Is Detox Always Necessary?
The reason for this is to adequately describe certain processes that occur as a result of discontinuing use of drugs or alcohol. It has been recognized by these organizations and clinicians that detoxification and the formal process of the withdrawal management program are not the same thing.
- The detoxification process (detox) is a physical process that occurs when the body is cleansed of toxins. Detoxification is a process that occurs mainly through the liver as a person’s system naturally eliminates a number of waste products, foreign substances, and other materials. The detoxification process is ongoing in healthy individuals (people without significant liver damage). Even an individual who is actively using some drug or medication will be undergoing detoxification as their liver continuously cleans their blood. Detoxification does not refer to any targeted intervention to cleanse oneself of impurities, but refers to a natural process of cleansing that occurs in the body.
- Withdrawal is one aspect of physical dependence that occurs when a person who has chronically abused or used some drug has adjusted to having a specific level of the drug in the system, and the system recalibrates itself to function in the presence of the drug. The normal detoxification process removes the drug from the system, and if the individual does not replenish the drug, then their system is thrown out of balance. As a result, the person experiences a number of unpleasant physical and emotional consequences. If the person takes the drug again, the withdrawal symptoms will often extinguish very quickly.
- The withdrawal management process refers to both medical and psychological interventions applied to individuals recovering from substance use disorders who experience withdrawal symptoms (have developed physical dependence on the drug).
In 2009, the World Health Organization (WHO) formally stated technical issues with continuing to use the terms detox and detoxification to describe the withdrawal management process. The terms were noted to have many different definitions, did not translate well outside of English, and could not be applied in many studies and clinics outside of English-speaking countries. WHO decided to describe the process as withdrawal management, and other organizations followed suit, including the American Society of Addiction Medicine (ASAM), the foremost organization of addiction medicine physicians in the United States. In their formal statement, they state that the liver performs detoxification and clinicians manage withdrawal symptoms.
ASAM has formally applied the term withdrawal management to all of their publications and has even restated some of their policies to include this term and remove the term detox from references to the management of withdrawal symptoms in individuals recovering from substance use disorders. Even so, medical detox is still sometimes used to describe a professional withdrawal management process.
Is Withdrawal Management Always Necessary?
Absolute statements are very difficult to defend. Because anyone can find a number of anecdotal reports where individuals negotiated the withdrawal process from potentially dangerous drugs without medical intervention, it is quite clear that a formal physician-supervised withdrawal management program is not always necessary; however, it is highly recommended in many instances.
First, even though the development of physical dependence on many classes of drugs, such as opiates (e.g., heroin, morphine, Vicodin, etc.), alcohol, other central nervous system depressants (e.g., benzodiazepines and barbiturates), amphetamines, and other stimulants (e.g., methamphetamine and cocaine), is very likely with chronic use or abuse, it is not inevitable.
Second, a number of intervening factors determine the severity of the specific withdrawal symptoms and whether an individual will experience any withdrawal symptoms at all. It is not certain that the development of physical dependence is 100 percent probable for any specific drug of abuse, and the severity of symptoms that individuals experience is often based on subjective evaluations that are subject to individual differences in metabolism and emotions.
According to a number of reliable sources, such as the textbook Chemical Dependency, there are various instances in which an individual should first consult with a doctor prior to ceasing use of a substance.
- Individuals with severe alcohol use disorders, anxiolytic use disorders (particularly abuse of benzodiazepines or barbiturates), polysubstance use disorders, and opiate use disorders (e.g., heroin, morphine, etc.) are very likely to develop intense withdrawal symptoms once they discontinue the drug. In the case of withdrawal from alcohol, benzodiazepines, barbiturates, and certain other classes of drugs, there is a potential that the individual will experience seizures during the withdrawal process, and there is a potential that some seizures can have serious and even fatal consequences. Although no one can predict who will develop seizures and who will not, withdrawal management, or medical detox, is recommended for all those struggling with addiction to these drugs.
- Many individuals who develop substance use disorders also have co-occurring mental health conditions that can include very serious disorders, such as bipolar disorder, major depressive disorder, personality disorders, eating disorders, etc. Simply going through the withdrawal process without medical intervention may exacerbate these conditions and result in the potential for self-harm or injury due to accidents or poor judgment. It is not always possible to recognize these co-occurring conditions in individuals attempting to recover from a substance use disorder without a formal assessment. When the presence of co-occurring conditions is identified, such individuals should engage in medical detox.
- The potential for relapse is high during the withdrawal process. Simply taking one’s drug of choice will self-treat the withdrawal symptoms; however, taking one’s drug of choice to limit withdrawal symptoms will also simply further the progression of one’s substance use disorder. Becoming involved in a physician-assisted withdrawal management program can reduce the risk of relapse.
It is important to understand that becoming involved in a withdrawal management program is neither necessary nor sufficient to recover from substance abuse. Something is deemed as necessary to achieve some end when its absence will guarantee that the goal the individual is attempting to reach will not be met. The majority of individuals will find greater success in using physician-assisted withdrawal management strategies.A factor is deemed to be sufficient in order to achieve some outcome when its presence alone guarantees that the outcome will be reached. Simply going through a withdrawal management program without any formal substance use disorder therapy is associated with extremely high relapse. Thus, it is quite clear that the withdrawal management process alone is not sufficient to ensure a successful recovery and that other steps must be taken. Individuals who undergo a formal substance use disorder treatment program, participate in social support groups, and have treatment for co-occurring disorders still display incidents of relapse, but they also display better long-term recovery rates and better adjustment as a group than individuals who do not seek formal treatment.
Thus, it is advantageous to seek out a medical detox program when attempting to discontinue any drug of abuse.
Using a term like natural detox is an inaccurate description of the attempt to apply certain home remedies to control withdrawal symptoms because the detoxification process is itself a natural occurrence. These “natural” approaches to withdrawal management may or may not have relevance, and the research on them is often scant. Most of the endorsements for these approaches are based on anecdotal evidence, which is often very unreliable and therefore cannot be used to make generalizations.
These programs often include such things as herbs, juices, smoothies, special diets, fasting, exercise, meditation, or the use of Epsom salts.
According to scholarly sources, such as the book Drugs, Addiction, and the Brain, the research that does exist on some of these approaches often has serious methodological flaws. More controlled research needs to be performed in order to ascertain how some of these approaches may be useful. Eating a balanced diet, getting rest, and engaging in light exercise will aid the withdrawal process, and these are activities that can be utilized whether one uses a formal physician-assisted withdrawal management program or not. It is important to remember that withdrawal from certain types of drugs is potentially dangerous, and individuals should consult with a physician first.
There are some approaches that can support the withdrawal process. When used in conjunction with medical oversight, these practices can ease some of the discomfort associated with withdrawal and smooth the transition to sobriety.
- Get plenty of rest. Adequate sleep is essential for healing.
- Eat a balanced diet. Nutritional deficiencies are common during active substance abuse so it’s important to replenish those levels during withdrawal.
- Drink plenty of water and remain hydrated.
- Engage in light exercise, if possible and approved by a physician.
- This can be a useful practice to deal with a number of symptoms that are common to withdrawal, such as headaches, nausea, mild fever, irritability, anxiety, etc.
- Avoid stressful situations that will exacerbate the symptoms of withdrawal. Individuals under significant stress may experience a magnification of withdrawal symptoms.
- Keep busy. This can distract one from a number of withdrawal symptoms, including issues with anxiety, depression, nausea, headache, etc. Boredom often results in the intensification of the subjective symptoms of withdrawal and an increase in the potential for relapse.
- Avoid triggers. Reminders of the positive aspects of one’s past substance use can increase the risk of relapse. The 12-Step adage of avoiding people, places, and things associated with one’s past substance abuse is very applicable here.