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In the past, patients who found themselves addicted to drugs or alcohol were doomed to unspeakable suffering as they tried to achieve abstinence. A few fortunate patients underwent drug detox at clinics and hospitals, where doctors could prescribe a handful of medications that eased the misery of withdrawal – but even these medications were only partially successful. Most patients were left to their own devices and the agony of a “cold turkey” detox (so called because of the symptoms of chills and gooseflesh that accompanied opioid and alcohol withdrawal). Those addicted patients who were unable to endure withdrawal often returned to drugs to obtain relief. Few made it through the detox process. Some even died.

Today, doctors who treat addiction no longer inflict cold turkey detox on patients. It’s ineffective, and it’s inhumane. Now doctors have new medications such as the newly approved opioid detox medication buprenorphine (Suboxone) to help patients through the detoxification process safely and comfortably. Proper detox makes it much more likely that addicts will seek treatment at an earlier stage of their illness, and will transition from treatment to long-term sobriety with greater confidence.

Addicts, like all patients, deserve treatment that best serves their needs and not ill-informed and tired ideologies about moral failings and bad choices. Combined with the traditional wisdom of twelve-step recovery, the medications available today to doctors who treat addicts paint a bright future for the treatment addiction. Patients who repeatedly failed treatment in the past are now reporting that for the first time in their lives they feel hope.

LENGTH OF DETOXIFICATION

Because detoxification often entails a more intensive level of care than other types of Drug treatment, there is a practical value in defining a period during which a person is “in detoxification.” There is no simple way to do this. Usually, the detoxification period is defined as the period during which the patient receives detoxification medications.

Another way of defining the detoxification period is by measuring the duration of withdrawal signs or symptoms. However, the duration of these symptoms may be difficult to determine in a correctly medicated patient because symptoms of withdrawal are largely suppressed by the medication. Chapter 3 describes the typical lengths of regimens for withdrawal.

THE ROLE OF DETOXIFICATION IN DRUG ABUSE TREATMENT

For many Drug-dependent patients, detoxification is the beginning phase of treatment. It can entail more than a period of physical readjustment. It can also be a time when patients begin to make the psychological readjustments necessary for ongoing treatment. Offering detoxification alone, without followup to an appropriate level of care, is an inadequate use of limited resources. People who have severe problems that predate their Drug dependence or addiction — such as family disintegration, lack of job skills, illiteracy, or psychiatric disorders — may continue to have these problems after detoxification unless specific services are available to help them deal with these factors.

IMMEDIATE GOALS OF DETOXIFICATION

To provide a safe withdrawal from the drug(s) of dependence and enable the patient to become drug free. Many risks are associated with withdrawal, some influenced by the setting. For persons who are severely dependent on alcohol, abrupt, unsupervised cessation of drinking may result in delirium tremens or death. Other sedative-hypnotics may produce life-threatening withdrawal syndromes. Withdrawal from opioids produces severe discomfort, but is not generally life threatening. However, risks to the patient and society are not limited to the severity of the patient’s physical disturbance, particularly when the detoxification is conducted in an outpatient setting. Outpatients experiencing withdrawal symptoms may self-medicate with street drugs. The resulting interaction between prescribed medication and street drugs may result in an overdose. Less severe side effects include sedation or a drop in blood pressure.

To provide withdrawal that is humane and protects the patient’s dignity. A caring staff, a supportive environment, sensitivity to cultural issues, confidentiality, and the selection of appropriate detoxification medication (if needed) are all important to providing humane withdrawal.

To prepare the patient for ongoing treatment of his or her Drug dependence. During detoxification, patients may form therapeutic relationships with treatment staff or other patients, and may become aware of alternatives to an Drug-abusing lifestyle. Detoxification is an opportunity to offer patients information and to motivate them for longer term treatment.

REPEATED DETOXIFICATION

Alling discussed detoxification and treatment in a text published in 1992:

Those not familiar with the chronic nature of addictive disorders often characterize detoxification programs as ‘revolving doors’ through which patients come and go in an endless cycle, and which have little or no impact on the recovery process. Although it is true that many people undergo detoxification more than once — and some do so many times — the assumption that little or no progress has been made is often false.

A pattern in individuals who return for several detoxification episodes, observing that young people with a history of Drug dependence of short duration (a year or less) “often are unrealistically optimistic about being able to remain drug free following detoxification.” When recently Drug-dependent persons return after several months for repeat detoxification, it is usually with a more realistic expectation about what is needed to remain free from Drugs. Individuals who subsequently relapse and return for detoxification a third time may have an even clearer understanding of what is required to sustain recovery.

During certain expected and predictable phases of recovery, addicted persons are at increased risk of relapse. However, relapse can occur at any point in recovery. Thus, relapse prevention is a legitimate area for patient education, and the relapsed patient is appropriate for clinical treatment. Treatment services designed precisely for this stage of the disease may facilitate the individual’s return to abstinence.

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