The National Institute on Drug Abuse (NIDA) states that drug addiction is a complex illness characterized by grave problems, namely intense and, at times, uncontrollable drug cravings along with compulsive drug seeking and drug use that persist even in the face of devastating consequences. While the path to drug addiction begins with the voluntary act of taking drugs, over time a person’s ability to quit becomes compromised, so seeking and consuming drugs become compulsive. These behaviors result largely from the effects of prolonged drug exposure on brain functioning. In other words, addiction is a disease that affects multiple brain circuits, including those involved in reward, motivation, learning, memory and inhibitory control over behavior.
The NIDA’s “Principles of Drug Addiction Treatment” reports that most treatment approaches for substance use disorders start with detox and medically managed withdrawal, often considered the first stage of treatment. Detox, the process by which the body clears itself of drugs, is designed to manage the acute and potentially dangerous physiological effects of stopping drug use. This step does not address the psychological, social and behavioral problems associated with addiction, so it does not typically produce lasting behavioral changes necessary for recovery. Thus, detox should be followed by a formal assessment and referral to addiction treatment.
Because it is often accompanied by unpleasant and potentially fatal side effects that stem from withdrawal, detox is often managed with medications administered by a physician in an inpatient or outpatient setting. In such treatment settings, this process is referred to as “medically managed withdrawal.” Medications are available to assist withdrawal from opioids, benzodiazepines, alcohol, nicotine, barbiturates and other sedatives.
The National Center for Biotechnology Information (NCBI) states that detox is a set of interventions that aim to manage acute intoxication and withdrawal. Medically supervised detox may prevent potentially life-threatening complications, and it treats withdrawal symptoms for people who want to become abstinent or who must observe mandatory abstinence as a result of hospitalization or legal involvement. Finally, for some patients, detox represents a point of first contact with the treatment system and the first step to recovery. On the other hand, treatment and rehab involve ongoing therapeutic services that promote long-term recovery.
The NCBI adds that detox is a broad process with the following three components:
- Evaluation tests patients for substances in the bloodstream, measures their concentration and screens them for co-occurring mental and physical conditions. Evaluation also assesses the patient’s medical and psychological condition and social situation to determine the appropriate level of treatment following detox. Essentially, the evaluation serves as the basis for the initial substance use disorder treatment plan once the patient has withdrawn successfully.
- Stabilization assists the patient through acute intoxication and withdrawal to attain a medically stable, fully supported, substance-free state. This feat is often done with the assistance of medications, though some approaches to detox use no medication. Stabilization familiarizes patients with the treatment milieu and their role in recovery. During this time, practitioners may seek the patient’s family, employers and other significant people to get involved.
- Fostering the patient’s entry into treatment prepares the patient for substance use disorder treatment; it stresses the importance of following through with the continuum of care. For patients who demonstrate a pattern of completing detox services and then relapsing, a written treatment contract may encourage a long-term commitment to treatment. This contract, which is not legally binding, is voluntary when patients are stable enough to commit to it: patients agree to participate in continuing care plans with details and contacts established before they complete detox.
These three components treat the patient with compassion and understanding. Patients who undergo detox need to know that someone cares about them, respects them as individuals and has hope for their futures. The actions that practitioners take during detox show the patient that the medical team can be trusted and followed.
Key Factor: Smooth Transition from Detox to Treatment
Especially when combined, medication and behavioral therapy are important elements of an overall therapeutic process that often begins with detox and then involves treatment and relapse prevention. The NIDA notes that medications can be used to help with the following phases of treatment:
- Detox – Medications suppress withdrawal symptoms during detox, but neither they nor medically assisted detox are full treatment, rather the first step in the recovery process. Patients who go through medically assisted detox are likely to relapse if they avoid further treatment.
- Treatment – Medications can be used to promote normal brain function, to prevent relapse and diminish cravings. Currently, medications treat addictions to opioids (heroin and morphine), tobacco (nicotine) and alcohol, and others are being tested for addictions to stimulants (cocaine and methamphetamine) and marijuana. However, people with severe addictions tend to abuse more than one drug, so they will require treatment for all of the substances they abuse.
Behavioral therapy helps patients engage the treatment process, modify their attitudes and behaviors related to drug abuse and increase healthy life skills. These treatments can also augment medications and help people stay in treatment longer. Treatment for substance use disorders can be delivered in many different settings with a variety of behavioral approaches, so find the best approach for your unique needs.
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