Those who come to alcohol or drug detox are signing up to cleanse their bodies of substances that in some cases have come to seem as essential as air, knowing that a possibly painful withdrawal syndrome is waiting.
Little wonder then that “a lot of them come in scared to death of the idea of detoxing,” said registered nurse Sarah Straub, a longtime detox specialist at the Promises West Los Angeles program for young adults and a board-certified psychiatric mental health nurse. “Everyone is really anxious. Everyone is apprehensive. They don’t know what to expect.”
That makes reassurance and education about what’s coming a key part of her job. “We let them know they’ll be prescribed, in most cases, several medications to keep them as comfortable as possible for the detox period and then those will be tapered off when they no longer need them.” It’s the whole aim of medically monitored detox after all — helping people rid their bodies of the substances that have caused them such misery as effectively, as safely and as painlessly as possible so that they can begin the work of creating new and better lives.
If you’re ready to begin your own journey to sobriety, simply knowing what to expect from detox can go a long way toward calming that very normal apprehension. Here are five things it helps to understand:
1. Everyone’s detox symptoms are different.
People react to substances in different ways, and they react to detoxing from those substances in different ways as well, meaning detox treatment must be individualized and flexible, Straub said.
A good program will have responsive doctors who check patients at least daily and a 24/7 nursing team that together can adjust medications and strategies as needed so that the person is as comfortable and safe as possible. “Nothing should be carved in stone.”
And while all discomfort can’t be avoided, “no one is in excruciating pain,” Straub emphasized. “They’ll be reasonably comfortable and whatever symptom they are exhibiting or feeling we will pay attention to. We don’t let people suffer.”
The detox process can take anywhere from a day or two to a couple of weeks, Straub said, and not everyone who is struggling with alcohol or drugs needs it. Those with less severe substance use problems may be able to proceed directly to an addiction treatment program that focuses on helping the person understand the “why” behind their use and develop strategies for preventing relapse.
2. Detox can help you regroup.
Detox is far from a vacation, but in a sense it’s an important break from responsibilities and daily stresses. “It’s kind of a separate time,” Straub explained. “We encourage them to be lazy for a few days, to take it easy.” They are free to stay in bed if they prefer, she said, or get up and socialize with others in detox if they feel up to it.
Emotionally, it allows the person to “get their bearings a little bit,” Straub said. “Then as soon as they’re cleared by the physicians, they can participate fully in all the activities onsite and offsite,” and the true work of recovery begins.
3. Mental health issues often emerge as part of addiction withdrawal.
Psychiatric care should be part of your detox program because substance use disorders so often go hand in hand with issues such as depression, anxiety, bipolar disorder, borderline personality disorder and others.
Sometimes the person isn’t even aware they’re struggling with a mental health condition, “but as they come away from their drug of choice, these symptoms will emerge — things that they’ve been self-medicating for, sometimes for years,” Straub said.
To successfully deal with the addiction, these underlying issues must be addressed.
4. The substance shapes the detox timeline.
Detox must be tailored not only to the individual, but to the substance. Here’s a quick overview of how it breaks down:
Opiate detox
(Including heroin and prescription painkillers such as Vicodin, Percocet, OxyContin and others)
“People don’t die detoxing from opioids,” Straub said, “but it’s a miserable process if they’re not getting medication.” Opiate withdrawal symptoms typically include chills, hot flashes, abdominal cramping, muscle and bone pain, nausea, vomiting, extreme anxiety and agitation.
For the anxiety and agitation, a sedative such as phenobarbital is typically used, Straub said, “and we typically start out with a pretty high dose to keep them very, very comfortable.” Clonidine, actually a blood pressure medicine, can help dampen the sympathetic nervous system and control the flight or fight feeling that sometimes sets in.
Other medications — some prescription, some over the counter — can help with the bone and muscle pain, nausea, cramping and digestive issues. “And we encourage lots of fluids, bed rest, and food when they feel like it.”
Suboxone and Subutex, which are forms of the medication buprenorphine and which help suppress opiate withdrawal symptoms, can be a valuable addition. “It makes for a more comfortable opioid detox for people who really need it,” Straub explained, but because the dosage must be started high and tapered down gradually, “it drags it out a little.” Instead of the usual five to nine days, opiate detox might take a couple of weeks.
Alcohol and benzodiazepine detox
Alcohol and benzodiazepines (sometimes called benzos) are the most physically dangerous drugs from which to detox — and the more of the substance the person was using, the greater the threat. “The big fear with alcohol and benzos is seizure,” Straub said. As a result, the patient must be carefully monitored.
Alcohol withdrawal medication generally includes phenobarbital, an antiseizure medication, along with a sedative. Other medication helps with common side effects like nausea and insomnia.
Because of the need for constant oversight, no one should risk detoxing from alcohol or benzos without medical supervision.
Cocaine and methamphetamine detox
Those who detox from cocaine or meth use are generally not in physical danger as they go through the process. Most people just want to sleep and eat, Straub said. With some, however, agitation and psychosis are a possibility. In those cases, a calming drug such as phenobarbital or an antipsychotic such as Seroquel can help.
Marijuana detox
Though many assume marijuana can’t be addictive, medical experts and those filling the nation’s treatment centers know otherwise. Withdrawal symptoms for this group, however, are generally mild, usually anxiety, agitation or insomnia. A sedative or a sleep aid is sometimes prescribed.
5. Detox is the first step, not the only step.
Addiction does more than affect the body, it changes the brain in ways that take time and repeated effort to overcome, Straub emphasized. That’s why it’s vital to follow detox with addiction treatment, preferably through a facility that allows a seamless transition, and that includes individual and supportive group therapy that addresses the behavioral, environmental and biological factors behind the substance use.
“There’s that primitive brain that’s down there that governs basic functions, and that’s still saying ‘Give me the drugs. Give me the drugs. Give me the drugs.’ And it takes a long time to retrain it,” Straub said.
Detox clears the body of substances, but if the effort stops there, relapse is almost certain.
“Lots of time,” she said, “the person’s brain is telling them they should be better but their body isn’t ready. And I explain to them that sometimes those two don’t work together and you just have to be patient. They have to give their brains and their bodies a chance to heal.”
She knows from long experience that such change is possible. The staff is often visited by former detox patients who have gone on to healthy, long-term recoveries. “They come to us so miserable and so sick, and then they start to progress,” she said. Seeing them living the lives that once seemed so far out of reach “is one of the things I love best about this job.”
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