Because addiction is a disease that changes the part of the brain responsible for rewarding tasks, overcoming addiction to anything can be a long process. Some substances can cause physically dangerous side effects when they are abused for years, and medical oversight is required during detox. Others so deeply change how dopamine is released that a person can suffer cravings for the substance years after undergoing detox and rehabilitation.
Certain substances foster addictions that are more difficult to overcome, due to the high addictive potential of the substance.
Below are the top five most difficult substances of abuse to detox from:
- Alcohol: Alcohol use disorder is one of the toughest addictions to overcome for various reasons. First, alcohol induces a relaxed euphoria, helping people who may feel angry, anxious, or stressed out to feel better. Next, it is legal for people ages 21 and older, so it is socially acceptable to consume alcohol in public. Because it is legal, it is easy for people to brush past the idea of having a problem with drinking too much until it begins to seriously impact their relationships, health, finances, or legal situation.
About 7 percent of the US adult population has a problem with alcohol, but few seek treatment. Those who do try to quit, especially if they have struggled with drinking too much for several years, are at risk of harmful withdrawal symptoms, like seizures or delirium tremens. Without support from medical specialists, friends, and family members, it can be very difficult for a person to overcome alcohol use disorder. Due to the potential for life-threatening symptoms, medical detox is always required for alcohol withdrawal.
- Benzodiazepines: These psychiatric medications can be very useful for controlling anxiety, panic attacks, and even seizure disorders, as long as the person takes them according to the prescription’s instructions and a doctor carefully monitors the individual’s consumption of these substances. Benzodiazepines act on GABA receptors and induce similar effects as alcohol; this means they can be equally intoxicating and addictive. Short-acting benzodiazepines like Xanax are more addictive than long-acting ones like Valium because the drugs begin to take effect rapidly. However, this means that the euphoria wears off quickly too, leaving only negative side effects. Additionally, mixing benzodiazepines with other intoxicating substances like alcohol, opioids, or cocaine can lead to serious, life-threatening side effects.
People who try to quit a benzodiazepine addiction cold turkey put themselves at risk of developing life-threatening seizures or protracted withdrawal symptoms, which can lead to cravings and psychiatric discomfort for a year. Even typical withdrawal symptoms, without the benefit of a drug tapering schedule, can mimic the original psychiatric symptoms and make detox very uncomfortable. As a result, medical detox and a tapering regime are always required for benzodiazepine detox.
- Heroin: This opioid drug is famous for its addictive nature. Most people inject the narcotic directly into a vein, inducing a relaxed euphoria within 5-30 minutes. However, the pleasant part of the heroin high wears off almost as soon as it arrives, leaving side effects like drowsiness and cognitive problems in its wake for several more hours. Because the onset is so rapid, it’s very easy for an addiction to form quickly. This leads to escalating use, which may end with an overdose.
The National Institute on Drug Abuse (NIDA) notes that heroin ranked second when it comes to drugs involved in admissions to publicly funded substance abuse treatment facilities, at 14.1 percent of admissions in 2008. Unfortunately, because of the intense cravings that heroin can inspire, only 23 percent of people who enter treatment remain sober.
Detox from heroin can bring particularly uncomfortable and even painful withdrawal symptoms. As a result, medical detox is recommended; supervising physicians will generally prescribe a replacement medication, such as methadone or buprenorphine, to ease the withdrawal process.
- Crack cocaine: Crack cocaine hit its peak of abuse in in the 1980s, alongside the cocaine epidemic. Crack cocaine is made from pure cocaine, but it is less expensive, and the high hits faster; a person who smokes crack experiences the high for about 10 minutes total. This can lead to binge use, which can cause overdose, and repeated binges can quickly lead to addiction.
Typically, only one-quarter of people who enter treatment for crack cocaine addiction remain sober six months after they leave treatment. Due to the intensity of cravings for crack cocaine, it’s important to get medical help with the detox process in a quality rehabilitation program and enlist support from family and friends.
- Crystal meth: The effects of crystal meth kick in rapidly after it is ingested, and the drug also releases both dopamine and norepinephrine in the brain. Dopamine is the “happy” neurotransmitter. When there is a lot of it in the brain, the person feels euphoric. It is also an important chemical in the reward system, which crystal meth can rapidly damage due to huge dopamine releases. Norepinephrine causes alertness, so a person struggling with crystal meth abuse feels happy and awake; consequently, when the drug wears off 15 minutes later, the person will feel depressed, tired, sluggish, guilty, and sad. Crystal meth can also cause hallucinations, which may be pleasant at first but can turn aggressive or paranoid, sometimes causing users to physically harm themselves.
Due to its high addictive potential, withdrawal from crystal meth can be intense. Medical professionals can supervise the detox process, offering medical support as needed and psychological support so clients can successfully complete withdrawal.
While these five drugs are often viewed as the worst substances to detox from, getting appropriate medical assistance makes the entire withdrawal process easier. At-home detox attempts are rarely successful. Individuals simply return to their substance of abuse when withdrawal symptoms and cravings become intense. Instead, medical detox provides the best chances for successful withdrawal from any substance of abuse, including those listed above.