What Is Direct Tapering?

Sometimes, when a person wants to stop using a drug, just quitting cold turkey isn’t an option. With some drugs, withdrawal symptoms can be so strong that they make cravings worse and increase the chances of relapse. In other cases, stopping use of the drug quickly can cause severe symptoms that put the individual’s life at risk. Because of these potential circumstances, just quitting cold turkey can actually be just as dangerous as continuing to use the drug – just in different ways.

There are other options for helping individuals stop drug use that can minimize these issues. Detox through drug tapering can reduce withdrawal symptoms and help the body adjust to the loss of the drug more smoothly, improving the experience of the detox process. As described by the National Institute on Drug Abuse, tapering can make it easier to manage continued drug treatment after withdrawal with a decreased chance of relapse to drug use.

The Detox Process

For many who want to stop using drugs, the detox process is an intimidating step toward recovery. Not knowing what to expect, these people pick up on rumors and worry that detox is going to be too much to handle. However, with a proper understanding of how detox works, these people can put their fears at ease and feel better about stopping drug use.

Stopping use abruptly cuts off the supply of the drug to the brain very quickly, which can prompt the brain to respond in a negative manner. This is because the systems affected by the drug are often damaged or unable to respond to the loss of the drug very quickly; the result is that the body is unable to perform needed functions without the drug, resulting in negative side effects, or withdrawal symptoms. Until the brain is able to readjust and make up for the drug’s loss, the individual may experience various symptoms, such as:

• Fatigue and altered sleep patterns
• Digestive upset and pain
• Nausea and vomiting
• Changes in heart rate and breathing
• Muscle aches and pains

There are a number of other symptoms that can occur, depending on the drug; some of these are life-threatening or can at least require that the individual receive emergency care. For this reason, drug treatment experts have spent a lot of time seeking ways to make the detox process easier and less risky.

Detox Using Direct Tapering

There are multiple ways of detoxing from drugs other than stopping abruptly. Working with a medical professional to find the most appropriate form of detox for the individual, which is then undertaken through medical treatment, is called medical detox. Drug tapering methods are part of the medical detox options and include:

• Direct tapering
• Substitution tapering
• Titration tapering

Direct tapering is the most straightforward of these tapering methods, and this method is often applied to help people cut down on drug use gradually. This makes it easier to manage withdrawal and move forward into the next steps in addiction treatment with a decreased chance of relapse into drug use.

The process of direct tapering is rather simple. Instead of stopping use completely in one step, the individual cuts the dosage of the drug by a small amount on a regular basis until all intake is stopped. This can help to manage some of the issues of withdrawal that are described above. This differs from methods like substitution tapering because there is no change in the drug being taken during the taper.

How Does Direct Tapering Help?

Direct tapering helps detox by giving the individual’s body the chance to adjust to loss of the drug over time, rather than forcing the brain to deal with losing the drug all at once. This, in turn, can help to reduce symptoms of withdrawal – sometimes to a large degree. Direct tapering can also help to prevent some of the more severe symptoms of withdrawal, making it less likely that the individual will experience a life-threatening situation during detox.

By reducing the drug dosage by small amounts over time – usually by eliminating about 10 percent of the dose each time, as in one direct taper process described by Magellan Health – the individual maintains a certain concentration of the drug in the body while still reducing the amount of the drug being taken. Over weeks, or sometimes even months, this slow decrease can occur without triggering the negative responses in the brain that can lead to severe withdrawal.

With decreased symptoms of withdrawal, the individual is less likely to experience a high level of desire to return to drug use, and cravings may be diminished. This makes it more likely that the person can make it through the detox and treatment processes and remain drug-free in the long run.

Statistics and an Example of Direct Tapering

A study from JAMA Internal Medicine demonstrates an example of using direct tapering to help people who were struggling with benzodiazepine use. Benzos are highly addictive, and trying to quit them abruptly can lead to a severe withdrawal syndrome, including seizures that can be life-threatening.

In the study, individuals who were given a direct taper plan were more likely to have stopped using benzos after six months – 27 percent of the individuals who did a direct taper were drug free by this point, compared with only 5 percent of those who did not quit using a taper. This demonstrates that, under the right circumstances, direct tapering is more likely to result in the individual stopping drug use. However, there are cases in which direct tapering is not the ideal method of detox.

When Direct Tapering Doesn’t Work

Some drugs, such as low-dose, short-acting medicines, may not be able to be reduced accurately with a direct taper. For example, low-dose benzodiazepines like Xanax may be too short-acting to enable an appropriate reduction in dosage without support. In these cases, methods like substitution or titration tapering may be more helpful.

As an example, as described in the Ashton Manual regarding benzodiazepine withdrawal, an individual on short-acting Xanax may be switched to a longer-acting dose of Valium to help with the taper because Valium lasts longer and comes in dosages that are easier to reduce in small amounts. However, if the individual is struggling with Valium to begin with, the taper can occur without changing to a different substance, resulting in a direct taper.

From Detox to Addiction Treatment

The key reason to apply medically supported detox is to achieve the highest degree of relapse prevention possible. Each person is different, meaning that one individual’s treatment needs might not be the same as another person’s. For this reason, trying to follow a generic detox plan, including taper plans like those found online, will often not work as expected, increasing the individual’s risk of severe or even dangerous withdrawal.

Working with a reputable, professional drug treatment program can help to decrease this margin of error, making it more likely that the individual will get a detox plan that is customized to the drug type, the degree of addiction, and the individual’s relapse risk. At the same time, receiving detox care that decreases withdrawal symptoms can also help the individual make it through the rough withdrawal period and move forward into the rest of treatment, in turn increasing the chance of continued abstinence and a return to a productive daily routine without drugs.