The process and criteria for drug and alcohol detoxification

By Dr. Jeffrey Huttman

CEO of Evolutions Treatment Center

For many individuals struggling with addiction, the process of seeking help can be confusing and frightening. It is often unclear when detox is necessary, what the process entails, and how to take the first steps to get the appropriate level of help. Detox is a necessary pre-requisite to initiating the recovery process, which is relatively easy to explain.

Simply put, detox is a medically supervised method to safely stop using substances that have been taken habitually and led to physical dependence. For many struggling with drug or alcohol addiction the compulsion to use has long since been driven by pleasure, but rather to ward off the extremely unpleasant symptoms of withdrawal that accompany immediate cessation of use. The need for more drugs or alcohol become driven by the fact that intense sickness will set in if one doesn’t continue to use his or her drug of choice.

For alcohol or substance dependent individuals, in-spite of legal, occupational, social, or familial consequences establishing good reasons to stop; the extreme physical and mental urges to use may make this virtually impossible without a medically supervised taper. The first step to sobriety is to stop use, which often stems from a safe detox process.

Many individuals don’t realize that in addition to unpleasant physical symptoms, abrupt discontinuation of certain drugs or alcohol without medical supervision can lead to seizures, dehydration, psychosis, or in severe cases death. A medically supervised detox by experienced licensed and credentialed providers does not need to be unpleasant. A good team of medical and clinical practitioners can make the process quite pleasant and comfortable. Additionally, detox does not need to occur in a hospital setting and can be safely accomplished in a private facility with a variety of amenities designed to promote overall wellness.

Detox starts with a detailed history of the substances being taken and a thorough assessment of physical symptoms indicative of withdrawal. Depending upon the substances one has become reliant upon, unpleasant physical and mental feelings can begin within hours of last use and progressively worsen with each passage of time. According to the Clinical Institute of Withdrawal Assessment of Alcohol Scale (CIWA-Ar) that is widely utilized in evidenced based detoxification settings, symptoms of withdrawal from alcohol can include the following: nausea and vomiting; sweating; tremors; anxiety; tactile, auditory, and visual disturbances; headaches, and disorientation. According to the Clinical Withdrawal Scale (CWS) that is also widely utilized in detoxification treatment, symptoms of withdrawal from opioids can include the following: Increased pulse rate; sweating; restlessness; abnormal pupil size; bone or joint aches; runny nose or tearing eyes; tremors; yawning; anxiety or irritability; changes in skin roughness or goosebumps, and GI (stomach) upset.

According to guidelines by the American Society of Addiction Medicine (ASAM) that should be utilized in any empirically guided program , one meets criteria for the inpatient detoxification level of care when at least one of three dimensions are met:

Dimension 1: Acute Intoxication and/or Withdrawal Potential.

This includes at least mild symptoms of withdrawal, or evidence that it will be imminent and one is at risk of experiencing more severe symptoms. There is evidence that the individual in need of medication is unlikely to complete detox at a lower level of care or enter into the next stage of treatment or self-help recovery without it. The individual requires medication to detox and has been unable to successfully do so in prior attempts in less intensive settings, nor does he or she have proper skills or support systems in place to complete detox outside of an inpatient setting. Lastly, this individual is simultaneously experiencing physical, emotional, behavioral, and cognitive symptoms that increase the intensity of withdrawal.

Dimension 2: Biomedical Conditions and Complications.

The physical symptoms experienced are manageable in an inpatient detox setting, increase the severity of withdrawal, and complicate the detoxification process.

Dimension 3: Emotional, Behavioral or Cognitive Conditions and Complications.

The emotional, behavioral, or cognitive symptoms are manageable in an inpatient detox setting, but complicate the detox process and intensify the clinical severity of withdrawal.

When withdrawal sets in there are a variety of medications, when safely administrated under supervision, that can avoid any physical or threatening symptoms from being initiated. These medications are then adjusted and decreased slightly each day until they are no longer needed and one is not at risk of illness without taking his or her drug of choice. The individual is then able to consider next steps in the road to recovery free of the medical complications related to prolonged use of an addictive substance.

While the process of seeking treatment can be frightening and overwhelming, detox itself does not need to be an uncomfortable experience. When offered in a private, warm, and comfortable setting through an experienced team of professionals, inpatient detox can be a very smooth and carefree time in the initial road to recovery. Upon being medically stabilized and beginning to clear up cognitively, one can begin to engage in counseling and case management services to help determine the next steps towards recovery. Detox is also a time to seek comfort through nutritious foods, physical and psychiatric assessments and a variety of treatment services. As with any intensive medical treatment, rest and relaxation is an essential part of the detox process.