Detoxification Health Article

Definition

Detoxification is a process in which the body is allowed to free itself of a drug. During this period, the symptoms of withdrawal are also treated. Detoxification is the primary step in any drug treatment program, and is used as the initial phase in treating alcohol, heroin, inhalant, sedative, and hypnotic addictions.

Purpose

The goal of detoxification is to clear the toxins out of the body so that the body can adjust and heal itself after being dependent on a substance. In order for the recovering person to stay abstinent on a long-term basis, detoxification needs to lead into long-term community residential program treatment or outpatient drug treatment lasting three to six months.

Precautions

When individuals are physically dependent on a substance, they experience withdrawal symptoms when they abstain from the drug. Withdrawal symptoms vary with each drug of abuse, but can be severe, and even dangerous. Patients who want to overcome their dependence need help managing the withdrawal symptoms. The patient's medical team strives to get the patient off a substance on which he or she is physically dependent, while treating the withdrawal symptoms.

Pregnant women cannot be detoxified from opiates (also called narcotics, including morphine, heroin, and similar drugs) because strict detoxification can increase the risk of spontaneous abortion or premature birth. These women are treated with methadone as an alternative. (Methadone acts as a replacement for the heroin in the woman's body, but the methadone does not provide the "high" that the heroin provides. In addition, methadone is safer for the fetus than heroin.)

In order to be an effective first step of treatment, detoxification must be an individualized process because patients have varying needs.

Description

The body, when allowed to be free from drugs, detoxifies itself through its normal metabolic processes. The withdrawal symptoms are treated during this process so that the patient will be comfortable while the body detoxifies itself.

The process of substance addiction

Before discussing detoxification, it may be useful to understand how the body becomes addicted and why withdrawal symptoms are experienced. In physical addiction or dependence, as a person uses a substance or chemical over a long period of time, his or her body chemistry changes. Once a substance enters the body through drinking, smoking, injecting or inhaling, it travels through the bloodstream to the brain. The brain has a complex reward system built in— when people engage in activities that are important for survival (such as eating), special nerve cells in the brain release chemicals (neurotransmitters, including dopamine) that induce feelings of pleasure. Because of this reward system in the brain, humans are programmed to want to repeat actions that elicit those pleasant sensations. In other words, feelings of pleasure reinforce certain activities or behaviors. Addictive substances interfere with this reward system. Some drugs mimic the effects of a natural chemical, some block the communication between nerve cells, and some substances trigger a larger-than-normal release of neurotransmitters like dopamine. The result of this interference is that dependent drug users physically need the drug to feel pleasure. As they become more dependent, their bodies becomes less responsive to the substance, and need more of it to get the desired response—a phenomenon called tolerance. Also as a result of the interference with the brain's system, when the dependent user does not have the drug in his or her system, feelings of depression or unpleasant withdrawal symptoms may be experienced. These consequences also reinforce the substance use— people dependent on substances resort to using more drugs to avoid the depression or the withdrawal symptoms.

Withdrawal symptoms

The symptoms and severity of these symptoms vary from one substance to another.

ALCOHOL. After a person who has used alcohol heavily for a long time stops drinking, he or she may experience increased heart rate, shaking, difficulty sleeping, nausea, restlessness, anxiety, and even seizures. The affected person may also experience hallucinations (seeing, hearing, or feeling something that isn't really present). In some cases, delirium tremens (DTs) may occur as part of the withdrawal. Delirium tremens is a violent delirium (fading in and out of consciousness) with tremors, increased motor activity, visual hallucinations, disorientation, confusion, and fever that happens 48-96 hours after the alcohol-dependent person has had his or her last drink. These symptoms can last anywhere from three to 10 days. This state is a medical emergency because it could be fatal.

HEROIN AND OTHER OPIATES. Heroin is part of a family of drugs called opiates or opioids, which are made up of drugs that come from the seeds of the Asian poppy (heroin, opium and morphine, for example) and also manufactured drugs that act like the natural drugs (meperidine or Demerol). Symptoms of opiate withdrawal include restlessness, insomnia, anxiety, irritability, loss of appetite, diarrhea, abdominal cramps, nausea, sweating, chills, and runny eyes and nose.

SEDATIVES AND HYPNOTICS. Sedatives and hypnotics are drug families that are often considered in one group called the sedative-hypnotics. These drugs depress or slow down the body's functions, and can be used to calm anxiety or to induce sleep. When taken in high doses or when abused, these drugs can cause unconsciousness or death. These drugs include barbiturates and benzodiazepines. Some barbiturates are amobarbital (Amytal), pentobarbital (Nembutal), and secobarbital (Seconal). Some benzodiazepines include diazepam (Valium), chlordiazepoxide (Librium), and lorazepam (Ativan). When a person dependent on these drugs stops taking them suddenly, he or she might experience restlessness, muscle cramps, anxiety, insomnia, irritability, paranoid behavior, and even seizures or death.