Medical detoxification is a critical early step in the treatment of a drug addiction (clinically referred to as a substance use disorder). The term step is used deliberately; detoxification is necessary in most cases but not sufficient to help a person maintain abstinence. As the National Institute on Drug Abuse (NIDA) explains, addiction is a complex disease, and treatment responses must, in turn, be designed to address the many layers involved (i.e., the emotional, psychological, and behavioral factors). NIDA advises that a person who completes a medical detox program must immediately transition into the second phase of drug recovery treatment, which involves therapy (individual and group) and a host of supportive rehab services (e.g., recovery group meetings, family therapy, expressive therapy, exercise, and wellness treatments).
When a person is seeking to detoxify from a drug, there are at least two immediate options. One is medical detox, and the other is the cold-turkey approach. Medical detox is a supervised process that involves being under the care of a doctor, support staff (e.g., nurses), and addiction specialists. A cold-turkey approach, which is seldom (if ever) advisable, is often what a person employs when they attempt to detox on their own at home.
There are numerous reasons why the cold-turkey or do-it-yourself approach is disfavored, including that withdrawal can be dangerous. Symptoms range from moderate to severe and, in some instances, can be fatal. Another main reason to avoid at-home detox is the risk of a relapse during this period. In addition to withdrawal symptoms being uncomfortable or painful, drug cravings generally emerge. To use a visual aid, a person standing on a shoreline (the start of the recovery process) has a better chance of getting passed the choppy waves (the symptoms) with a boat and a crew (medical detox and the attending staff) compared to trying to swim out alone (a DIY approach).
Medical detoxification targets the biological reality of addiction; however, recovering clients are also provided with psychological support. In order to safely engage in the recovery process, a person must necessarily eliminate the drug of abuse from the body. In some instances, individuals are provided with substitution therapy, which is not a complete detoxification per se. Anyone who is interested in medical detox will quickly learn that the process is individually tailored, and treatment settings vary. Medical detox can occur at a rehab center, a standalone facility, a hospital, and any other qualified, well-equipped setting.
Since a medical detox facility provides medical services, it will be subject to federal, state, and possibly even local laws, including licensing requirements. The medical staff and any therapists in employment will be subject to whatever laws govern in the jurisdiction and in the profession overall. For instance, a medical doctor who is supervising and treating a patient in medical detox must be board-certified; the certification areas may vary, but some doctors have an addiction medicine certification. The nurses and counselors must also be properly certified. A client, or concerned loved one, may inquire with the medical detox center to learn about the attending staff members’ qualifications.
If asked, a medical detox center should also be able to provide evidence of its current licensing. With this said, it is understood that most people do not question whether treating doctors and medical centers are up to date on their certifications and licensing, but knowing that it is one’s privilege to ask is important. Sometimes, a quick scan of the lobby or doctors’ offices will provide this information, as licenses, local and national awards, certifications, and educational degrees may be displayed.
Review the Services Offered
During the consultation or admissions process, a trained counselor will do an intake with the prospective or incoming client. The intake is the counselor’s opportunity to learn about the client’s history of drug abuse, any physical or mental health diagnoses, immediate detox goals, long-term recovery goals, and drug treatment history (if any). The counselor will take the information and relay it to the assigned doctor (who may confer with a team of addiction specialists). The doctor (and possibly a team of addiction specialists) will create a tailored detox plan for the client.
The detox plan may include a full detoxification (i.e., ridding the body of the drug entirely), a tapering approach (as in the case of benzodiazepine withdrawal), or medication-assisted treatment (discussed in further detail below). In addition, benzodiazepines, and other FDA-approved medications, can be used to help a person withdraw from alcohol.
Within the field of addiction recovery, there is a pharmacologically based treatment that is clinically referred to as medication-assisted treatment (MAT) for opioid addiction. The following is a list of some of the component parts of MAT.
- The medications approved for use are methadone, buprenorphine, and naltrexone. Naloxone is used in emergency cases of opioid overdose.
- All addiction medications that are used in MAT have received approval from the US Food and Drug Administration.
- These medications may be used in the detox phase as well as in the abstinence maintenance phase as a substitution therapy, which means that the recovering person transitions from the drug of abuse to a medication that is safer. Depending on the individual, the substitution therapy can last weeks, months, a year, or longer.
- MAT is research-based for the drugs of abuse for which it is indicated.
- As MAT is considered to be an effective treatment, pharmaceutical companies are working on addiction treatment medications that can target other drugs of abuse, such as cocaine.
It is also helpful to understand what MAT is not. MAT medications do not cure addiction. Rather, they are intended to help a recovering person safely avoid a relapse. A main benefit of MAT medications is that they can stop, or lessen, withdrawal symptoms, such as drug cravings. MAT is not the same as over-the-counter drugs or prescriptions (mild to moderate) medications that a doctor gives a patient to help with withdrawal symptoms. For instance, if a person is withdrawing from stimulant abuse and experiencing a migraine, a doctor may provide a headache relief medication. That medication, even if it is a prescription, is not MAT.
After the intake process is complete, and should a medical detoxification plan that includes MAT be proposed, the benefits and any drawbacks entailed in using MAT will be discussed. In many instances, MAT is a recommendation made to help ensure safety in the detox process (and possibly later, during the abstinence maintenance phase). The attending doctor can collaborate with the client, and any concerned loved ones, to arrive at the most suitable course of treatment.
Quality of the Center
The quality of the amenities at a medical detox center (be in it a hospital, rehab, or standalone facility) will vary. A luxury program will have a well-appointed facility, which a state-funded program will likely not be able to provide. If a person has health insurance that (fully or partially) will cover medical detox or the means to pay out of pocket, and is seeking a mid-level or luxury center, various amenities and services may be available. Look for the following options:
- The patient-to-staff ratio suggests that the patient will receive ample time and attention.
- A doctor is present or on call at all times.
- The accommodations (in the case of a residential, or inpatient, program) are comfortable, clean, and nicely furnished. The client may have the option to have a single or shared room, shared bath, or private bath.
- The accommodations are regularly cleaned, and linens are changed.
- The meals (can apply to both outpatient and inpatient programs) are nutritious, well-balanced, and designed to support the withdrawal program. A well-appointed program will usually prepare the meals on site as well as get input on the menu from a trained nutritionist.
- The grounds are well-kept, manicured, and inviting.
- The availability of a gym or other exercise activity, such as a yoga class being held on sight. The recommended level of physical activity will vary by individual, per the attending doctor’s advisement.
- The availability of recovery group meetings on site, especially if it is a residential program. The treatment team will recommend when participation in group recovery meetings is advisable. In some instances, the treatment team may advise a client to wait until medical detox is completed.
- Although medical detox addresses the biological components of recovery, a comprehensive program should provide counseling as needed. Counseling can help a person to remain motivated and confident throughout the process, especially if drug cravings arise. Having psychological support is an added layer of protection against relapse.
Drug abuse can dramatically weaken every facet of a person’s life, from the inside out. Recovery services, starting with medical detox, can stop the negative spiraling effects of drugs and help a person to gain steady ground once again. Since medical detox is an integral part of the recovery process, receiving guidance on what to look for in a program can go a long way.