Drug and Alcohol Detox

What is Detox and What Can You Expect?

Drug and alcohol detoxification, also known as detox, refers to the process of breaking an individual from the physical bonds of addiction. However, the physical ties are usually just as strong as the mental ties. Usually, there are several reasons why many people want to quit abusing drugs or alcohol. But, the long-term use of such substances has dramatically changed the way the brain and nervous system function and therefore the cravings can be overwhelming.

The side effects that occur during detox (otherwise known as withdrawals) can be dramatic and influential. These effects may vary widely from one drug to another, including things like cramps, aches, sleeplessness, paranoia and even hallucinations. For this reason, the process of detox can last a few days up to a few weeks.

The overall goal of the detox process at DreamLife Recovery is to minimize all of the symptoms of withdrawal and keep the individual as comfortable as possible. This is done with the oversight of medical staff giving individualized attention to each person.

After a short stay in our detox facility, the individual is ready to move into our residential or outpatient rehabilitation programs.

What Makes Detox Important?

Going through detox is especially important for the individual suffering from substance use disorder. The physical and mental ties can be so great that they are overwhelming to deal with alone. While there are some substances where the withdrawal symptoms are minimal, it is always better to take caution. Detoxification should be done in a safe, secure environment in case more extreme symptoms occur, and medical staff is available to aid the individual.

This is one of the many reasons why we discourage attempting to detox at home. It is a very dangerous decision, and more often than not, life-threatening. With the possibility of severe symptoms such as delirium tremens and seizures. We strongly recommend that individuals seek the help of medical professionals and do not attempt detox cold turkey.

The DreamLife Recovery Detox Process

We believe in an individualized approach to detox that is fully comprehensive and understanding of all facets of the patient’s mental and physical well-being. As the process begins our team will be there monitoring your health and overall comfort. We will also provide any necessary guidance and support as you focus on overcoming this very difficult experience.

We do utilize medications as part of our detox process. We will mention more about those in our Medication-Assisted Detox Section. Basically though, these will help offset any of the more dangerous side effects and reduce or eliminate the intensity of cravings.

Remember that detox is only the beginning of the process. Once you are through detox, the next step is a treatment program that is suited to your needs. Generally, we suggest residential (or inpatient) treatment to those suffering from prolonged addiction, however, some may qualify from our outpatient programs.

Read more to discover more comprehensive information regarding our detox program and what to expect from our medication-assisted detox treatment plans.


MEDICATION-ASSISTED DETOX

Withdrawal symptoms can pose significant risks if not managed and observed in a medical facility with trained professionals. These symptoms that are so closely associated with opiate addiction treatment also lead to strong urges to relapse. Medical professionals at our state-of-the-art Pittsburgh detox facility can help ease the discomfort of withdrawal symptoms with carefully-administered medications. DreamLife Recovery utilizes modern medication detox treatment protocols to make the detox treatment process more comfortable.

In addition to trained oversight with a low client-to-staff ratio, detoxification is managed by trained professionals in a tranquil, spa-like setting. Should withdrawal symptoms be encountered during opiate addiction treatment, the optimal setting for coping with and recovering from these is a comfortable location. At our location, we want clients to feel safe and assured they can trust every staff member along the journey.

Our approach at DreamLife Recovery is to ensure around-the-clock support during a stay. We provide gourmet meals to assist the body and mind during the healing detoxification process. Our attentive counseling, risk-assessments and medical reviews, which are all part of our suboxone program, can help the transition to the next level of care.

Modern Medication-Assisted Treatment (MAT)

“Medications are an effective treatment for opioid addiction,” said Kelly J. Clark, the president of the American Society of Addiction Medicine in an interview with “Business Insider” magazine (3).

WHAT IS MEDICATION-ASSISTED TREATMENT?

Medication-assisted treatment is the use of medications along with behavioral therapies to reduce a person’s dependence on drugs, especially opioids. Different medications are available that can help reduce the effects of withdrawal during opiate addiction treatment as well as prevent the likelihood of relapse.


EARLY HISTORY

While drug addiction and specifically opioid addiction have made headlines more frequently in the past decade due to rising deaths and addiction rates from opioids, they are by no means a new problem in addiction. Doctors in Civil War battlefields used opioids to treat pain, and there are detailed accounts from this time regarding soldiers who came back from the war and were addicted (5).

By the turn of the year 1900, the greatest number of people who were addicted to opioids were women, many of whom had been prescribed opioids to treat menstrual or menopausal issues (5). While opioid addictions continued to rise in the 20th century, doctors, researchers, and government officials sought solutions to help reduce the issues.


MEDICAL TAPERING

One of the first known examples of using opioid tapering plans was Dr. Vincent P. Dole, a New York City-based specialist and chair of the city’s Narcotics Committee of the Health Research Council (5). He received a grant to study the feasibility of opioid maintenance therapies that included the concept of tapering opioid dosages instead of trying to have people detox from the medications and experiencing side effects that could later lead to relapse (5). The researchers examined the possibilities of using existing known medications to treat addiction, including morphine, oxycodone, and meperidine (Demerol). However, these were all deemed too short-acting to be effective.


METHADONE TREATMENT BEGINS

As a result, researchers turned their focus to methadone (5). This had challenges in the 1960s because technology wasn’t yet available to test how long a drug lasted in a person’s body. Instead, the researchers observed patients to estimate the length of the effects and understand how long and at what doses people seemed to experience fewer side effects. The initial research studies informed the beginning of research related to methadone maintenance for opioid addiction (5). This research, which our methadone clinic in Pittsburgh has studied at great length, was then transferred to Manhattan General Hospital in New York City. The officials at this hospital founded a treatment program that maintained patients on methadone doses from 80 to 120 milligrams a day (5). Several years later, in 1970, methadone maintenance would become a public health initiative, due to the leadership of Dr. Jerome Jaffe, who was the head of the Special Action Office for Drug Abuse Prevention for the White House (5).


NALTREXONE FOR TREATMENT

While researchers attempted to develop other medication-assisted treatments, the next innovation in medication-assisted treatment did not hit the market until the early 1980s with naltrexone. The U.S. Food and Drug Administration (FDA) approved naltrexone for the use of medication-assisted treatment for opioid abuse in 1984 (5). The FDA would go on to approve naltrexone for the treatment of alcohol abuse in 1995.


MEDICATION-ASSISTED TREATMENT SAVES LIVES AND MONEY

One of the most supportive research studies related to medication-assisted treatment came in 1994 when the California Department of Alcohol and Drug Programs published the results of a study on substance abuse treatment as a whole in the state (5). The study reported that methadone treatment was one of the most cost-effective treatments, saving $3 to $4 for every dollar spent. The study also found that methadone maintenance caused the greatest reduction in heroin use when compared to other approaches to opioid treatments. This is why those suffering from addiction should consider our methadone clinic in Pittsburgh as the place to turn their lives around.

Further support was gained for methadone maintenance therapy when two major health institutes released papers and statements supporting medication-assisted treatments. The first was in 1995 when the Institute of Medicine released a study called the Federal Regulation of Methadone Treatment (5). The second was in 1997 when a National Institutes of Health panel released a report that called for the expansion of available methadone maintenance treatment programs in the United States and asked for an increase in funding for these programs (5).


HOW DOES MEDICATION-ASSISTED TREATMENT WORK?

DURING YOUR DETOX IN PITTSBURGH

Different approaches exist to the detox treatment process, and the best approach often depends upon each individual. One detox approach is to have a person go “cold turkey” and stop using illegal substances. Withdrawal symptoms will occur, which a suboxone program is entirely prepared for, and medication-assisted treatments may start after detox. This may occur in order to reduce cravings or reduce the likelihood of returning to substance abuse.

Another option is to use a tapering plan or medication treatment plan to reduce the detox process. Sometimes, a person may start medication-assisted treatment, such as methadone maintenance within suboxone treatment centers. This approach can be especially helpful in cases of heroin abuse.

Aftercare and Opioids

The U.S. Food & Drug Administration (FDA) has approved three medications in aftercare treatments to help enhance a person’s sobriety as well as reduce the likelihood of relapse. These medications include…

Buprenorphine:

This partial-agonist medication helps to block some of the opioid receptors in the brain. This medication can help to reduce cravings and relieve pain without creating the same “high” can be experienced when using painkilling medications.


Methadone:

Methadone is a medication used to reduce painkiller and heroin abuse. When taken at our methadone clinic in Pittsburgh, the medication is a full-agonist medicine that can relieve pain. The medication is taken daily and is available in pill, liquid, and wafer forms (1). However, methadone must be prescribed via an opioid treatment program, which the Substance Abuse and Mental Health Services Administration regulates. Participants must be monitored regularly to ensure that excess methadone is not present in their systems and to ensure the person is continuing to pursue their sobriety. Methadone maintenance therapies can take 12 months or more to be effective, according to The Pew Trust (1).


Naltrexone:

Naltrexone is a medication used to assist in the reduction of opioid abuse. It is an antagonist medication, meaning it blocks the effects of opioid receptors. If a person is on naltrexone and takes an opioid, they may not experience the “high” they usually would. Naltrexone is available as a pill formulation a person can take daily or as an extended-release injectable medication that is given monthly (1). People take naltrexone to reduce the likelihood they will relapse, but it does not assist in reducing withdrawal symptoms.

AFTERCARE FOR MEDICALLY ASSISTED TREATMENT

ALCOHOL

Medication-assisted treatments are available for those addicted to alcohol as well. These medications are usually intended to deter drinking by causing unpleasant side effects if a person does drink again after being sober. Examples of medicines used in medication-assisted treatment for alcohol abuse include:

Acamprosate:

This medication is an alcohol deterrent. When this medication is taken and alcohol is consumed, the person will feel ill after drinking. Examples of symptoms include diarrhea, nausea, loss of appetite, dizziness, and problems sleeping. The medication is available as a pill taken three times daily.


Disulfiram (Antabuse):

This medication is available as a pill taken once every day. If a pill is taken and alcohol drank, unpleasant side effects include headache, nausea, and vomiting (2). These symptoms can occur within 10 minutes of drinking alcohol.


Naltrexone:

Naltrexone is used in medication-assisted treatment for both opioids and alcohol. People who have suffered from alcohol abuse take it because it does not cause an intoxicated feeling when drinking after taking the medicine. As a result, a person is ideally less likely to turn to alcohol (2).


Dangers of Mixing Medications

A person who uses medication-assisted treatment should talk to their doctor about all their current medications. Some medications, especially those to treat opioid addiction, can cause fatal side effects when combined with medications like benzodiazepines that are used to relieve anxiety. Examples include Xanax or Valium.

WHAT ARE SOME MISCONCEPTIONS ABOUT MEDICATION-ASSISTED TREATMENT?

IT’S A SUBSTITUTE

A common misconception about medication-assisted treatment is that the process simply substitutes one approach for another (2). Medication-assisted treatment has many different goals compared to suffering from substance abuse. Doctors prescribe medications to reduce cravings and minimize withdrawal symptoms whenever possible. These medications can be taken more safely when a person can see a doctor for monitoring.

“People ask me all the time, ‘Well, aren’t they just substituting one drug for another?’ The answer is no. These are evidence-based treatments and they work,” said Patrice A. Harris, a board-certified psychiatrist and the chair of the American Medical Association’s opioid task force interviewed in Business Insider magazine (3).


IT’S THE ONLY SOLUTION

Another misconception about medication-assisted treatment is that it is the only line of treatment a person needs for their treatment to be effective (3). Medication-assisted treatment can help address the physical addiction and cravings side to addiction, but it doesn’t address the mental pull that alcohol or opioids can have on a person. This is why psychotherapy and behavioral therapies are vital to help with overcoming addictions.


EVIDENCE OF EFFECTIVENESS

According to the non-profit organization and research group The Pew Charitable Trusts, “the use of medications combined with psychosocial treatment is superior to drug or psychosocial treatment on its own” (1). According to the Trust, a person who uses medication-assisted treatment is more likely to adhere to their treatment program and reduce their illegal drug use (1). By using medication-assisted treatment, a person is less likely to contract infectious diseases, such as HIV and hepatitis C (1).


GAPS IN PROGRAMS

While the Trust has found medication-assisted treatment is effective in addiction treatment, there are gaps in available treatment programs. For example, an estimated 23 percent of publicly-funded treatment programs offer medication-assisted treatment (1). The number is slightly higher for private treatment programs, yet less than half of all programs offer these medications in their programs (1). Some of the most common barriers cited for not offering medication-assisted treatments include a lack of or limited insurance coverage or limited availability of medical personnel who could prescribe these medications.


PROVEN BENEFITS

In addition, to support from The Pew Trust, the Substance Abuse and Mental Health Services Administration (SAMHSA) also reports that combining medical therapies and counseling can help to successfully treat substance abuse disorders (2). Some of the proven benefits associated with medication assisted-therapies include (2):

  • improved patient survival rates
  • enhanced retention in treatment programs
  • enhanced ability to gain employment and stay employed
  • improved birth outcomes among pregnant women
  • decreased criminal activity among those who suffer from substance abuse

Other advocacy groups who support medication-assisted treatment include the National Council for Behavioral Health, the American Society of Addiction Medicine, the U.S. surgeon general, and the White House Office of National Drug Control Policy (3).

In addition to these benefits, there are several studies that outline the effectiveness of medication-assisted treatment. This includes one published in the American Journal of Public Health, which studied heroin overdose deaths in Baltimore, Maryland, between the years of 1995 and 2009. The authors found the availability of treatments like methadone and buprenorphine decreased deaths from overdoses by roughly 50 percent (4).


WHERE CAN I FIND MEDICATION-ASSISTED TREATMENTS?

Medication-assisted treatment is offered at varying levels at public and private rehabilitation centers across the United States. For a listing of methadone maintenance clinics in the United States, you can visit the website www.methadone.us. If you are interested in a particular rehabilitation facility and medication-assisted treatment, such as our methadone clinic in Pittsburgh or another detox in Pittsburgh, contact the counselors at the facility and ask if they offer medication-assisted treatments, and what treatments they are licensed to provide.


What is Suboxone

Suboxone is a medication used to treat opioid dependence, containing buprenorphine and naloxone. According to the World Health Organization (1), an estimated 15 million people suffer from opioid dependence in the U.S. and estimates are that this will increase to over 17 million in 2018.

  • About 275 million people worldwide (5.6 percent of the global population aged 15 – 64 years) used drugs at least once during 2016. Among them, there were about 34 million people who used opioids and about 19 million who used opiates.
  • There were an estimated 27 million people who suffered from opioid use disorders in 2016. The majority of people dependent on opioids used illicitly-cultivated and manufactured heroin, but an increasing proportion used prescription opioids.

Buprenorphine and naloxone, formulated as Suboxone, are used to treat this dependence. Buprenorphine is considered a “partial opioid agonist,” (2)meaning that it produces a milder form of the effects produced by opioids (which are “full opioid agonists”). It essentially fills the brain’s opioids receptors without producing the same high as full opioids. One of the advantages of using Suboxone is that it cannot be taken to achieve a full opioid effect, making it more difficult to abuse than other forms of medication-assisted treatment. Suboxone can be utilized for both detox withdrawal symptoms and long-term opiate addiction treatment as well.

Article Reviewed by Lidice Morales

Lidice MoralesLidice Morales, an honors graduate from the Kaiser University, has made a name for herself as the Director of Nursing at several behavioral health facilities and as the Director of Operations for Detox MD. Now she is the VP of Operations at DreamLife Recovery. She strives for better patient care through constant self-improvement and furthering her education. Her steadfast work ethic and passion in the field has remained the most important aspect of her professional career; showing dedication to not only the acquisition of new knowledge, but also its mastery. Lidice believes that a professional work atmosphere fosters cohesion and malleability amongst herself and her coworkers; thereby increasing both the level of patient care and quality of life.

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