Drug detoxification (informally, detox) is variously the intervention in a case of
physical dependence
Physical dependence is a physical condition caused by chronic use of a tolerance-forming drug, in which abrupt or gradual drug withdrawal causes unpleasant physical symptoms. Physical dependence can develop from low-dose therapeutic use of certai ...
to a
drug
A drug is any chemical substance that causes a change in an organism's physiology or psychology when consumed. Drugs are typically distinguished from food and substances that provide nutritional support. Consumption of drugs can be via inhala ...
; the process and experience of a
withdrawal syndrome
Drug withdrawal, drug withdrawal syndrome, or substance withdrawal syndrome, is the group of symptoms that occur upon the abrupt discontinuation or decrease in the intake of pharmaceutical or recreational drugs.
In order for the symptoms of with ...
; and any of various treatments for acute
drug overdose
A drug overdose (overdose or OD) is the ingestion or application of a drug or other substance in quantities much greater than are recommended. .
A detoxification program for physical dependence does not necessarily address the precedents of
addiction
Addiction is a neuropsychological disorder characterized by a persistent and intense urge to engage in certain behaviors, one of which is the usage of a drug, despite substantial harm and other negative consequences. Repetitive drug use o ...
, social factors, psychological addiction, or the often-complex behavioral issues that intermingle with addiction.
Process
The
United States Department of Health and Human Services
The United States Department of Health and Human Services (HHS) is a cabinet-level executive branch department of the U.S. federal government created to protect the health of all Americans and providing essential human services. Its motto is ...
acknowledges three steps in a drug detoxification process:
#''Evaluation'': Upon beginning drug detoxification, a patient is first tested to see which specific substances are presently circulating in their bloodstream and the amount.
Clinician
A clinician is a health care professional typically employed at a skilled nursing facility or clinic. Clinicians work directly with patients rather than in a laboratory or as a researcher. A clinician may diagnose, treat, and otherwise care for pat ...
s also evaluate the patient for potential co-occurring disorders,
dual diagnosis
Dual diagnosis (also called co-occurring disorders (COD) or dual pathology) is the condition of having a mental illness and a comorbid substance use disorder. There is considerable debate surrounding the appropriateness of using a single catego ...
, and mental/behavioral issues.
#''Stabilization'': In this stage, the patient is guided through the process of detoxification. This may be done with or without the use of medications but for the most part the former is more common. Also part of stabilization is explaining to the patient what to expect during treatment and the recovery process. Where appropriate, people close to the addict are brought in at this time to become involved and show support.
#''Guiding Patient into Treatment'': The last step of the detoxification process is to ready the patient for the actual recovery process. As drug detoxification only deals with the physical dependency and addiction to drugs, it does not address the psychological aspects of drug addiction. This stage entails obtaining agreement from the patient to complete the process by enrolling in a
drug rehabilitation
Drug rehabilitation is the process of medical or psychotherapeutic treatment for dependency on psychoactive substances such as alcohol, prescription drugs, and street drugs such as cannabis, cocaine, heroin or amphetamines. The general intent i ...
program.
Rapid detoxification
The principle of rapid detoxification is to use heavy sedation alongside dosing with opioid
antagonists. This approach is expensive, ineffective and extremely dangerous. Rapid detox and ultra-rapid detox are non-standard medical detoxification protocols that have been investigated for their role in managing opioid withdrawal.
Etymology
The concept of "detoxification" comes from the discredited autotoxin theory of
George E. Pettey and others.
David F. Musto
David Franklin Musto (January 8, 1936 – October 8, 2010) was an American expert on U.S. drug policy and the War on Drugs who served as a government adviser on the subject during the Presidency of Jimmy Carter. He wrote extensively on the his ...
says that "according to Pettey, opiates stimulated the production of toxins in the intestines, which had the physiological effect associated with withdrawal phenomena.
..Therefore treatment would consist of purging the body of toxins and any lurking morphine that might remain to stimulate toxin production in the future."
Rapid detox controversy
Naltrexone therapy, which critics claim lacks long-term efficacy and can actually be detrimental to a patient's long-term recovery, has led to controversy. Additionally, there have been many questions raised about the ethics as well as safety of rapid detox following a number of deaths resulting from the procedure.
Some researchers say that relapses to injection use of illicit opioids during or following repeated detoxification episodes carry the substantial potential for injury associated with uncontrolled drug use and include
drug overdose
A drug overdose (overdose or OD) is the ingestion or application of a drug or other substance in quantities much greater than are recommended. ,
infection
An infection is the invasion of tissues by pathogens, their multiplication, and the reaction of host tissues to the infectious agent and the toxins they produce. An infectious disease, also known as a transmissible disease or communicable di ...
s, and death.
[Ling W, Amass L, Shoptaw S (Jun 2006]
"A multi-center randomized trial of buprenorphine-naloxone versus clonidine for opioid detoxification: findings from the National Institute on Drug Abuse Clinical Trials Network."
PMID
PubMed is a free search engine accessing primarily the MEDLINE database of references and abstracts on life sciences and biomedical topics. The United States National Library of Medicine (NLM) at the National Institutes of Health maintain the ...
16042639
/ref>
See also
* Alcohol detoxification
References
{{reflist
Drugs
Drug rehabilitation
Substance dependence
Detoxification
pl:Detoks