Detox Centers & Programs

Medically Supervised Detox

Medically supervised detox is an important process on the road to recovery from a substance abuse disorder or addiction. During detox, patients are safely and systematically withdrawn from the substance they are using, while being looked after by a physician. When people use drugs or drink alcohol excessively, they can become physically dependent. At that point, if they were to stop using, they will start to experience withdrawal symptoms. These symptoms are uncomfortable at best and lethal at worst, so it is very important that they are properly managed. During the process of detox, the bodily effects of no longer using a substance are treated, while the body cleanses itself of the toxins that are still present within the body.

Detox & Outpatient Centers

Depending on the substance and the severity of the abuse or addiction, detox can be completed through outpatient centers such as private clinics, addiction clinics, or mental health centers. It can also be completed in outpatient centers, such as residential treatment facilities or hospitals. With inpatient treatment, the recovering addict can be monitored around the clock and it also means that they will not have the opportunity to get back to using the drug or drinking alcohol. As such, the physical detox is usually completed much more quickly. However, by going to an outpatient facility, people experience far less disruption to their personal lives, and it is also usually much less expensive. Choosing between the two options will depend on a range of different factors, including the substance in question, how much the patients have been using, how long they have been using or drinking, whether any mental health issues are present, how old they are, what psychosocial conditions are present, and more.

The majority of drug and alcohol treatment centers have detox facilities of their own. For some, this means having partnerships with local detox sites, such as clinics and hospitals. Licensed detox centers exist all over the country. The best way to find one is to visit the Substance Abuse and Mental Health Services Administration (SAMHSA) website, which offers an online treatment locator at findtreatment.samhsa.gov. They have a detailed search menu available where you can enter your city and state, after which you can choose detox as well as the type of care you are most interested in. This includes hospital inpatient, non-hospital residential, day treatment, partial hospitalization, and outpatient.

Alcohol Medically Supervised Detox

During alcohol medically supervised detox, it is very important to be under the care of a physician. While the majority of people who have an alcohol addiction or dependency only experience mild to moderate withdrawal symptoms, it is possible for detox to be fatal. This is why it is very important to receive supportive monitoring and care. Generally, however, alcohol detox can be done without any medication.

Preventing Complications from Detox Using Medication

If an alcoholic is at risk of developing complications, which is possible in people who have been drinking for a long period of time, or in those who also have co-occurring conditions, then it is incredibly important that medically supported detox is done on an inpatient basis. For those who fall into this category, they may experience severe withdrawal symptoms, including delirium tremens and seizures. It is important, therefore, that they are medically managed, for instance, by being prescribed benzodiazepines, which can help stop the adverse effects. There are other medications that have been used for alcohol detox as well, including clonidine. Clonidine has been shown to be particularly effective in dealing with mild depression, tremors, anxiety, high blood pressure, and tension. Carbamazepine is another popular drug, which is an anti-convulsant drug that helps prevent delirium or seizures.

Interestingly, new research has shown that outpatient detox has been shown to be equally effective for alcohol addiction as inpatient treatment, at least in those with mild to moderate problems. Additionally, it is much more affordable. However, it does require daily monitoring and followup in order to be truly effective. Usually, outpatient alcohol detox is achieved by providing patients with a tranquilizer, such as 2mg of lorazepam, 10mg of diazepam, 15 to 30mg of oxazepam, or 50mg of chlordiazepoxide. These drugs are administered once every six hours for 24 hours. As the symptoms change, dosages can be reduced, increased, or discontinued.

Need to Treat Electrolyte and Nutritional Deficiencies

It is very important that people detoxing from alcohol are also treated for electrolyte and nutritional deficiencies. During detox, their withdrawal severity should also be closely monitored. Afterwards, abstinence must be maintained, which is why patients should be referred to self help groups and alcoholism recovery programs.

Outpatient Detoxification

Outpatient detoxification is commonly performed by using a tranquilizer such as chlordiazepoxide 50 mg, oxazepam 15 to 30 mg, diazepam 10 mg, or lorazepam 2 mg every 6 hours for the first 24 hours. Additional medication can be provided as medically necessary and doses can be decreased as symptoms resolve. Supportive care for patients undergoing detoxification includes providing treatment for nutritional and electrolyte deficiencies, monitoring withdrawal severity and abstinence, and providing referrals to alcoholism recovery programs and self-help meetings.

Cocaine Medically Supervised Detox

There is currently no proven or U.S. Food and Drug Administration (FDA) approved pharmacological treatment option for people with a cocaine addiction. That said, several medications have been and continue to be used regardless. When people are chronic cocaine users and go into withdrawal, they often experience depression, anxiety, and incredibly intense cravings. This can be addressed by medication in a range of different ways, including:

    1. Antidepressants, including phentermine and fenfluramine combinations, or desipramine. They have helped to reduce feelings of depression and anxiety, common during withdrawal.
    2. Tranquilizers, including diazepam and other benzodiazepines. They help to reverse the anxiety that is commonly experienced during withdrawal from cocaine.
    3. Parkinson’s disease medication, particularly Amantadine. This has been shown to be effective in people who go through more severe withdrawal symptoms. It has also helped to reduce the cravings usually associated with addiction.
    4. Dopamine enhancers such as bromocriptine. This has been shown to help lower cravings for cocaine during detox. Additionally, it helps to prevent mood disturbances.
    5. Beta-blockers like propanolol, which is usually used in the treatment of high blood pressure. It is believed to help people with severe withdrawal symptoms because it suppresses some of the adrenal gland’s functions. As such, the body no longer goes into flight or fight mode when exposed to stress. It has been used successfully in the treatment of anxiety that is common in people with a cocaine addiction. Furthermore, propanolol has also helped to reduce other withdrawal symptoms, including sweating and palpitations. In so doing, it also significantly reduces cravings in individuals. However, there are significant risks associated with propanolol, including decreased blood flow to the heart, as well as other issues. Effectively, people with a predisposition to heart problems may develop a more permanent arrhythmia, while raising their blood pressure and thereby risking that a stroke will happen. With cocaine withdrawal, it is vital that people are carefully monitored.

Opiate Medically Supervised Detox

In order to properly withdraw from opiates and opioids in a safe way, it is important to seek high quality medical treatment. This is often offered in residential centers or hospitals, where people can access a proper detoxification unit. For those who have used opiates or opioids, and particularly for those who have used them at high dosages and/or for long periods of time, this really is the only way for them to remain safe during withdrawal and to actually come out on the other side.

Inpatient Detox Recommended

These substances often lead to very uncomfortable withdrawal symptoms, many of which last for long periods of time. If someone were to also have a health problem, with is common in those who have an addiction to opioids, these symptoms can become even worse. Through inpatient detox, patients are able to be fully monitored throughout the entire process, being provided with the right medical intervention at the right time to ensure their journey is successful. With opioids, this is usually done through tapering, meaning that the recovering patient is provided with a different agent that acts in a similar manner to the drug of choice, and then the dosage is gradually reduced.

Rapid Detox

Those with an opioid addiction can also go through rapid detox. Here, they are placed under general anesthesia, and an intravenous opiate blocker is provided to them. Other drugs are usually also injected, including anti-nausea medication and muscle relaxants, so that patients don’t suffer too many ill effects. Through this process, people are able to withdraw from their substance, which can include nalmephine, naloxone, or naltrexone to name but a few, in a very rapid way. In fact, they will be considered as detoxed within just six to eight hours. This treatment has to be completed within an intensive care unit, however, and patients generally have to stay in hospital for at least 48 hours before they can return home or attend an inpatient rehab facility.

During rapid detox, the distressing feelings associated with opiate withdrawal are reduced significantly. This is why it is an important and useful method for those who take narcotic type drugs, such as prescription painkillers, hydrocodone, oxycodone, codeine, morphine, opium, OxyContin, Darvocet, Dilaudid, Demerol, Percocet, Vicodin, or heroin. The period of detox is made significantly shorter and the pain and discomfort associated with going through withdrawal are completely removed. This can truly be of great benefit for those who would suffer from more severe withdrawal symptoms, particularly if they have repeatedly tried to detox in different ways, but were never quite able to achieve it. Unfortunately, rapid detox is very expensive, as the procedure has to be completed in a surgical unit in a hospital and because patients have to be monitored for possible complications for at least 48 hours.

Stepped Rapid Detox

The next option is the stepped rapid detox. This is a great alternative to rapid detox. Here, patients are provided with a small Naloxone or Narcan dosage that is injected just underneath the skin. Additionally, they take naltrexone every other hour, which is quite an intensive commitment. Because this method uses both subcutaneous and oral routes, it is slower than rapid detox. When patients start to experience more severe withdrawal symptoms through this process, they can quickly be provided with a Buprenorphine tablet, which they place under the tongue. This method is preferred by many because fewer medications need to be provided overall. Additionally, the patients are awake so that they are able to communicate with the medical professionals around them until detox has been completed. It is possible to detox with this type of therapy in between two and four manageable bites. As an added benefit, if the patients use the substance they are addicted to while taking Naltrexone, it will be ineffective because the medication blocks all receptors.

Ultra Rapid Detox

Next, there is ultra rapid detox. Here, patients are placed in a medically induced coma and they are provided with Naltrexone to block all the endorphin receptors. Doing this makes the withdrawal process much quicker, pushing people into 100% detox in a five to 30 minute time period. This is extremely painful, but it can be tolerated when under a general anesthetic. It is incredibly costly, however, and also quite risky.

Outpatient Detox

The next option is outpatient detox. This is generally an effective and safe method of detoxification for those who will only suffer from mild to moderate withdrawal symptoms. As an example, people could receive outpatient detox in a primary care setting by being provided with clonidine on its own, combined with naltrexone, or through buprenorphine-naloxone (BUP/NX). Buprenex is FDA approved for outpatient withdrawal and can be prescribed by general physicians so long as they have received the necessary training. This method is very popular, because it takes just one to two weeks for patients to be physically free of the drug.

Methadone

Last but not least, there is methadone. This is actually the most common medically supervised detox for people with an opiate addiction. Patients attend a methadone clinic for a dosage that is slowly tapered down. If done properly, this takes just 21 days to complete. The withdrawal period is still very uncomfortable, however, and the downfall of the methadone program is that many people continue to use drugs as well.

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