There have been enough popular films and television programs about substance abuse and addiction treatment that most people are familiar with the terms “detox” and “rehab.” For those unclear about the distinctions, detox, or detox treatment, refers to the process of physical detoxification from an addictive substance. Detox is usually just the first step of treatment for alcohol or drug addiction. Rehab refers to what is, or what should be, the next step in addiction treatment. That is, detox should be followed by a rehabilitation program that involves reconnecting the addict to a life free of substances through a combination of individual/group counseling and other evidence-based treatments, as well as educational sessions to learn healthy coping tools and relapse-prevention strategies. Many people think that removing an addictive substance from a person’s system is all that is necessary to heal and move forward, and this is an unfortunate misconception. Detox is very important, of course, but because of how addictive substances affect our brains and biochemistry, the rehabilitation phase of treatment is critical in effecting the behavioral, emotional, physical and psychological changes required to develop a solid foundation of abstinence, sober behaviors and emotional support that will carry an addicted person through early recovery and beyond.
Detox: A Closer Look at the Initial Step in Addiction Treatment
There are different types of detox, all of which can last from a couple of days to a week or so. Some types of detoxification are safer than others, depending on which substance an individual has been abusing, how much and for how long. Social Model Detox refers specifically to when a person undergoes the detox and withdrawal process from an addictive substance without the use of any medication to help them manage withdrawal symptoms. There are some addiction treatment centers that use social model detox. With this detox model, staff members will typically monitor, supervise and support clients through counseling, but will prevent access to any drugs or alcohol and will not use any of the medications approved by the Food and Drug Administration (FDA) for detoxification. According to best-practice guidelines for the treatment of substance use disorders, social model detox can help clients avoid taking other medications and also keep costs down, but a concern with this model is that it is not the safest choice for everyone. People detoxing from certain substances, such as alcohol, benzodiazepines or heroin and other opiates may encounter particularly difficult and dangerous phases in the withdrawal process that require medical treatment. For example, some alcoholics in withdrawal can experience delirium tremens, or DTs, which can be life-threatening. In these cases, medically assisted detox treatment will be the safer and more appropriate choice. Medical Model Detox is the preferred approach for detox treatment if a client is addicted to a substance that can lead to particularly severe withdrawal symptoms, such as those associated with alcohol withdrawal syndrome or benzodiazepine withdrawal syndrome. This model may also be the best choice if a client has co-occurring disorders or health conditions that will be impacted by the detox process and require medical management. Often, secondary conditions are unknown or undiagnosed until detox and rehab are initiated and detox of the addictive substance reveals recognizable symptoms of an underlying disorder. In these cases, a client may be switched from social model detox to medical model detox to safely manage any issues with targeted medication. During medical model detox, a client is typically tapered off of their substance of abuse gradually over time to help diminish withdrawal symptoms. Other medications may be introduced to further manage or diminish withdrawal symptoms and side effects, as well as to reduce cravings for the addicted substance. A sub-type of medical detox is rapid detox, for which the supervising physician will administer anesthesia. The use of anesthesia doesn’t make the detox occur more rapidly than other types of detox, but the client won’t remember the process so they have the sensation that it has occurred more rapidly. The use of anesthesia is intended to prevent an individual from experiencing the most difficult or painful aspects of withdrawal and essentially regain full consciousness at the end of the detox process.
Detox and Rehab With a Drug-Free Approach: Realistic or Idealistic?
Many clients, families and addiction treatment professionals have concerns about using medications, particularly those that can be addictive, to treat patients who already have addiction problems. Shouldn’t people seeking recovery be completely drug-free? Not necessarily. Sometimes drugs like buprenorphine or naltrexone (Vivitrol), which are used to help clients manage severe withdrawal symptoms and cravings, are what make rehab and recovery possible. Medically assisted treatment (MAT) and recovery may be the only way some people are going to make it — being completely drug-free in recovery is simply not realistic for everyone, particularly those addicted to opioids or opiates. For these clients, being closely monitored while receiving prescribed medication that blocks the effects of opioids is necessary to prevent them from relapsing. The best model or approach for drug and alcohol detox is usually one that is tailored specifically to you, the client, and your individual needs based on your health history, any co-occurring conditions, discussion with your addiction care and therapy teams about your safety and well-being, the substance of abuse and your personal preferences. Your aftercare plan should also take into account what will be feasible for you for maintaining abstinence and sustaining your recovery in the long term. Sources Detoxification and Substance Abuse Treatment Training Manual Based on a Treatment Improvement Protocol/TIP 45. Center for Substance Abuse Treatment (CSAT) of the Substance Abuse and Mental Health Services Administration (SAMHSA), 2009. https://adaiclearinghouse.org/downloads/TIP-45-Detoxification-and-Substance-Abuse-Treatment-49.pdf An Overview of Outpatient and Inpatient Detoxification. Motoi Hayashida, MD, ScD. NIAAA, NIH, Alcohol Health and Research World, 1998. https://pubs.niaaa.nih.gov/publications/arh22-1/44-46.pdf Opiate Addiction & Withdrawal Treatment; Opiate Addiction Treatment at Promises. https://www.promises.com/what-we-treat/opiates/ Effective Treatment for Opioid Addiction Isn’t the Same for Everyone. Clarity Way, 2017. https://www.clarityway.com/blog/effective-treatment-opioid-addiction-isnt-everyone/ How to Choose the Right Detox for You. Clarity Way. https://www.clarityway.com/blog/how-to-choose-the-right-detox-for-you/