Detox refers to the detoxification process of the body. Anytime a person spends time ridding their body of toxic or unhealthy substances through abstinence is considered detox. The term is most commonly used to refer to a specific period of an addict’s recovery from substance use/abuse; the initial abstinence and the associated withdrawal symptoms. In the process of substance use/abuse the body develops an increasing tolerance to the substance and requires more and more to obtain the desired effects.
When a person stops using those substances, especially doing so using the “cold turkey” method rather than weaning themselves slowly, withdrawal symptoms can be quite severe and disturbing. Every substance affects people differently and every withdrawal period is experienced by people differently. However, there are some basic expectations in terms of symptoms and duration.
The Reality of Detox
Detox from substance use/abuse is often misunderstood by the general public. Many think that once a person has gone through detox they are “cured” from their prior dependence or addiction. In reality detox is really only the first step of recovery. The detox process itself is basically made up of three distinct phases; evaluation, abstinence/withdrawal management, and planning further treatment.
It is generally understood that most detoxification from drugs and alcohol should be done under the supervision of medical staff, usually in a hospital/clinic type location where withdrawal symptoms can be medically managed if necessary, away from the stresses and temptations of life which may have led to the addiction in the first place. This is not always possible in today’s economic climate and many people may choose to detox on their own or with the help of untrained but supportive friends and family members. The more these people educate themselves about the process the more successful the eventual recovery will be.
Evaluation involves collecting data about initial use and increasing dependency, current use amounts, physical health, mental health, laboratory testing to determine the amounts currently in the system, the specific drug and its common withdrawal symptoms and the creation of a very specific detox strategy which advises the “detoxer” of what to expect during the process and how to get help and support throughout the process. Once a comprehensive evaluation is complete the actual abstinence can begin. Detox is different for everyone but there are certain guidelines for each substance as to the potential symptoms you can expect and the potential duration.
Drug withdrawal generally involves distinct phases; the initial acute withdrawal stage (24-72 hours), the early abstinence stage (1-6 weeks), and the protracted abstinence stage (6 weeks and longer). Most “detoxers” refer to the initial acute withdrawal stage as the most difficult. For most substances for which the body and brain have developed a tolerance, the sudden absence of these substances can cause the brain and body to “go into shock”. The first 24-72 hours can produce the scariest and most dangerous symptoms, often requiring medical treatment to prevent serious illness/injury or death.
Different Substances, Different Detoxes
In the case of acute alcohol withdrawal most users/abusers experience a condition known as delirium tremens (DTs), which is a nervous system response to lack of alcohol, it can cause tremors, fever, sweating, pallor, muscle aches, confusion, agitation/irritability, hallucinations, seizures, elevated heart rate, shallow breathing and death. Once the acute phase passes the early abstinence stage for alcohol includes anxiety, depression, fatigue, loss of appetite, headache and heart palpitations. After these first few weeks as the user enters the protracted abstinence phase with alcohol most physical symptoms begin to disappear while psychological symptoms change from those of extreme anxiety and depression to milder residual anxiety, emotional fluctuations and cravings. The acute withdrawal stage can begin as early as 8 hours after the last drink (though DTs don’t usually appear for a few days), withdrawal symptoms tend to peak around 24-72 hours and protracted symptoms typically last a few weeks.
When it comes to barbiturate withdrawal, as a central nervous system depressant the withdrawal symptoms are like those of alcohol. Barbiturates are usually prescription medications that were originally prescribed to a person to help them with anxiety, insomnia, seizure disorder or chronic pain. The dangers of barbiturate addiction have been recognized for a very long time in the medical community and most doctors prefer to prescribe benzodiazepines in their place. Withdrawal symptoms can be life threatening. Much like alcohol detox, barbiturate detox should occur under the guidance of medical professionals. Acute withdrawal symptoms may begin within a few hours of the last dose and include fever, sweating, pallor, muscle aches, confusion, agitation/irritability, hallucinations, seizures, elevated heart rate, elevated breathing rate and death. Medications are available to help mediate withdrawal symptoms of barbiturates, it is believed that this greatly impacts the success rate of recovery as well. As the early abstinence phase kicks in the most serious and dangerous physical symptoms begin to dissipate and are replace with the psychological symptoms of depression and anxiety. Protracted abstinence involves residual psychological symptoms of anxiety and cravings.
Bath Salts (including flakka)
A recently popular drug addiction is that of “bath salts” or more technically synthetic cathinones. They cover a wide range of drugs taken for their psychoactive properties and go by many names, including but not limited to: flakka, boom, cloud nine, lunar wave, vanilla sky, white lightning, and scarface. These bath salts are a stimulant drug and the withdrawal symptoms are similar to those of most amphetamines. Not much is known about the exact effects that these drugs have on the brain and with such a wide range of them and unknown additional active ingredients it is hard to predict exact physiological and psychological effects. However, initial research shows that withdrawal symptoms of depression, anxiety, tremors, difficulty sleeping and paranoia can be reliably expected. The acute phase seems to begin within 48 hours and last up to a week. One popular detox program claims that those who quit cold turkey will tend to feel under the weather for about 3 days. A more protracted phase of less severe symptoms is said to last several weeks.
Benzodiazepines like Xanax, Valium, Klonopin and Ativan prescribed to help people with anxiety, panic disorder, sleep disorders, and seizures have been used for years as a “safer” alternative to barbiturates as they are considered less addictive. Like most prescribed medications for these types of problems they are expected to be used in the short term. After extended use one can expect serious withdrawal symptoms from abstinence. Their sedative nature results in withdrawal symptoms of a rebound effect, meaning they enhance the very problem they were prescribed to alleviate. Sometimes users become convinced that they “need” the drug.
Acute withdrawal phase symptoms include: tension, panic attacks, tremors, difficulty concentrating, short-term memory loss, anxiety, irritability, disturbed sleep, headache, heart palpitations, sweating, nausea, muscle pain and stiffness, hypertension and irregular heart rate. More serious side effects of delirium, hallucination, extreme confusion, fever and seizures are possible. Some grand mal seizures resulting in coma or death have been reported in heavy users who quit cold turkey. While the acute symptoms usually begin within 1-4 days of last use, they tend to peak within the first two weeks and the protracted phase is said to last months or years without consistent supportive treatment.
Cocaine withdrawal is a special case because of the incredibly short half-life of cocaine in the system. The half-life is less than hour which means the effects come on just as rapidly as they dissipate which usually results in a bingeing type of use rather than an extended chronic use like most other drugs. Cocaine has its own unique withdrawal stages made up of an initial “crash period”, followed by acute withdrawal and then “extinction”. Crash symptoms occur within hours of the last binge session and can last anywhere from 9 hours to 4 days according to the National Highway Traffic Safety Administration (NHTSA). Crash symptoms are usually the opposite of the stimulant effects of using cocaine, sleeping for extended periods of time, increased appetite, depression and anxiety. The acute withdrawal phase tends to last 1-3 weeks and involves irritability, fatigue, depression, insomnia, anxiety and cravings. The extinction period involves a more chronic depression, occasionally suicidality due to a prolonged feeling of loss of pleasure, and continued cravings for several months. Due to a lack of intense physical symptoms as with other drugs cocaine withdrawal is not considered life threatening. Suggestions for withdrawal assistance usually involve psychological treatment and support rather than medical.
Opiate use covers many legal prescription pain relievers as well as illegal substances like heroin which are opium derivatives. While all opiates are considered highly addictive, the short half-life of heroin makes its withdrawal symptoms a little different from those of morphine, oxycodone, hydrocodone, codeine and fentanyl. Acute withdrawal symptoms of opiates mimic cold and flu symptoms and usually occur within 8-12 hours of last use, and tend to peak within 12-48 hours and last 5-10 days, with heroin symptoms lasting longer, sometimes as long as a few months. Specific symptoms might include, muscle aches, runny nose, eye watering, sleepiness or insomnia, agitation and anxiety, racing heart, hypertension and sweating. They can progress to nausea and vomiting, chills or goose bumps, diarrhea, abdominal cramps, and dilated pupils. Since most of these symptoms provide the opposite feeling of use they can confirm for many users their “need” for the drug in order to feel “normal” and can often get in the way of successful recovery. Medically assisted detox is highly recommended and seems to coincide with more successful results.
Medical treatment for addiction to opioids sometimes involves the use of another opioid called methadone. Methadone was considered a “safe” alternative to the addictive opiate and used to wean users slowly to help minimize and manage some of the worst withdrawal symptoms, hopefully leading to one of those more successful recovery situations. However, it was later discovered that without stringent responsible use some addicts merely substitute their addiction for the original opiate with an addiction to methadone thus requiring methadone detoxification. Another similar drug, suboxone was used in much the same way with similar results requiring detox.
Withdrawal symptoms are similar to those of other opioids but with a longer protracted period. Physical symptoms may include: lightheadedness, eye watering, dilated pupils, photosensitivity, hyperventilation, runny nose, fever, sweating, chills, nausea, vomiting, diarrhea, tremors, restlessness, elevated heartrate, elevated pain sensitivity and hypertension. Psychological symptoms may include: cravings, anxiety, depression, suicidal ideation, insomnia, delirium, hallucinations, agitation/irritability/nervousness, paranoia, and delusions.
Methamphetamine use takes many forms. It can be inhaled/smoked, swallowed in the form of a pill, snorted, or injected as a powder diluted with water or alcohol. It is a stimulant used for its dopamine increasing effects which are often short lived, depending on purity and ingestion method. Just like cocaine, this short half-life leads to a bingeing pattern of use. Withdrawal symptoms differ from person to person and vary based on frequency and duration of use, but commonly include: fatigue, increased appetite, agitation, insomnia, paranoia, hallucinations, red/itchy eyes, incoherent speech, loss of motivation and suicidal thoughts. Acute withdrawal symptoms tend to begin within 24 hours of the last bingeing episode, peaking within 4-10 days and protracted withdrawal symptoms can last months, or years in severe cases.
In Conclusion: Planning Further Treatment
Regardless of the specific drug, detoxification is a necessary and important first step. It can involve various symptoms that may encourage the user to continue using in an effort to avoid. Education about the process and the expected symptoms can help many users get through this difficult time. For many people, medical, psychological and social support for defeating their addiction is needed as well. Once the body is detoxified from the addictive substance users can proceed on the road to successful recovery by developing a long-term treatment plan to teach coping methods, provide support, prevent relapse and encourage positive life changes associated with living a healthier life.