A thin line separates substance use and abuse. A substance may be any of the following psychoactive compounds; alcohol, opioid derivatives, morphine, hypnotic, sedative, or stimulant medications.
These substances are valuable medications used in disease management, but when the drug becomes a desire or an inappropriate need, instead of a necessity, it becomes abused.
These psychoactive substances produce a range of unfavourable effects that can be harmful, and even fatal, in cases of chronic abuse, over dosage, and patients with preceding medical conditions. Proper medical detoxification is a must.
For the sake of simplicity, in this article, substance refers to both alcohol and drugs, unless mentioned otherwise.
Tolerance and Dependency:
Tolerance implies that the body is getting accustomed to substance abuse and the person progresses to consume more and more substance(s) to achieve a similar effect. Tolerance leads to dependency. Dependency is described as the need for the psychoactive substance by an individual to the point that they feel lacking and non-functional in the absence of the substance.
Consuming psychoactive substances is a double-edged sword; substance abuse shows its own set of effects, but if the drug is stopped, the body of the dependent person responds adversely and starts presenting withdrawal symptoms.
These symptoms may be physical, emotional, or psychological and vary in severity from person to person. Some of these are shaking, sweating, palpitations, nausea, vomiting, fatigue, sleeplessness, depression, confusion, seizures and hallucinations. The individual can also experience these symptoms in the setting of detoxification. Certain medications are given to prevent some of these symptoms or reduce the severity, giving the individual a strengthening push to continue the therapy in a comfortable setup.
The process of removing toxins from the body is called detoxification, or detox for short. Substance abuse leads to disorder in all organ systems of the body. In such cases, detox involves removing these toxins from the body, freeing the body of drugs or alcohol, in a way that is both comfortable and clear for the individual.
Theory of detox:
The detoxification concept given in the autotoxin theory states that opiates stimulate the production of toxins in the intestines, which form the physiologic basis of the withdrawal phenomenon. Thus, it would be inappropriate to only treat drug dependence and not purge the body of the toxins.
Types of detox:
Currently, two overlapping paths are available for detox; medically supervised or medical detox, and clinically managed or social detox.
As the names suggest, medical detox is done under the supervision of medical and mental health professionals. In this method, medicines are used in a safe and comfortable environment to reduce cravings and withdrawal symptoms. Detox centers and rehabilitation centers provide these services to those in need.
Social detox occurs at the community level, constituting short-term strategies for people with mild to moderate dependencies, such as professional support groups and peer encouragement sessions.
Deciding the best route for detox is individually tailored, considering the level of physical dependence and the need for medical assistance. Treatments are done in the least restrictive environment optimal for best results.
Although the time period for the detox varies from person to person, the average length of detox is less than 8 days. Factors affecting the duration of detox include the type, duration and dosage of substance(s) used, the amount of substance present in the system, the type of detox, the goals and condition of the individual’s health.
Detoxification programs form part of the rehabilitation program in recovery from dependence. They involve intervention to stop physical substance abuse, clearing the body of toxins, management of withdrawal symptoms, and encouragement for continuing treatment, in a safe and comfortable environment.
These programs focus on the future for improved physical independence and social behaviours.
Steps of detox:
All cases of detox follow the same three steps of progression, described by the U.S Department of Health and Human Services.
1- Evaluation– the first steps are to identify and estimate the amount of substance(s) abused in an individual through breath, blood or urine testing, and to assess the mental and medical status of the individual. These factors guide which paths to be taken for detoxification.
2- Stabilization– this is the difficult, yet, the outcome-defining part of the treatment process. The health professionals direct the patient to discontinue the drug and achieve sobriety. This can be assisted psychologically in society or medically in the detox centers. Despite the professional and medical support, this process can be painful as the patient may experience withdrawal symptoms and cravings. But once the patient is sober and clear-headed, they can focus on the next step of detox.
3- Rehabilitation– detox cleanses the substances and rehabilitation makes the treatment of addiction. Once the drug-free state is established, the patients are guided to involve themselves in further treatment. The support programs play a role here to promote independence and commitment to continue abstinence.
Facts to take care of:
Detox affects each patient in different and individualized ways.
Detoxing alone can be life-threatening.
Rapid and ultra-rapid detox is considered partly effective, yet their risks greatly outweigh the benefits.
Medications given to help the withdrawal phase are FDA approved and are given only by health professionals.
Recovery from dependence can be hurting and unsafe without help.
What happens After Detox?
After the sessions of detox, the patient is advised for regular follow-ups with the medical and mental health teams for support and evaluation. Detox does not mean complete withdrawal from substance dependence; the individual’s dedication and support system in the form of family, friends, and various therapy platforms, helps boost their confidence and self-esteem to be independent. Patients with a strong support system are less likely to relapse.
Detox is the first step for a wide range of substance-dependent individuals. It forms an integral part of a constant point of care for substance abuse. Affected persons should undergo the complete individualized process with support and care. After detox, people are guided for therapy and counselling. Addiction and rehabilitation centers help the person cope with the physical and mental disturbances that come with abuse and detoxification. The cravings eventually subside and the person gets a new beginning.