What is a Drug & alcohol detox? What to Expect.
If you need a drug and alcohol detox, it can be confusing knowing when and how to start.
In order to recover, you first of all have to break the addictive cycle and go through the process of withdrawal. This process can be very difficult and uncomfortable. With some substances, especially alcohol, it can even be life threatening.
There are various means and ways of undergoing a drug and alcohol detox. It is important to know that not all methods of detoxification are safe or clinically approved.
Here, Recoverloution looks at the various methods of detoxification and what they involve. We also advise when a detox is needed, when to seek medical help and what to expect during the process.
What is a drug and alcohol detox?
Detoxification is the process by which the body eliminates a specific substance or substances.
Process addictions, where a person has developed an addiction to an activity or behaviour, also require a period of detoxification. Science has proven that detoxing from a process addiction can also lead to withdrawal symptoms, especially during the early days of abstinence 1
In terms of addiction treatment, drug and alcohol detoxification involves a set of evidence based interventions. Detox interventions manage and minimise acute withdrawal symptoms.
Medically recognised methods of drug and alcohol detoxification involve medication, therapy, gradual reduction, or a combination of all three.
Detoxification is also a recognised form of palliative care. Palliative care reduces the intensity of the discomfort a person experiences whilst going through the process 1
Some people who suffer from a drug and alcohol dependence need the assistance of a registered rehab or hospital. Medical detoxification, within a medical setting, helps to prevent life threatening complications from developing.
For some, the compulsion to ‘use’ is so overwhelming that the only way they can break free from an addiction is to have constant supervision.
Those who undergo a medical detox within a registered addiction treatment facility will usually go on to undertake an intensive rehabilitation programme. Rehabilitation is vital in preventing relapse and in addressing behavioural issues.
Why detox is needed & how it affects the brain
Addiction often causes drug and alcohol dependence. The first step to recovery is safety stopping the addictive substances or activities. Cessation of addictive substances breaks the addictive cycle and provides a window of opportunity in which a person can heal and recover.
Addiction affects the brain's pathways, causing profound and lasting changes. These changes remain even once substances have been stopped. Substance use disorders also impact on the way the brain communicates and functions, and removes the element of choice.
Detox is needed to clear the brain of toxins and give it time to recalibrate. Rehabilitation then helps to support the brain in adjusting to living without substances, helping the person to heal and adopt healthy coping strategies.
Dopamine’s role in addiction
The physiological changes that happen to the brain during the formation of an addiction cause the brain to prioritise the substance (or activity) as the primary source of dopamine. Therefore, addiction is medically recognised as a mental and physiological illness. 2
Once addiction has formed in the brain, the sufferer is compelled to seek and take substances, regardless of the probable negative consequences. The substance or activity eventually becomes all consuming, affecting other areas of the sufferers life.
Activities that naturally produce dopamine (mother nature's feel good chemical) such as eating, hobbies, sex, time with loved ones, etc, all become sidelined in favour of the artificially induced high.
Eventually, an addicted brain stops organically producing dopamine. Instead, it comes to rely on alcohol, drugs or a specific behaviour to stimulate the production of this vitally important brain chemical.
The addicted brain develops tolerance
As well as the brain's pathways changing, the brain adjusts to form tolerance.
Tolerance in an addicted brain is a never ending cycle of taking progressively larger amounts of substances and taking increased risks.
Each time the brain will recalibrate to normalise the increased intake.
Dependence and withdrawal
By the time dependence occurs, the brain will have undergone substantial changes, both structurally and on a cellular level. Eventually, every single part of the brain becomes negatively affected by the illness of addiction.
Taking away or stopping the substance or activity suddenly, sends the brain into acute shock as it scrambles to find equilibrium.
In every single addiction there will be a strong element of craving. Craving is a symptom the brain produces to ensure that the person continues to meet its needs (in terms of artificial dopamine production) 2
During detoxification and withdrawal, the brain will produce withdrawal effects that are generally the opposite to the effects of the drugs or alcohol. How severe these withdrawal effects are depends on the severity of the addiction and the method of detoxification.
Drug and alcohol detox symptoms are at best are very uncomfortable, and at worst they can become life threatening.
Managing drug and alcohol detox withdrawal symptoms
A medically managed detox reduces the severity of withdrawal symptoms and their duration.
Managed detoxes include medication, therapy or a gradual reduction regime. Most importantly, managed detoxes reduce the chances of life treating complications occurring.
A managed detox assists your brain in recalibrating and calms acute overactivity. It also reduces symptoms and cravings which increases your chances of recovery. Once the brain is more settled, you can then begin rehabilitation and start the recovery process.
Stopping a substance or problematic behaviour does not cure addiction, it merely arrests it temporarily. Successfully completing a detox provides the opportunity to rehabilitate and maintain change without the influence of chemicals.
Methods of drug and alcohol detox and what to expect
There are various methods of detoxification. Here we give a brief overview of each method and what you can expect.
What is a cold turkey detox?
A cold turkey detox is where a person abruptly stops all drugs and alcohol without any professional guidance or help
What to expect during a cold turkey drug and alcohol detox
Going cold turkey as a method of detoxification is the most dangerous and least successful way of stopping drugs and alcohol. Nevertheless, for some going cold turkey does work (albeit not without discomfort or risk)
Abruptly stopping a substance or behaviour without professional help, causes withdrawal symptoms to be at their most severe. There is also a much higher risk of developing PAWS (post acute withdrawal syndrome)
Whilst it is safe to undergo a cold turkey detox for an addiction to an activity, this can still produce discomfort.
Detoxification from a gambling or sex or addiction will typically produce the following withdrawal symptoms :
- Intense cravings
- Changes in sleep and appetite
Engaging in a mutual aid support groups and accessing therapy lessens the severity of cravings and withdrawal symptoms.
Withdrawal symptoms occur due to dopamine levels dramatically dropping in the brain. The impact of dopamine reduction is even more pronounced in an unmanaged detox.
Cold turkey from alcohol and drugs
Cold turkey detoxes from alcohol or drugs will bring about severe physical and psychological withdrawal symptoms.
Detoxing, using the cold turkey method, from any central nervous system depressant can cause life threatening complications.
The most dangerous drugs to detox from are:
- Benzodiazepines - ie diazepam, xanax, nitrazepam, temazepam
- Opiates and opioids
- Certain prescription medications such as pregabalin and gabapentin
- Antidepressants and antipsychotics
By quitting drugs and alcohol cold turkey you are also more likely to develop Post Acute Withdrawal Syndrome. PAWS symptoms can come and go for months, sometimes even years.
How you choose to detox matters!
When to see a doctor for detox withdrawal symptoms
If you experience any of the following drug and alcohol detoxification symptoms, you should seek urgent medical help:
- Uncontrollable shaking
- Rapid breathing and heart rate
- Delirium tremens
- Suicidal ideation
- Chest pain
- Severe vomiting and diarrhoea, which can lead to electrolyte imbalances and heart complications 3
Substance reduction method
A substance reduction regime will lessen the severity of drug and alcohol withdrawal, as you gradually taper your intake over a period of time.
A reduction regime is rarely successful in a person who suffers from addiction.
Why? Because addiction is characterised by compulsion and a distinct lack of control.
What to expect during a drug and alcohol reduction detox
If you suffer from addiction, undergoing a reduction regime will prove extremely difficult physically, emotionally and mentally. You will find yourself continually batting with cravings and a brain that cannot control your drug and alcohol intake.
The reduction method of detox doest usually work well for those that suffer from addiction. Occasionally, it can work IF a person is extremely motivated and has a lot of therapeutic support.
If you are planning on stopping a drug or alcohol dependence through a reduction regime it is wise to speak to your doctor first and establish a plan. Your doctor can then support you in reducing safely
If you'd rather not speak to your doctor as you are addicted to an illegal drug, your local drug and alcohol team should be your first port of call.
Community and home detox
A community or home detox involves approved prescribed pharmaceutical medications and low levels of support.
A medically assisted detox is prescribed by a qualified doctor. The detox is then overseen by professionals (qualified in administering prescribed medications).
Workers overseeing a detox in the community or at home should also be trained in basic health monitoring, i.e checking blood pressure and body temperature 1,4
What to expect during a home detox
Home detoxes can work very well, if you are fully committed to your recovery.
The medication prescribed will drastically reduce and manage withdrawal symptoms. Supervision from a friend or family member is also important, not just for safety but also for moral support.
Community and home detoxes can prove to be challenging as temptation is still a factor. It is up to you, as the person undertaking the detox, to remove yourself from avoidable temptation.
A home detox will likely backfire if you drink alcohol or take drugs whilst detoxing. This can lead to an addiction to detox medication, and can prove fatal - due to the increased risk of overdose.
Whilst you are undertaking a home detox it is important to access therapy and/or support from mutual aid support groups. This will increase your chances of staying in recovery once your detox is complete.
Inpatient drug and alcohol detox
Inpatient drug and alcohol detoxes can only be accessed through CQC registered rehabs. They are the more costly option but are clinically proven to be the safest and most successful.
After an initial consultation with a detox doctor, you will be prescribed a bespoke medical detox using approved pharmaceutical medication(s).
Your detox will be monitored 24/7 by qualified nurses. Moral support and light therapeutic interventions will also be delivered by support workers and qualified counsellors 4
What to expect during a residential detox
You can expect to receive very high levels of medical care and professional support if you undertake a full medical detox within a registered detox clinic.
During a residential detox, a multidisciplinary team of staff will look after your mental health and help to heal the root causes of your addiction.
The process of detoxification should be mostly comfortable, primarily due to being continually monitored and cared for by qualified professionals. You will also benefit from the continued support of your peers and recovery workers.
Support of the right kind is a critical in assisting a successful drug and alcohol detox
Hospital drug and alcohol detoxes are rare and only carried out on those in a medical crisis
Whilst you will have the benefit of qualified nursing care, a general hospital lacks the specialist addiction treatment that you would receive whilst in a detox clinic or rehab.
Detox is only the beginning of the recovery journey from addiction
Which ever method of detoxification you choose (hopefully one that is safe) it is important to understand that detox is only the very beginning of the recovery journey.
Even once you have stopped the activity or substance you were addicted to, your brain remains in the same damaged and altered state. This is why addiction is defined as a chronic and progressive brain disease, characterised by relapse and continuation despite negative consequences 5
The good news is that whilst addiction cannot be cured, it can be arrested through detox and recovery can be maintained.
Everyone has different medical, emotional, social and educational needs. Your personal rehabilitation needs to take this into account.
There is simply no “one size that fits all” when it comes to treating addiction.
Our professionals at Recoverlution focus on improving your quality of life beyond a drug and alcohol detox. Here, you will find support, help and proven therapeutic techniques to help you become the very best and happiest version of yourself in recovery.
Read more: Do I need rehab to get sober?
- Overview, essential concepts and definitions in detoxification - https://www.ncbi.nlm.nih.gov/books/NBK64119/
- The addicted brain: understanding the neurophysiological mechanisms of addictive disorders - Understanding the addicted brainEdited by: Sidney A. Simon, Duke University, USA. Reviewed by: Sean B. Ostlund, University of California at Irvine School of Medicine, USA; Patricia H. Janak, Johns Hopkins University, USA. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4365688/
- Quitting substances cold turkey: safety, risks and more - https://www.healthline.com/health/opioid-withdrawal/quitting-cold-turkey#safety
- Detoxification and substance abuse treatment. 2 settings, levels of care and patient placement. Medically assisted detox v medically managed detox https://www.ncbi.nlm.nih.gov/books/NBK64109/
- Drugs, brains and behaviour. The science of addiction. Drug misuse and addiction NIH https://www.drugabuse.gov/publications/drugs-brains-behavior-science-addiction/drug-misuse-addiction