What is Medically Assisted Detox?
The time has finally come. Another addict has become sick and tired of being sick and tired. They seek help through traditional channels and eventually find themselves packing a bag and preparing to change their life for the better. Large amounts of nervous anticipation are often experienced, as the addict knows that they are going to be pulled away from their chemical security blanket. Most addicts require a medically assisted detox from their drug of choice. This can ease the potentially tremendous amounts of pain and discomfort that follows cessation of use, and allows the subject to spend their time in preparation for spiritual and behavioral improvement. Modern medicine has greatly expanded the library of drugs and techniques that are available for detoxification from substance dependency, allowing each unique situation to be treated accordingly.
Upon being admitted into the detoxification facility, doctors will often interview the subject to determine which drugs they are dependent on. While even a heavy addiction to opiates or stimulants can be unbearably uncomfortable to discontinue use without medical assistance, it generally will not put the addict into any significant harm. However, chronic addictions to anti-anxiety drugs (medically known as benzodiazepines) and alcohol can be very dangerous, complicated and potentially lethal if not treated correctly. These drugs act on the body’s GABA receptors, which are the main neurotransmitters in the central nervous system. Those with a heavy and prolonged addiction to alcohol and benzodiazepines have made their GABA neurotransmitters reliant on these chemicals to function. A sudden cessation of use can result in seizures, heart attacks and a bevy of other symptoms that when compounded have the capability of being fatal.
So what drugs are used when treating withdrawals? The goal of any medically assisted detox is to undo an addict’s physical dependence on a drug as quickly and comfortably as possible. Many recovered addicts will cite their own uncomfortable detox experience as a key landmark in their sobriety; the memory of that intense discomfort giving them the strength to stay away from the constant allure of a chemical escape. Others may argue that medical assistance during detox gives the addict the ability to use this valuable time to reflect on their situation and reaffirm that they are truly making the right choice. The answer is different for every detox, as each may employ differing types and amounts of medication to treat the withdrawal period.
Niacin is a commonly used drug that is compatible with every substance detoxification. A water soluble B vitamin, Niacin plays a crucial role in the widening of blood vessels, allowing the subject to cleanse their system of their drug of choice much faster, while also providing them with much needed B vitamins that are often in low amounts among alcoholics and other drug abusers. Other vitamins play a large role in the detoxification process. Magnesium can ease the symptoms of Restless Leg Syndrome that often plague those withdrawing from opiate use, while a typical multivitamin can help addicts who are often suffering from vitamin deficiencies. Vitamin deficiencies are common among those who abuse stimulants (such as methamphetamine and cocaine), alcohol, or opiates, which is frequently due to the addict’s prolonged lack of a proper diet, which can further exacerbate and lengthen the withdrawal process.
Tranquilizers are routinely necessary in the detoxification process. Despite comprehensive medical assistance, detoxification will still be painfully unbearable for some. Tranquilizers can help those recovering from heavy use to regulate panic attacks, generalized anxiety and insomnia that can occur during this period. A carefully planned benzodiazepine taper can be paramount to the detox process, and is generally used for all types of substance dependency detoxification. The most often used medications are Ativan and Valium, but some facilities will utilize the barbiturate phenobarbital in place of a benzodiazepine, especially if the subject is trying to break an addiction to benzodiazepines.
For those experiencing opiate withdrawals, buprenorphine, most often in the form of Suboxone or Subutex, is prescribed in lieu of a tranquilizer. Buprenorphine is a potent opiate that has a very long half-life. It also blocks other opiates from attaching to receptors in the brain, making it more attractive than methadone as a deterrent. Unfortunately, many who use Suboxone can become addicted to it in place of their previously abused opiate. Suboxone’s long duration means that withdrawals are far greater in magnitude and duration than traditional opiates, often leaving the user in a worse place than they were before. This is why buprenorphine is used most successfully in a clinical environment, where a medical professional can taper the dose quickly over the course of 1-2 weeks. The popular anti-diarrheal medication Loperamide can also be used to quell the gastric complications that often come with opiate detox. Loperamide is also uncanny in its chemical similarity to opiates in structure, but it doesn’t have enough strength to cross the blood-brain barrier to affect the central nervous system. Loperamide’s structural similarity does provide greater withdrawal relief than other anti-diarrheal medications, and is often used by those who do not have the necessary finances to detox in a medical environment.
While the progression of modern medicine has allowed us to confidently and comprehensively treat substance dependency detoxifications, it is only one piece of the puzzle in conquering the complicated and convoluted disease of addiction. Many argue that a comfortable detox did them no favors in the long term, and that it took a great degree of experiential suffering before they were completely motivated to make the changes necessary to achieve lasting sobriety, but the road to recovery is different for everyone, and understanding the strain that chemical dependency has on the body is only one piece of a much larger puzzle.