What is detoxification in situations of substance abuse?

Overview

Detoxification (detox) is applied to chronic situations of substance abuse , such as alcoholism and drug addiction. It also applies to acute conditions such as alcohol poisoning caused by binge drinking and drug overdoses. Detox is only the first step in the resolution of a substance abuse problem. It removes the substance from the body and restores homeostasis (a state of normalcy), but it does not remove the person’s desire to ingest the substance again. Follow-up care is essential to reduce the likelihood of continued substance abuse.

Alcohol Detoxification

Alcohol detox is necessary in cases of alcohol poisoning caused by the rapid ingestion of a large quantity of alcohol over a short time and in cases of long-term alcohol abuse (alcoholism). Most cases of alcohol poisoning are caused by ingestion of ethanol (C2H5OH), which is a component of beer, wine, and hard liquor. Ethanol is produced by the fermentation of sugar.

Some cases of alcohol poisoning are caused by methanol (CH3OH) or isopropyl alcohol (C3H8O). Methanol is primarily used in the production of other chemicals; it is sometimes used as an automotive fuel. Isopropyl alcohol is a component of rubbing alcohol and is widely used as a solvent and cleaning fluid.

The amount of alcohol in the body is usually measured as the blood alcohol content (BAC). The BAC is expressed as the percentage of alcohol per liter of blood. Alcohol consumption is also measured by the number of drinks consumed.

Alcohol Poisoning. Treatment of alcohol poisoning consists of supportive measures as the body metabolizes the alcohol. These measures include insertion of an airway (endotracheal tube) to prevent vomiting and aspiration of stomach contents into the lungs; close monitoring of vital signs (temperature, heart rate, and blood pressure); oxygen; medication to increase blood pressure and heart rate, if necessary; respiratory support, if necessary; maintenance of body temperature (blankets or warming devices); and intravenous fluids to prevent dehydration. Glucose should be added to fluids if the patient is hypoglycemic (has low blood sugar). Thiamine is often added to fluids to reduce the risk of a seizure. A final measure is hemodialysis (blood cleansing), which might be needed in cases of dangerously high BACs (more than 0.4 percent). Hemodialysis is also necessary if methanol or isopropyl alcohol has been ingested.

Alcoholism.
Withdrawal symptoms from long-term alcohol abuse may range in severity from mild tremors to seizures, which can be life-threatening. Approximately 5 percent of patients undergoing alcohol withdrawal have delirium tremens (DTs), which are characterized by shaking, confusion, and hallucinations. DTs also cause large increases in heart rate, respiration, pulse, and blood pressure. These symptoms usually appear two to four days after abstinence from alcohol. Withdrawal may require up to one week. Patients suffering from DTs require inpatient care at a hospital or a treatment center.

Although some patients with less severe symptoms also receive inpatient care, many can be successfully treated as outpatients. Sedatives are administered to control withdrawal symptoms, which range from anxiety to seizures.

Drug Detoxification

A patient in need of detox can be either a long-term substance abuser or a person who has had an acute drug-related episode (for example, an overdose). Drugs requiring detox include both illegal substances such as heroin and cocaine and prescription medications used inappropriately. Most cases of drug abuse involve psychoactive (mood-altering) substances. Psychoactive substances are either central nervous system (CNS) stimulants (cocaine and methamphetamine) or CNS depressants (heroin or barbiturates). Many substance abusers ingest more than one drug with different properties, which complicates detox measures. Drugs are sometimes ingested with alcohol, which is a CNS depressant.

Long-term substance abusers are admitted voluntarily to a health care facility, through the prompting of friends or relatives, or by court order. Initially, health care staff take a complete medical history (with particular attention to substances abused). This history is followed by a physical examination and laboratory tests, which check for levels of substances in the bloodstream. A treatment plan is formulated based on the duration of abuse and on the substances involved.

The condition of persons experiencing an acute drug-related episode ranges from euphoric to comatose; furthermore, the status may change rapidly. For example, a relatively alert person may lapse into a coma, have a seizure, or suffer cardiac arrest. For a person with a drug overdose, detox consists of supportive measures similar to those for alcohol poisoning. If a CNS stimulant was ingested, medication may need to be administered to lower the patient’s heart rate, blood pressure, and respiration. If a CNS depressant was ingested, medication may need to be administered to raise these parameters.

The first step of detox is to evaluate the patient’s physical and mental status and determine the types of substances involved. In some cases, information can be obtained from the person, witnesses, or physical evidence (such as syringes or pill containers). If this information is not available, medical staff conduct laboratory tests to determine the substances (and amount) present in the bloodstream.

If necessary, supportive measures such as oxygen administration, respiratory assistance, and intravenous medication will be initiated. Usually, medication is required to guide the patient through the detox process. Patients will be told of the medications used during treatment. The detox process may take one or two weeks and can be done on an inpatient or outpatient basis, or in combination.

For people with a serious substance abuse problem, inpatient care is often necessary. These programs include detox followed by counseling, group therapy, and medical treatment. A benefit of an inpatient program is that it greatly reduces the risk of a patient gaining access to harmful substances. For anyone who receives inpatient care, regular outpatient follow-up is essential. Many medical centers include treatment for substance abuse. Stand-alone facilities also are present throughout the United States and in other developed nations. Some provide care in a basic, clinical setting while others function in a resort-like setting. One well-known facility is the Betty Ford Center (in Rancho Mirage, California), which was founded by former US First Lady Betty Ford. The one-hundred-bed nonprofit residential facility offers inpatient, outpatient, and day treatment for substance abusers. It also provides prevention and education programs for family members (including children) of substance abusers.

Rapid Detoxification

Rapid detox is a controversial treatment method for addiction to opiates such as heroin. In rapid detox, the patient is placed under a general anesthetic and is administered drugs such as naltrexone, which block the brain’s opiate receptors from any circulating opiates. Additional medications are administered to accelerate the physical reactions to the rapid withdrawal while the patient is unconscious. Proponents of the process state that the procedure not only shortens the withdrawal process but also avoids much of the associated pain, which can be severe. Opponents point to studies that some patients undergo serious complications and death, and to other studies that describe the return of withdrawal symptoms after the patient awakens from the anesthetic. Critics also note that the treatment can be expensive.

Nicotine Detoxification

Nicotine , which is contained in tobacco leaves, is highly addictive. In addition, cigarette smoking (or chewing) has pleasurable associations and induces stress relief. This component of smoking markedly increases the likelihood of a relapse. Detox occurs on an outpatient basis with the use of aids such as nicotine patches or gum, which are gradually decreased in amount.

Innumerable resources are available to individuals who desire to quit smoking. These resources include personal physicians, smoking-cessation clinics, and self-help groups. Some people can simply quit smoking on their own and endure the withdrawal symptoms, which include strong cravings for a cigarette, restlessness, and irritability. Withdrawal from nicotine takes one to two weeks after last dose.

Bibliography

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Fisher, Gary, and Thomas Harrison. Substance Abuse: Information for School Counselors, Social Workers, Therapists, and Counselors. 4th ed. Boston: Allyn, 2008. Print.

Liptak, John, et al. Substance Abuse and Recovery Workbook. Whole Person, 2008. Print.

Miller, William. Rethinking Substance Abuse: What the Science Shows, and What We Should Do About It. New York: Guilford, 2010. Print.

Seixas, Judith. Children of Alcoholism: A Survivor’s Manual. New York: Harper, 1986. Print.