotional dependence, or addiction, making chemical changes in your brain and body.
An alcohol or drug dependency can be a difficult habit to break, and many times withdrawal symptoms can be painful and even dangerous. Detox should be medically supervised in a safe and secure environment. The two main types of detox are natural and medical detox. Both can be facilitated in either an inpatient or outpatient capacity. An approach that doesn’t introduce any medications is considered natural, while medical detox often introduces the use of pharmaceuticals.
There are various types of medications that can help ease the detox process and relieve some of the withdrawal symptoms including:
- Opioid agonists
- Non-opioid agonists
- Opioid antagonists
- Partial agonists and antagonists
The type of medication used for detox and the duration of treatment depends on the type of substance abused and the severity of the addiction.
Benzodiazepines and Antidepressants
The National Institute on Alcohol Abuse and Alcoholism estimated that in 2012 approximately 7.2 percent of adults in America over age 18, around 17 million people, suffered from an alcohol use disorder (AUD).
Alcohol withdrawal symptoms are very unpleasant and range from mild to severe including:
- Nausea and vomiting
- Rapid heart rate
- Convulsions or delirium tremens (DTs)
DTs can be a severe symptom of alcohol withdrawal and can be fatal without proper treatment. Alcohol alters brain chemistry by stimulating certain neurotransmitters, the brain’s chemical messengers, and suppressing others. Benzodiazepines are psychoactive drugs that work to slow down the central nervous system, helping to relieve alcohol withdrawal symptoms with tranquilizing and anticonvulsant effects. Benzodiazepines, including Valium and Librium, are often used in alcohol detox programs.
Due to their own potential for abuse, however, benzodiazepines are mainly recommended for short-term use. Benzodiazepines, like Diazepam, are also used to counteract the anxiety produced as a withdrawal symptom of some stimulants including cocaine. Currently, there are no medically approved pharmaceuticals for detox from stimulants; however, some withdrawal symptoms can be managed medically.
Withdrawal symptoms from many different illicit substances include anxiety and depression. These can be dangerous emotions that can lead to suicidal tendencies if not managed properly. Antidepressants are often used in detox in order to counteract these symptoms. Desipramine, fenfluramine, and phentermine, or a combination of these antidepressants, are often used to aid in cocaine detox for example.
Opioid and Non-Opioid Agonists
Opioid drugs are derived from the opium poppy plant and, with the exception of heroin, are typically prescription painkillers like morphine, hydrocodone, oxycodone, and codeine. Opioids attach to opioid receptors in the brain and body, thus reducing the sensation of pain. Opioids also stimulate the brain’s reward system, producing a euphoric effect that can be addicting.
The misuse of prescription drugs is an epidemic in the United States, second only to marijuana use, with one in 22 people over age 12 admitting to using prescription pain relievers for nonmedical purposes in the past year, according to the National Survey on Drug Use and Health.
Withdrawal symptoms from opioids are not typically life-threatening, although they can be very uncomfortable and include:
- Hot flashes
- Increased respiration
- Elevated blood pressure
- Muscle cramps
There are several types of medications that can help relieve these symptoms as well as help you detox from opioid addiction. These medications usually fall into one of two categories: opioid agonists and opioid antagonists.
An opioid agonist binds to opioid receptors in the brain and mimics and heightens the naturally occurring neurotransmitters’ effects. Methadone, often dispensed in clinics, is an opioid agonist commonly used to detox from heroin. It stays in your system longer than street drugs and can relieve withdrawal symptoms and cravings.
Methadone doesn’t produce the same high as other opioids, although long-term use can still create a dependence. Methadone use should be monitored closely.
Other non-opiate agonists have shown some success in managing opioid withdrawal symptoms and may be effective during detox as well. One such alpha-adrenergic agonist is clonidine which works to suppress opioid withdrawal symptoms by stimulating alpha receptors in the brain and reducing nerve signals sent to blood vessels.
Clonidine is a blood pressure medication that helps reduce the flood of adrenaline, which causes the “fight-or-flight” response, a common withdrawal symptom. Clonidine can assist in detox from narcotics, methadone, and sometimes even alcohol. Another high blood pressure drug with similar effects that acts as a beta-blocker, propranolol, may help with severe cocaine and alcohol withdrawal symptoms as well.
Opioid antagonists actually block the opioid receptors in the brain, preventing the neurotransmitters from being stimulated even when new drugs are introduced. This means that while taking an opioid antagonist, your body will no longer accept any other forms of opioids. Since this effectively blocks the ability to get high, it decreases the desire to take more drugs. Many of these antagonists are used after the detox process is complete in order to prevent relapse, although some can be used for detox purposes as well.
Naltrexone is an opioid antagonist available in tablet form under the names ReVia and Depade and also in an extended-release injected form called Vivitrol. Since none of these forms counteract opioid withdrawal symptoms, naltrexone is usually recommended for use after most of the opioids are out of your system. Naltrexone is used as a part of the long-term treatment plan for opioid and alcohol addiction.
Naloxone is another opioid antagonist, often known as Narcon, that is generally used to reverse the effects of opioids in the case of an overdose. It works quickly via an injection or when inhaled through the nose. Naltrexone and naloxone can also be used for detox if withdrawal symptoms are not overly severe.
Oftentimes, a medical detox performed in an inpatient setting will not introduce any new drugs but rather taper off the use of the substance being abused. This means that a schedule is introduced in which you take less and less of the drug every day until you are drug-free. This can help alleviate or greatly reduce withdrawal symptoms but should be performed under direct supervision. Stopping cold turkey can be dangerous and even turn fatal if not closely monitored. In these cases, a weaning, or tapering off, schedule may be introduced.
It is important to realize that detox is not a cure and that there is no magic pill for recovery from addiction or substance abuse dependency.
Substance abuse disorders are considered diseases affecting people both physically and mentally. While medications can be a useful tool to aid you during the detox process, they should be used in combination with a rehabilitation program also. Behavioral therapies can help to identify the triggers that may have opened the door to addiction in the first place, as well as modify negative thoughts and behavior patterns. Group, individual, and family therapy can give you the support you need to recover fully and prevent relapse.
Substance abuse disorders and mental health issues often co-occur, creating the need for a dual diagnosis treatment plan. Co-occurring disorders treated concurrently offer the highest rates of success. Dual diagnosis treatment models provide detox in a safe and controlled environment as well as the necessary psychological care.
Highly trained and compassionate professionals offer detailed evaluations that can help you decide on the right course of action for you or your loved one. For more information on dual diagnosis care, contact us today at 844-675-1221.
David W. Newton is a board certified pharmacist and also has been a board member for boards of examiners for the National Association of Boards of Pharmacy since 1983. His areas of expertise are primarily pharmaceuticals as well as cannabinoids. You can read an article about his expertise in CBD on the National Library of Medicine.
Reviewed by: Kim Chin and Marian Newton