Which Drug Addictions Require a Medical Detox?

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Some drugs require a supervised medical detox before treatment or getting sober, the most common of which are, alcohol, benzodiazepines and opioids.


With any significant and continuous use of mood-altering substances, profound changes in the physiology and structure of the brain occur. Many of the changes that occur are reversible; However, depending upon the amount and duration of the drug addiction, some of the changes that occur may be irreversible. Therefore, it is important for those addicted to drugs to seek rehab treatment as soon as possible.
With some drugs of abuse, and depending upon the amount and duration of use, the treatment process often first begins with an inpatient medical detox. Because each drug affects the body differently, the cessation of use of some addictive drugs requires a medical detox and others do not. It is important to remember that just because an inpatient medical detox may not be required, the brain and body are still undergoing profound changes with the cessation of any drug usage in an attempt to return to their baseline physiologic state.
First, let’s review the classes of the common drugs of abuse.

1) Opiates – Heroin and Prescription Pain Relievers
2) Benzodiazepines, Barbiturates, and Other Sedatives
3) Stimulants
4) Synthetic Drugs
5) Marijuana and Hallucinogens

Mood-altering and addictive drugs from the classes of stimulants, synthetic drugs, and marijuana/hallucinogens typically do not require an inpatient medical detox. However, the body will still exhibit signs and symptoms of withdrawal and the patient will likely experience mood, sleep and appetite changes at a minimum.

More often than not, patients who are only addicted to drugs from the stimulant, synthetic drug, and marijuana/hallucinogen classes will directly enter drug treatment directly at the rehab level, rather than first undergoing a medical drug detox.

Addiction to drugs from the opiate and benzodiazepine/sedative classes almost always requires a medical detox. The initial treatment of opiate dependence, although the withdrawal is typically not life-threatening, usually requires inpatient detox due to the severe symptoms that are experienced by the patient. Symptoms include nausea, vomiting, diarrhea, low appetite, muscle cramping, headache, sweating and significant mood swings. Withdrawal from opiates can create severe discomfort for the patient. There are times, however, that the withdrawal can be so severe, or in cases where the patient has significant underlying medical problems, that it can be life-threatening.

There are two basic protocols for medical detox from opiates. The first does not utilize mood-altering drugs in the withdrawal protocol. Instead, medications to treat the symptoms of opiate withdrawal are used, including medications for nausea, vomiting, diarrhea, insomnia, muscle-cramping, and any other physiologic signs and symptoms that the patient is experiencing. The second main type of opiate medical detox is one that actually uses opiates for the withdrawal. The U.S. Drug Enforcement Agency (DEA) has approved three narcotic medications that can be prescribed for this purpose: methadone, buprenorphine (Suboxone and Subutex), and levomethadyl acetate (LAAM).

Withdrawal from benzodiazepines, barbiturates, and other sedatives causes the most potential for significant, severe life-threatening complications and almost always must be treated medically. Medical detox from drugs in these classes can last anywhere from three to fourteen days and is essential for those with chronic, long-term drug addiction. The detox is carried out by slowly tapering a benzodiazepine such as Ativan, Klonopin, or Valium, for example, or a barbiturate, such as phenobarbital. The signs and symptoms of withdrawal will include tremors, nausea, vomiting, headache, muscle cramping, high blood pressure, fever, confusion, anxiety, panic attacks, insomnia, poor concentration, and other impairments in cognitive functioning. Seizures, stroke, and heart attack can also occur. Of course, as with all other substances, cravings are likely to occur.

Being treated at a medical detox can prevent relapse back into drug addiction with any addiction and it can prevent relapse, suffering, medical complications, and death. If medical detox is not required, it is important that the addicted person seek treatment at a drug and alcohol rehab to regain manageability in their life and to stop the addiction from progressing and resulting in additional and more severe consequences.

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