What Is Substitution Tapering?
Medical professionals use tapering to help patients detox from drugs and alcohol as safely and comfortably as possible.
This article will discuss a specific type of tapering known as substitution tapering. Read on to learn more about this technique, how it works, and how it can jumpstart the recovery process for someone who is battling addiction.
What Is Substitution Tapering?
Substitution tapering is a method used by doctors to help patients attempting to quit drugs or alcohol. During substitution tapering, doctors gradually reduce the amount of the addictive substance and replace it with another substance that triggers a similar action in the body.
The replacement substance works to manage or stave off the more severe symptoms associated with withdrawal, enabling the body to adjust to a slow decrease in the substance rather than deal with the functional effects of an abrupt loss.
Why Use the Substitution Tapering Method?
Some drugs can be harmful to quit cold turkey. These substances, when misused or abused, can cause extremely uncomfortable and dangerous withdrawal symptoms that increase the risk of relapse, injury, illness, or even death.
When a person struggling with addiction attempts to reduce or stop use, these symptoms can create complications and make it more difficult to quit.
For example, abruptly stopping use of substances like benzodiazepines or alcohol may cause severe withdrawal syndromes with life-threatening symptoms, such as:
- Heart or breathing problems
- High fever
- Delirium tremens (alcohol, specifically)
Heroin withdrawal can result in severe cravings and uncomfortable symptoms like body aches, mood swings, insomnia, and other physical and mental reactions. Although these are not life-threatening, quitting cold turkey can intensify these symptoms, increasing the person’s desire to relapse and return to use.
Treatment at our medical detox facility near Tampa can minimize or even prevent some of these symptoms, ensuring the patient stays safe and comfortable throughout the withdrawal process. Once a patient successfully completes detox, they are more likely to get into a comprehensive treatment program and continue on to full recovery.
How Substitution Tapering Works
When a person becomes addicted to a drug or alcohol, the brain becomes accustomed to the presence of the substance in the body. In many cases, the neurochemical and other systems affected by the drug—including the dopamine, GABA, and stress hormone systems—can stop functioning normally as a result of the drug being in the body.
As the person continues use, the brain becomes less and less able to recover, and the body becomes dependent on the drug to function properly. This is what accounts for withdrawal symptoms when the drug is stopped; the body has become unable to manage these functions on its own.
Tapering makes it possible for the body to slowly pick up the slack for the drug over time, lessening its shock to the drug’s absence.
For some drugs, it is possible to just decrease the amount of the drug of abuse over time. This is referred to as direct tapering. However, for some substances, direct tapering may be difficult or impossible.
These substances include:
- Alcohol, since prior doses are hard to estimate accurately
- Short-acting, low doses of benzodiazepines that are almost impossible to divide accurately
- Substances like opioids that are considered to have high addiction and relapse potential
Examples of Substitution Tapering
Over the years, researchers have closely studied substitution tapering and its efficacy. These studies include:
- The Ashton Manual, which examined short-acting benzodiazepine withdrawal. Here, experts substituted a longer-acting benzo medication at a dosage that was easier to taper down, making it less likely that the individual will experience the most severe symptoms of withdrawal.
- A study from the Journal of Substance Abuse Treatment demonstrated that substitution tapering with long-acting benzos can reduce or even eliminate withdrawal symptoms such as seizures.
- Similarly, research in the Journal of Clinical & Diagnostic Research explained that benzodiazepine substitution has become the standard treatment for alcohol detox because of its ability to reduce or eliminate the severe symptoms of delirium tremens and other elements of the alcohol withdrawal syndrome.
- The Primary Care Companion to the Journal of Clinical Psychiatry, which focused on alcohol withdrawal. In this case, alcohol was replaced with a long-acting benzo to avoid the risk of delirium tremens, a severe withdrawal syndrome that can result in hallucinations, tremors, and catatonia, as well as seizures that can lead to death.
Additionally, a very well-known type of substitution tapering involves the use opioids with lower addiction potential to taper down from more addictive opioids like prescription painkillers or heroin. This is done to reduce withdrawal symptoms as well as intense cravings that can lead to relapse.
Substitution Taper Risks
The major risk of substitution tapering is possible development of a subsequent addiction. If the substituted medication or substance is also addictive, there is a chance that the individual will continue to struggle with addiction following treatment with a substitution taper.
To avoid this, experts recommend that tapering is limited to a short-term period. It is also important to make sure a medical professional monitors a substitution taper, so the individual being treated complies with treatment and ceases use of the substitute, as well as the original addictive substance when the taper is done.
However, even in cases of successful detox completion, relapse remains a concern unless an individual seeks further support through addiction treatment.
Treatment and Substitution Tapering
Treatment for substance abuse and addiction can make the difference between relapse and maintaining recovery.
The skills, knowledge, and support gained through a research-based, certified rehab program include:
- Cognitive therapies to recognize triggers and substitute heathy behaviors for drug use
- Motivational therapies that support continued commitment to abstinence
- Family and social therapy that help to build a social support structure for staying sober
- Mitigation of co-occurring mental health disorders that contribute to substance abuse
- Post-treatment support that helps the individual apply these skills in daily life
Combined with a medical detox process that involves a substitution taper (as appropriate), these treatment elements offer a greater chance at recovery and future free from substance abuse.
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