Detox is an important part of substance abuse treatment, often laying the foundation for whatever therapies are to follow. Sometimes, however, people struggle with detox because of withdrawal symptoms that are uncomfortable and, in some cases, even dangerous.
Medical detox can help both with the discomfort of detox and the risks that arise in withdrawing from substances like alcohol and benzodiazepines. Addiction treatment professionals can provide medications during the detox process to help lessen some of the discomfort of physical withdrawal symptoms, like nausea and body aches, as well as the challenging psychological symptoms of anxiety, depression, and cravings for the substance.
Types of Detox Medications
The medications used in detox depend on the person’s degree of addiction and the substances that have been abused, as certain medications treat the specific symptoms of withdrawal from specific substances. Certain medications may also be used to help with other, co-occurring mental health conditions. Some of these types of medicines include:
- Medicines that counteract or decrease the effects of the substance of abuse
- Medicines to reduce cravings for drugs or alcohol
- Antidepressants or anti-anxiety medications
- Pain relief medicines
- Anti-nausea medicines
- Medicines to help normalize sleep patterns
The combinations of medications used can also depend on the person’s addiction potential for other substances. In addition, the selection of medicines may be dependent on whether or not the person is already using more than one type of drug.
Opioid Withdrawal and Detox Medications
During detox from opioid drugs like heroin and prescription painkillers, the following withdrawal symptoms may occur, according to the National Library of Medicine’s Medline Plus:
- Muscle aches and pains
- Runny nose and watery eyes
- Digestive discomfort
- Nausea and vomiting
- Restless leg syndrome
- Agitation and anxiety
Some of the medications used to treat these symptoms include:
- Clonidine: According to the Medline Plus article, this anti-anxiety medication can treat a large number of withdrawal symptoms, including agitation, restless leg syndrome, body aches, sweating, runny nose and eyes, and stomach cramping.
- Buprenorphine: This is a partial opioid agonist that produces milder euphoric effects and is less likely to be abused. This medicine can help in tapering off a stronger opioid drug by decreasing withdrawal symptoms and easing cravings. According to research done by the Cochrane Collaboration, buprenorphine use can also help people reduce opioid abuse during treatment.
- Methadone: Similar to buprenorphine, methadone can help a person taper off heroin or other, stronger opioids. Used during detox, it can make withdrawal symptoms feel milder. As with buprenorphine, methadone is sometimes used for long-term withdrawal.
- Naloxone: As described by com, naloxone completely blocks the effects of opioids, reducing symptoms of drowsiness, slow or shallow breathing, or unconsciousness. It is used in emergency detox situations to reverse overdose and prevent death.
A note on rapid detox using anesthesia: There are groups that claim that putting people under anesthesia and administering high doses of medicine to quickly remove opioids from the body leads to faster, easier detox. Research, however, does not support this claim. This method has even been shown to be dangerous, based on a study in Morbidity and Mortality Weekly Report, especially when it is not performed in a hospital.
Alcohol Withdrawal and Detox Medications
Alcohol withdrawal symptoms can be dangerous. Depending on the person’s degree of addiction and length of time abusing the substance, seizures may occur, along with a condition called delirium tremens (DTs) that may result in death. For this reason, medically assisted detox from alcohol is important to avoid dangerous withdrawal symptoms. Additional symptoms of alcohol withdrawal include:
- Anxiety, nervousness, and shakiness
- Inability to focus or confusion
- Pale skin and sweating
- Rapid heart rate
- Loss of appetite
- Nausea and vomiting
- Benzodiazepines: WebMD lists medications like Valium (diazepam), Ativan (lorazepam), and Xanax (alprazolam) as being used for alcohol detox because they behave similarly to alcohol in the body, making it easier to taper dosages and make some of the symptoms of withdrawal milder. However, these drugs also have a high addiction potential, so they are generally only given for a short period of time and then their use should be reduced to avoid addiction complications. In cases where the person is abusing benzos as well as alcohol, this type of medicine is best avoided altogether.
- Gabapentin and carbamazepine: According to the Journal of Addictive Diseases, an effective type of treatment for alcohol withdrawal is found in these anti-seizure medicines, which can help normalize sleep patterns and minimize the occurrence of seizures.
- Naltrexone: This medicine can help people withdrawing from alcohol by bonding to the part of the brain that produces the reward effect caused by drinking, thereby reducing cravings.
- Acamprosate: Particularly for heavy users of alcohol, this medicine can treat many of the symptoms of withdrawal that may last for a long period of time, such as insomnia, anxiety, restlessness, and depression, according to the National Institute on Drug Abuse.
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Medicines for Benzodiazepine Detox and Withdrawal
According to studies reviewed by the Cochrane Database of Systemic Reviews, there are no drugs that seem to be as effective for withdrawal from benzos as other benzos. However, because of the risk of continued abuse, this type of withdrawal should be monitored by a medical professional experienced in benzo withdrawal.
The main process for benzo withdrawal is to slowly taper the drug over a long period of time. This will minimize symptoms as much as possible, and cravings should slowly decrease over that time period as well. Some people have recommended that those who are on short-acting benzos should switch to a long-acting version before the taper; the Cochrane report states that this does not matter very much.
Therapy and other treatments both during and after detox can address and manage the urge to relapse. Still, there are some medications that may help somewhat with the detox process:
- Carbamazepine: Using this particular benzo as an adjunct to the taper shows mild reduction of withdrawal symptoms and better post-detox abstinence outcomes.
- Non-benzo antidepressants: According to the research website org.uk, in cases of severe depression symptoms with benzo withdrawal, antidepressant medicines that are not related to the benzodiazepine family can alleviate these symptoms slightly. Once treatment begins, therapy can supplement these medications to manage symptoms of depression.
Detox and Withdrawal Medications for Stimulant Abuse
In a report from Models of Intervention and Care of Psychostimulant Users, symptoms of withdrawal from stimulants, like cocaine, amphetamines, and meth, are often treated using similar means. The Substance Abuse and Mental Health Services Administration advises that these symptoms include three basic phases:
- Agitation, anxiety, and aggression
- Intense cravings
- Fatigue with insomnia
- Inability to concentrate
- Excessive sleepiness and prolonged periods of sleep
- Extreme hunger
No single medication has been found that can help minimize stimulant cravings. However, some medications that are used to help other individual symptoms include Benadryl, to counter insomnia, and occasionally antidepressants to manage anhedonia, a severe depression, or the inability to feel pleasure.
Other Medicines Used in Detox
Some withdrawal symptoms may occasionally be managed using simple over-the-counter medicines, such as Pepto-Bismol for stomach upset and diarrhea, or analgesics like acetaminophen or ibuprofen for muscle aches and pains. However, depending on the substance of abuse, these can have some mild risks. For example, taking acetaminophen for the aches that result from alcohol withdrawal can increase toxicity to the liver and promote liver damage and disease.
For these reasons, medical professionals recommend that detox be undertaken in a professional facility, such as a hospital or dedicated facility. In particular, a reputable, research-based inpatient treatment facility can provide medically assisted detox based on the most current, accurate information available, giving clients the best chance at completing the detox process and moving forward into a treatment program that will result in positive outcomes.