Medical Detox
Detoxification is the process by which an individual experiences the gradual reduction of the substance in the body. When one develops substance dependence, it means that the body, especially the brain, has adapted to being exposed to the substance. This adaptation includes a number of processes such as tolerance (the need for an individual to ingest more of a substance to obtain a similar effect) and withdrawal (a constellation of symptoms that result in the abrupt discontinuation of a substance).
Substances are metabolized by the body at different rates. Some may be completely gone from the body in a matter of hours; others may take a number of weeks. For example, alcohol is generally metabolized at the rate of 1 standard drink per hour, and no longer in the body after a few hours. Cocaine is metabolized over a 2-3 day period. Some barbiturates and marijuana are still detected in the urine after 4-5 weeks.
Generally, the substances which require a medical detoxification include alcohol, benzodiazepines, barbiturates, and opiates. The process involves using prescribed medicines which share properties of these substances, enabling the brain to gradually experience a reduction and therefore slowly adapt to the absence of the substance.
Most commonly, benzodiazepines are used to “detox” someone from alcohol and benzodiazepines. Long-acting barbiturates are used for barbiturate dependence. In the case of opiates, the options include the long-acting opiate, methadone, and the partial agonist, buprenorphine (see Opiate Dependence).
For most people with alcohol dependence, the detoxification process takes 7-10 days. Benzodiazepine detoxification usually takes longer, depending on how long someone has been dependent, the dose to which they have become tolerant, and whether they were abusing a short or long-acting benzodiazepine. Sometimes, it may take many weeks to slowly taper the benzodiazepine. The short-term addition of an anticonvulsant medicine like carbamezepine or valproic acid may enable the process.
Opiate detoxification is becoming a controversial recommendation. The research studies clearly show that most people with opiate dependence will relapse after 1-2 weeks of detox. The vast majority remain abstinent from street opioids if they remain on a prescribed opioid under the care of a physician. This has the advantage of much higher treatment retention rates, which would then enable the individual to learn effective relapse prevention skills and become a productive, healthy member of society before attempting to taper off of the prescribed opioid.
Detox is only the first step in addiction treatment. Most people with addiction experience significant cognitive deficits as a result of the substances. These deficits improve with abstinence, but they must be taken into consideration when designing the appropriate rehabilitation treatment plan. At the end of detox, these deficits are only just beginning to improve. People who leave detox without entering the rehabilitation phase have extremely high relapse rates because the parts of the brain which regulate impulsivity, mood, anxiety, and motivation are still very much impaired.