One of the hardest parts of the drug treatment process can be stopping use of the drug. Developing the motivation to quit can be difficult enough, but people are often also intimidated by their expectations about the detox process and the symptoms of withdrawal that will occur once the drug is eliminated from the body. Fears people experience regarding this part of addiction recovery can prevent them from even trying to stop using drugs or alcohol.
To overcome fears and concerns about this process, it can help to know that there are ways to minimize and prevent the discomforts of withdrawal through different methods of detox. The key element of all of these detox methods is medical support, which provides knowledge and a variety of tools that can ease the symptoms of withdrawal and make it easier to transition to the next steps in addiction treatment.
Detox and Withdrawal
Detox is the process of eliminating a drug from the body so the brain is no longer under the effects of the substance of abuse. When a person becomes dependent on a drug, the body often decreases or even loses the ability to produce or use the natural substances that the drug has replaced. This means that when the person stops using the drug, those substances are not available to take the drug’s place, and the brain is unable to maintain normal function.
Withdrawal is the result of this loss of functional capability in the brain. Because the individual’s neural systems are unable to continue working properly, the body responds to the lack by producing withdrawal symptoms. Some of these are the reversal of the symptoms produced by the drug; for example, if the drug is a stimulant, the individual might experience fatigue or sleepiness as a withdrawal symptom.
Other withdrawal symptoms are the body’s attempts to get the person to start using the drug again, so the discomfort won’t continue. This accounts for strong cravings for the drug that can occur during this part of the treatment process. While cravings can happen at any time, including long after treatment, some people consider them to be strongest during withdrawal as the body tries to adjust to the loss of the chemical.
Different Situations, Different Methods
Different individuals may react to loss of a drug in different ways. Also, different drugs may cause issues with what would otherwise seem like a straightforward process of stopping drug use. Because of this, there are a number of different ways to perform detox that can support the individual’s particular needs or mitigate the risks that come with quitting specific drugs. The four best methods include:
- “Cold turkey” detox, with medical support
- Direct tapering
- Substitution tapering
- Titration tapering
These methods, how they work, and how they are commonly used are described below.
1. “Cold Turkey” Detox with Medical Support
Studies have recently indicated that, in a number of situations, stopping drug use abruptly – or quitting “cold turkey” – is an excellent way to begin the treatment process. In particular, a study discussed by the National Library of Medicine has shown that a person who quits smoking cold turkey is more likely to continue abstaining from smoking in the future than someone who tapers off cigarette use.
The cold turkey method can be even more likely to work if there is medical support for the symptoms of withdrawal that occur during detox from the drug. A number of prescription and over-the-counter medications can help with these, including:
- Pepto-Bismo or similar medications for digestive symptoms
- Aspirin, acetaminophen, or ibuprofen for body aches and pains and headache
- Anti-anxiety medications for anxiety or depression
- Medications to calm cravings, such as naltrexone in alcoholism treatment or bupropion for nicotine addiction treatment, as described by the National Institute on Drug Abuse
It is important to know that for a number of drugs, the cold turkey method may not be appropriate because some of the symptoms of withdrawal can be too strong to control by simply treating the symptoms themselves. In some cases, withdrawal can also be dangerous, requiring the use of other methods to ease the process. Working with a doctor to quit is the best way to manage any form of detox; however, a doctor should certainly be consulted before attempting the cold turkey method in case of these potential complications.
2. Direct Tapering
Direct tapering is the process of slowly decreasing the dosage of the drug over time to ease the brain’s response to losing the drug. The idea is that the person doesn’t stop using the drug right away but instead slowly decreases the amount used, encouraging the brain and body to begin producing and using its natural chemical systems properly again. The result is a decreased level of withdrawal symptoms.
The direct tapering method can be used with a number of different types of drugs, including opioids, some benzodiazepines, and stimulants. However, depending on the dosage being used, the degree of addiction, and the individual’s particular risk of relapse, one of the other tapering methods might be used to provide an even greater measure of support for withdrawal. These methods can be used to prevent dangerous withdrawal symptoms, particularly for certain types of benzos and club drugs as well as heroin.
3. Substitution Tapering
Substitution tapering involves replacing the drug of abuse with a different but similar drug before tapering. The substituted drug may be used for a variety of reasons, including:
- A higher dosage to replace a low-dose drug that would otherwise be difficult or impossible to taper in small enough amounts, as is common with benzodiazepines
- A more stable type of drug that can prevent some of the severe symptoms of withdrawal, such as benzodiazepines substituted for alcohol to prevent life-threatening delirium tremens
- A form of the drug that is considered to have lower addiction potential, such as buprenorphine for addiction to heroin or other opioids
One type of substitution tapering that is well known is the use of methadone to help people who are struggling to quit heroin. As described in an article from the National Institute on Drug Abuse, methadone can be substituted for heroin to prevent cravings by replacing some of the actions of heroin but without the intense high and, therefore, with what is considered to be a lower addiction potential.
The challenge of substitution tapering is that the individual can become addicted to the substituted drug. This has often occurred with methadone and with benzos used to support alcohol detox. It is important in these cases that a treatment professional is involved to make sure that the dosages of the substitution drug are then appropriately tapered so the individual is eventually weaned from any drug use.
4. Titration Tapering
Titration tapering is a specific method used to decrease some medications that might otherwise be difficult to taper. In this method, the dosage of the drug is dissolved in water first; part of the water is then removed to decrease the dose by a small amount before the water with the drug in it is consumed. This enables removal of seemingly miniscule amounts of the drug dose, allowing for an extremely gradual taper. It is often used in benzodiazepine or club drug detox.
An example of this is demonstrated by a study from European Addiction Research, in which detox from GHB – a club drug – was performed using titration tapering. GHB withdrawal has been notorious in that it cannot be treated through substitution tapering because nothing seems to reduce or mitigate the symptoms of withdrawal, which often result in treatment in an intensive care unit. By using titration tapering, however, the trips to intensive care were eliminated and the withdrawal symptoms were said to be greatly reduced.
The challenges of titration tapering include a risk of imprecise decreases in dose, drugs that don’t dissolve, time-release medications that can’t be reduced through titration, and other situations that depend on the drug type and the individual. Again, titration tapering is best performed with a doctor’s support and guidance, particularly with the help of an addiction treatment expert who can make sure the taper is being performed correctly.
Supported Detox Improves Treatment Outcomes
Drug treatment experts are the first to say that drug treatment doesn’t end with detox, a truth emphasized by the National Institute on Drug Abuse. There are a number of additional steps needed to help individuals transition from ending their drug abuse to maintaining sobriety. Nevertheless, the individual’s experience of the detox and withdrawal process is still important to the rest of the treatment process because it sets the person’s expectations about what life will be like without the drug.
By working with treatment professionals to promote a smooth detox process with minimized withdrawal symptoms and cravings, the person who is trying to stop abusing drugs is also creating a higher likelihood of staying motivated through the rest of treatment and achieving recovery with a reduced risk of relapse. Certified, research-based treatment programs are most likely to be able to provide this important detox support, setting the stage for the person to stay motivated in treatment and ongoing recovery.