What Is Titration Tapering?
When a person is struggling with drug addiction, the first step in recovery is withdrawal from the substance of abuse. Detox is the method through which the individual stops using the drug and enables the chemicals to clear from the body. Often, this is considered to be among the hardest parts of the drug treatment process because uncomfortable withdrawal symptoms and cravings can result in the person quickly relapsing to drug use. Some withdrawal symptoms can even be dangerous.
For this reason, a variety of different detox methods have been developed – some with medical support – to manage the process of withdrawal, minimizing the risk of relapse or severe withdrawal symptoms. One of these methods is titration tapering, which is used to taper off the drug in very small amounts.
Methods of Detox
There are multiple ways to detox from substances; these include either quitting “cold turkey,” or using one of several tapering methods that have the individual step down dosage levels until the drug is stopped altogether. The method of tapering used depends on a variety of factors, including:
- Type of substance
- Dosage being taken
- Length of time person has been using the drug
- Severity of the substance use disorder
- Individual health considerations
Titration tapering is one of the medically supported, tapering forms of detox, used mostly in cases of low-dosage drugs or drugs that would otherwise be very difficult to taper slowly enough to avoid risky or severe withdrawal symptoms, as described by Magellan Rx Management. The process of titration tapering involves diluting the drug with water in specific amounts to make it easier to taper down by much smaller amounts than would otherwise be possible, decreasing dosage of the drug slightly each day or each week.
Risks of Detox
Some types of drug abuse can result in a dangerous detox process. With these substances, quitting abruptly can result in severe withdrawal symptoms, some of which can even be life-threatening. Withdrawing from very low-dose but highly potent drugs can be a challenge in this case because it can be difficult to step down from a very low dose. This is true of benzodiazepines, as described by The Ashton Manual.
There are also types of drugs that do not respond well to other forms of detox, such as substitution tapering or other medically supported methods. In these cases, with no way to help prevent withdrawal symptoms, the individual who is trying to detox may relapse or experience dangerous or otherwise painful withdrawal symptoms.
An example of this type of drug is GHB, a synthetic and recently popular “club” drug. As described by a study from European Addiction Research, abruptly stopping this drug can lead to withdrawal symptoms that do not respond to treatment through substitution tapering or medical support using benzodiazepines. As a result, detox from GHB can often require that an individual go to the emergency room with severe and uncomfortable symptoms of withdrawal.
How Titration Tapering Helps
When the brain becomes dependent on an addictive substance, the neurochemical systems involved can be damaged or hindered from operating properly. As described by the National Institute on Drug Abuse, this sometimes results in loss of nerve cells or neurotransmitter receptors, or reduces the body’s ability to produce certain neurotransmitters properly. Then, when the drug is stopped, the brain is unable to produce the needed responses on its own, and it goes into shock, resulting in the withdrawal symptoms the individual experiences.
Titration tapering helps to prevent this reaction by providing a precise, gradual taper and enabling the individual to step down from the drug without shocking the neurochemical system affected by loss of the drug. By tapering in such miniscule amounts, the brain is still getting the drug and able to adjust to the slight decreases in dosage by relearning how to use the body’s own neurochemicals to replace it.
Example of Titration Tapering
The GHB study from European Addiction Research is a great example of how titration tapering works. The individuals who were attempting to detox from GHB were provided dosages through titration that enabled them to find a balance between experiencing the drug’s effects and experiencing withdrawal symptoms. The titration dose was then slowly decreased over one week until the drug was stopped.
The individuals reported minimal withdrawal symptoms and did not have to be admitted to intensive or even moderate care in a hospital. The positive effect of this treatment method has led to it being adopted for these more challenging types of drug tapers, leading to a better chance of treated individuals being able to get off the drug and continue with rehab.
When Not to Use Titration Tapering
There are cases in which titration tapering is not helpful. These include cases that involve:
- Nonsoluble substances: If the pill or drug does not dissolve in water, accurate titration is not possible.
- Time-release drugs: Because time-release drugs are designed to dissolve on a particular schedule, crushing them does not usually result in proper dilution of the substance, risking the individual getting more of the drug than expected.
- At-home detox attempts: Because titration is used for drugs that may have severe or dangerous withdrawal, it is not advisable to use it without medical guidance. Serious problems can occur with the solution or dosages so it should not be attempted without direct medical supervision.
Medical professionals can determine whether or not titration tapering will work for a specific individual’s situation. Other types of tapering and detox are available, and experienced drug treatment professionals can help clients to select the right approach for a given situation.
When an individual is looking at stopping drug use, medical detox is the safest way to quit without experiencing detrimental symptoms from withdrawal. This level of medical support can help to ease cravings and make relapse less likely. In addition, medical support for withdrawal provides a smooth transition into substance abuse treatment, helping the individual sustain abstinence and make the most of the rehab process.