The Diagnostic and Statistical Manual of Mental Disorders (DSM-5) describes the 11 criteria that clinicians use to determine whether someone struggles with addiction. One of those criteria is repeated attempts to stop abusing the drug and then relapsing back into substance abuse. For drugs including nicotine, marijuana, alcohol, opioids, cocaine, and benzodiazepines, among many other substances, trying to quit without help increases the risk that the person will relapse and continue abusing drugs. This is because other features of addiction, including intense cravings, uncomfortable withdrawal symptoms, and compulsive behaviors mean that the person cannot control their mental or physical state without help.
Why Medical Assistance for Detox Is Needed
Of course, there are stories of people successfully quitting drugs or alcohol cold turkey. The idea that a person can just put down an intoxicating substance and not pick it back up is enticing. However, this continues the longstanding stigma that addiction involves willpower, and a person with strong enough will can just quit abusing a substance. The medical understanding of addiction, however, considers addiction a chronic disease that changes the brain and behaviors. No one just stops having a chronic disease, whether it is addiction, diabetes, hypertension, or asthma.
Instead of stigmatizing substance abuse, it is important to understand how medical professionals approach detox, which is the controlled, monitored process of ending the body’s physical dependence on a substance. The medical detox process manages withdrawal symptoms, which occur as the last dose of the drug is metabolized out of the body and the brain attempts to reach chemical equilibrium on its own. The process can take a few days or a few weeks, depending on how the detox process is handled.
For some people who have not abused a substance for a long time, withdrawal symptoms can be eased with over-the-counter drugs like ibuprofen or moderate exercise. For people who have abused potent drugs for a long time, though, a medication-assisted treatment (MAT) like buprenorphine, naltrexone, or bupropion can offer important, prescription relief from intense cravings and body aches, although the process of tapering off the MAT means detox takes longer.
- Intense cravings for the drug or obsessive thoughts about taking more
- Muscle aches or joint pain
- Feeling cold or flulike symptoms
- Appetite changes, either eating a lot or losing one’s appetite
- Vomiting or consistent nausea
- Mood swings, depression, and anxiety
- Physical shaking or tremors
- Sleep disturbances like night terrors or insomnia
- Heart rate changes, like racing heartbeat or low blood pressure
- Hot or cold flashes
Some drugs, like alcohol and benzodiazepines, have life-threatening side effects like hallucinations, high fevers, or seizures, so getting medical attention for this process is essential.
For most other drugs, withdrawal symptoms are uncomfortable, but not life-threatening; however, the discomfort, especially psychologically, can increase the risk of relapsing back into substance abuse.
Psychological and physical discomfort can be alleviated in two main ways: with medical intervention and with support from friends and family.
- Medical support: Getting support and supervision from medical professionals is the safest approach to detox. A physician and nursing staff can manage the most intense withdrawal symptoms, like seizures or psychological struggles. A doctor will start the detox process with a physical workup and a questionnaire like the Clinical Opiate Withdrawal Scale (COWS) to understand their patient’s experience of withdrawal symptoms. Based on how serious withdrawal symptoms are, the doctor may prescribe medications or offer complementary therapies.Home remedies without supervised detox are never recommended, but a physician may suggest meditation, yoga, dietary supplements, massage, and other approaches to ease stress, which can relieve many withdrawal symptoms. They may also suggest over-the-counter painkillers, fortified drinks like juice or electrolyte-infused water to ease malnutrition or dehydration, anti-constipation or antidiarrheal drugs, and more.
- Social support: Treatment for drug or alcohol addiction can feel frightening and isolating. Many people who struggle with addiction also have friends or family members who struggle with addiction, so there may be a fear of losing a sense of community. As a result, getting social support, in addition to medical support, for the detox and rehabilitation process is very important.Supporting a loved one to get the help they need is crucial. Offer reassurance that evidence-based treatment works, provide emotional support in a safe and drug-free environment, and, if possible, offer to help. Cook meals, drive the person to appointments, help them manage financial resources, or offer other forms of support. A person struggling with addiction may not be able to find a treatment program they like, so offering to help them with research can be an important first step. Finding ways to spend time together that do not involve intoxicating substances is another great way to support friends or family members who are overcoming addiction.Without social support, the risk of relapse increases, and the person has no one they trust to turn to if they do relapse. Having the support of friends and family to make healthy changes, stay sober, and get back into treatment in the event of relapse means that the person is more likely to get healthy and stay abstinent.
Avoid Relapse with Medical and Social Support Structures
Once the body’s tolerance to drugs or alcohol has started to lower, relapse is more dangerous than withdrawal symptoms. People who relapse and consume the amount of drugs or alcohol they took before may poison themselves, leading to an overdose. Although relapse is considered part of the chronic disease of addiction, finding ways to prevent relapse or to get the person back into treatment before they overdose must be part of rehabilitation. This is why detox is only the first step in the longer process of recovery from addiction.
- Change in attitude toward substances or the importance of abstinence
- High levels of stress, or a stressful event like job loss or a death
- Denial that substance abuse is a problem
- Experiencing withdrawal symptoms again, especially psychological symptoms like anxiety, depression, cravings, and memory loss
- Changes in behaviors
- Losing relationships with friends and family or refusing to participate in social events
- Loss of structure, like daily schedule, exercise or medication routine, etc.
- Loss of judgment and making many irrational choices
Quitting substance abuse without help does not work, no matter what urban legends exist. Medical detox and comprehensive behavioral therapy are both key medical interventions to overcoming addiction. In addition, support from friends and family to foster a safe drug-free environment is also crucial to healing.