Which Drugs Require Medical Detox Before Addiction Treatment?

It’s easy to think of detox as separate from addiction treatment. One is medical, and one is psychological, right? Actually, medical detox is part of the continuum of care in addiction treatment. It is an important first step for many people in addiction treatment. Medical detox involves 24-hour medically managed treatment for people going through withdrawal symptoms.

Through detox, you may be treated with medications to help avoid severe withdrawal symptoms or to manage discomfort. You may also be treated for other medical needs that may be occurring alongside your substance use problems. Detox may also involve clinical services that can start to address the underlying issues that may be related to substance use problems like mental health issues. 

When you first enter an addiction treatment program, you’ll go through an assessment process to find out the appropriate level of care for your needs. Every person is different and may come to treatment with different needs. While the type of drug you take is a significant factor in whether or not you need detox, it will ultimately depend on your individual needs. 

Still, some drugs are more likely to require medical detox than others. Here are some examples:

Opioids

Opioids include drugs like morphine, oxycodone, hydrocodone, and illicit substances like heroin. They’re driving the current opioid epidemic, which has seen a rise in addiction and overdose rates over the past several years. Around 2.1 million people struggle with opioid use disorders, and only a small percentage of them get the help that they need.

For many, the withdrawal process is a significant barrier to treatment. Opioid withdrawal is notoriously unpleasant, causing symptoms like nausea, vomiting, diarrhea, runny nose, sweating, and body aches. Many people describe opioid withdrawal as a particularly bad case of the flu. However, is it bad enough to require medical detox?

Opioids bind to opioid receptors all over the body. When you stop taking the drug, you’ll feel full-body symptoms that can be extremely unpleasant. Opioids aren’t known to cause life-threatening symptoms during withdrawal, but in certain circumstances, they can be dangerous. You may notice that, just like the flu, many symptoms involve water exiting your body. When you have the flu, your doctor tells you to drink plenty of water. 

That’s because there is some risk of dehydration. Opioid withdrawal has the same risk. Dehydration is easily remedied by drinking water, but if you don’t have access to clean water or if you can’t keep water down without throwing up, dehydration can lead to life-threatening complications. In opioid withdrawal, these issues are rare, but if you can’t keep water down, you need medical attention. 

Even though life-threatening opioid withdrawal isn’t common, relapse is. Along with these extremely uncomfortable symptoms, you’ll also experience strong cravings and compulsions to use the drug again. Going through opioid withdrawal on your own can risk relapse or a failure to achieve sobriety. Medical detox can alleviate your discomfort as much as possible and help you avoid using again before your withdrawal is over. 

Alcohol

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Alcohol is the most commonly misused substance in the United States, and the vast majority of American adults have tried it at least once. The 2019 National Survey on Drug Use and Health reports that more than 14 million people have an alcohol use disorder. Alcohol use problems can lead to long-term health, social, and financial problems, and alcoholism should be addressed as soon as possible. However, alcohol is one of the most dangerous substances when it comes to withdrawal. 

Alcohol is a central nervous system depressant. It works by increasing the effectiveness of a natural chemical called GABA (gamma-Aminobutyric acid), which is responsible for facilitating sleep and relaxation. As your body gets used to the presence of alcohol in your system, it will try to adapt to achieve chemical balance around alcohol. 

When you stop using, the depressing effects of alcohol will be gone, suddenly sending your nervous system into a chemical imbalance. This can cause you to feel overstimulated. Symptoms often include anxiety, shakiness, headache, insomnia, tremors, and nausea. 

But in some cases, symptoms can be worse. Heavy alcohol use over a long period can cause you to have a severe dependence on alcohol. If you try to quit cold turkey, you might experience deadly symptoms. Seizures and a condition called delirium tremens may occur. 

Delirium tremens is a condition that’s characterized by sudden confusion, panic, sweating, seizures, heart palpitations, and chest pains. It can cause cardiac arrest or stroke in some cases. Because alcohol can cause potentially life-threatening symptoms, it’s usually recommended that you speak to a doctor or go through a detox program before trying to quit cold turkey.

Benzodiazepines

Benzodiazepines are another central nervous system depressant like alcohol. They’re used as prescription medications for anxiety and sleep disorders, and they’re sold under the brand names Xanax, Valium, and Klonopin. Some benzodiazepines may also be used to treat alcohol use disorders. Because they act in the brain in a way that’s similar to alcohol, they can help taper you off alcohol dependence. 

However, long-term use of a benzodiazepine can also cause tolerance and dependence. Even though benzodiazepines are used to treat alcohol withdrawal, they can potentially cause dangerous withdrawal symptoms as well. 

As a depressant, benzodiazepines can cause some of the same withdrawal symptoms that alcohol can. If you use them for a long time and quit abruptly, you may experience more severe symptoms. While issues like delirium tremens aren’t as commonly associated with benzodiazepine withdrawal as they are with alcohol, it’s possible to experience some severe symptoms, like seizures. If you’ve become dependent on a benzodiazepine, you should speak to a doctor before trying to quit cold turkey. Medical detox may be the safest option.

Cocaine

Cocaine is a powerful central nervous system stimulant and a commonly misused drug. In many ways, cocaine is the opposite of depressants like alcohol. It works by increasing the activity in your nervous system, making you feel energized and alert. Cocaine works with feel-good chemicals in the brain, like dopamine

Dopamine is a chemical that’s tied to reward and pleasure. It may also make you feel alert and excited when it activates its receptors. Cocaine works to block dopamine from being removed from your system through a process called reuptake. This allows more dopamine to bind to more receptors, creating a more intense effect. People that take cocaine feel an intense sense of empowerment, excitement, wakefulness, and confidence. A cocaine high is generally short-lived, but cocaine’s effects can last for several hours.

When you stop using cocaine after becoming dependent on it, your body will be thrown into chemical imbalance, just like it would be if you suddenly stopped drinking. However, instead of the overstimulating symptoms, you might feel with alcohol, you’ll feel depressing symptoms. Cocaine can make your body used to the presence of a stimulant, so it adapts by creating more calming chemicals. When you stop supplying your body with the stimulating drug, your chemical balance will tilt toward depression. 

One of cocaine’s most common withdrawal symptoms is fatigue. The stimulating wakefulness is gone, and your body is left feeling overworked. If you spent time binging cocaine before quitting, you may have also gone for a long period without sleep. You may experience hypersomnia with restless sleep. 

Other cocaine withdrawal symptoms may include agitation, restlessness, general discomfort, increased appetite, unpleasant dreams, sleep disturbances, and depression. Cocaine withdrawal isn’t commonly associated with life-threatening symptoms. 

In many cases, the most severe symptoms are psychological. Cocaine withdrawal can cause deep depression, and sometimes that leads to suicidal thoughts and actions. Detox can also help alleviate discomfort and monitor your mental health. Clinicians are often on staff at detox facilities to help address issues like depression.

Amphetamines

Amphetamines are a category of stimulants that includes ADHD medications like Ritalin and Adderall. They’re used for their ability to increase focus in people with attention problems. People sometimes misuse amphetamines as cognitive performance-enhancing drugs. Students may use them to increase wakefulness and focus during study sessions in order to improve grades. 

Another type of amphetamine is used for recreational purposes. Methamphetamine is a powerful stimulant that causes feelings of excited euphoria. Like cocaine, meth works with chemicals like dopamine. However, meth can both block dopamine reuptake and increase the release of dopamine, flooding your receptors with the chemical. This can actually damage your dopamine receptors, making it harder for you to feel reward and pleasure without meth. 

Meth withdrawal can come with many of the same symptoms as cocaine, but damaged dopamine receptors can make some symptoms more intense. People in the meth withdrawal phase may experience a condition called anhedonia, which is the inability to feel pleasure. 

This can lead to deep depression and suicidal thoughts. Meth use is also associated with some medical issues like tooth decay and infections that may need immediate medical care. While meth withdrawal isn’t known to be as life-threatening as alcohol withdrawal, a detox program may be the safest way to achieve sobriety.

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