The History of Drug Detoxification
Most people know about detoxification as it relates to purging the body of unhealthy chemicals from food or overdoing it with sugar or caffeine. In a case like this, you want a natural detoxification to help you get back in balance. Whether as a result of an illness or simply getting on track to live more healthily, a natural detox is a great beginning. Drug detoxification takes the process a step further.
The History of Detoxification
Body cleansing or detoxification has its roots in Ancient Egypt. The Egyptians, and later the Greeks, believed that foods could cause an imbalance of the body’s natural balance, that the “humors” could be misaligned by eating too much of certain foods. It was the Greek physician Hippocrates (460-370 BC) who developed the mature medical theory.
He believed certain human moods, emotions and behaviors were caused by fluids in the body: blood, yellow bile, black bile, and phlegm. Well into the mid-20th century the term “autointoxication” was used to describe the theory that eating too much of certain foods would build up toxins in the body. In modern times this theory still persists. Except in the case of purging drugs from the body, the medical establishment has turned away from detoxification as a prescribed method of curing a patient’s ills. Certainly your body encounters toxins every minute of the day. Fortunately the liver, kidneys, lungs, intestines, and blood continuously clean. If we don’t introduce extra chemicals, like drugs, into our bodies then the internal cleansing process keeps us from literally poisoning ourselves.
History has very little to say about drug detox. Alcohol, the drug of choice for most of human history, does have a tried and true detox remedy in Milk Thistle. It has been known since before medieval times as a liver tonic. Modern clinical studies have confirmed the usefulness of Milk Thistle extracts in cases of cirrhosis and other chronic liver aliments associated with alcohol abuse.
History of Detoxification Services
In the late 50’s the American Medical Association made it their official position that alcoholism is a disease. Slowly shifts in society’s understanding of addiction changed how people with a dependency on alcohol and other drugs were treated. 12-step programs certainly helped. Until the mid 1970’s people arrested for “public intoxication” were held in local jails. Depending on the length of the sentence, a person might experience alcohol detox in jail, with little or no medical intervention. This happened regularly even though in 1971, the National Conference of Commissioners on Uniform State Laws adopted the Uniform Alcoholism and Intoxication Treatment Act which recommended that “alcoholics not be subjected to criminal prosecution because of their consumption of alcoholic beverages but rather should be afforded a continuum of treatment in order that they may lead normal lives as productive members of society” (Keller and Rosenberg 1973, p. 2). It was only a recommendation, not a law, but it helped create a change in the legal implications of addiction. Over the next quarter century understanding of drug detoxification grew and became the medical process we recognize today.
The Basics of Drug Detox
Drug detoxification refers to several possible intervention strategies related to controlling drug addiction and/or drug withdrawal. Flushing the body of traces of the drug is paramount to recovery. Detoxification will mitigate the physical effects caused by the drug or drugs and can be an important step on the road to becoming drug-free.
It must be noted that detoxification programs do not necessarily treat other aspects of drug addiction. The psychological aspects of addiction, the behavioral and the social must be treated in tandem or after the detoxification process has occurred.
There are typically three steps to clinical drug detoxification
First, evaluation. The patient is tested to see what substances are presently in their bloodstream. The amount of the drug or drugs is also noted. Staff will also review the patient’s history and current behavior for potential disorders, mental or behavioral issues.
Second, stabilization. At this point, the patient goes through the process of detoxification. Medications may or may not used during this phase. Generally, medications are used. As a secondary part of stabilization, information is extremely important. The patient should be informed about what to expect during treatment and recovery. If it seems prudent, family members and friends can be introduced into the environment to aid in stabilization.
Third, treatment. The last step in the detox process is to ready the patient to enter a recovery program. Remember, drug detoxification only deals with the physical dependency. It cannot meaningfully address the psychological aspects of drug addiction. The treatment stage concludes with agreement that the patient will complete the recovery by going to rehab.
Drug detoxification can happen in many settings. The level of intensity and patient commitment can vary within these settings. Deciding which sort of clinic, hospital or other setting should be determined by the patient’s needs. It’s important, as the process starts, to begin thinking about post detox help. Often this can happen in the same facility as the detoxification. Insurance, or the lack of insurance, plays a huge part in where and for how long the process can happen. People needing to detox come from all walks of life and income situations. Clinics realize this and most offer plans equipped to tailor treatment to their client populations. Knowing that detox was successful can be measured, in part, by whether someone enters or remains in rehab after detoxification.
Where the patient goes for detox (and possibly post-detox treatment) depends in part on the drug or drugs used. Experts suggest that for alcohol, sedative, and opiate withdrawal, hospitalization (or some form of 24-hour medical care) is often the preferred setting for detoxification. If hospitalization cannot be provided, then a setting that provides a high level of care – 24/7 – is recommended.
A big challenge for detoxification programs is ensuring that exiting patients have information and access to substance abuse treatment services. Spending time in treatment is almost always needed if the patient is going to be clean in the long term. The stats are astounding. Over 250,000 people detox in hospitals every year. Only 20% of them go on to receive substance abuse treatment.
Stats come from this document:
Detoxification and Substance Abuse Treatment
by Norman S. Miller, M.D. & Steven S. Kipnis, M.D.
Drug Detoxification with 12 Step Programs
The best way to define a 12-step program is that it gives you a roadmap for recovery from addiction, compulsion, or other behavioral problems. The original 12-steps were first published in1939 in the book, Alcoholics Anonymous: The Story of How More Than One Hundred Men Have Recovered From Alcoholism.
These are the original Twelve Steps:
- We admitted we were powerless over alcohol—that our lives had become unmanageable.
- Came to believe that a Power greater than ourselves could restore us to sanity.
- Made a decision to turn our will and our lives over to the care of God as we understood Him.
- Made a searching and fearless moral inventory of ourselves.
- Admitted to God, to ourselves, and to another human being the exact nature of our wrongs.
- Were entirely ready to have God remove all these defects of character.
- Humbly asked Him to remove our shortcomings.
- Made a list of all persons we had harmed, and became willing to make amends to them all.
- Made direct amends to such people wherever possible, except when to do so would injure them or others.
- Continued to take personal inventory and when we were wrong promptly admitted it.
- Sought through prayer and meditation to improve our conscious contact with God as we understood Him, praying only for knowledge of His will for us and the power to carry that out.
- Having had a spiritual awakening as the result of these steps, we tried to carry this message to alcoholics, and to practice these principles in all our affairs.
Alcoholics Anonymous (4th ed.)
Over the years many groups, wanting to address behaviors besides alcohol addiction, have reworded the language to fit their groups’ focus as well as any differentiating religious or cultural identity. The Steps have a chameleon like ability to become what a group needs them to become.
There are as many ideas about recovery as there are stars in the sky, but the Steps work. Over and over and over, the Steps show that they work. It’s not a painless way to get over your heroin addiction, but it has the best chance of working. Once you deal with just getting the drugs out of your system, once you detox and get your head clear, then you can begin to replace the hole in your soul. Because that’s really the question, right? Why did you start using in the first place? When you get to the 4th Step…. the moral inventory, that’s when healing can really begin.
So take some time to visit the AA website and see what I mean.
Alcohol Detox
We can thank Hippocrates, the Greek father of modern medicine, for recording an eye witness description of alcohol withdrawal. If the patient, he wrote for future students, is “in the prime of life and if from drinking he has trembling hands,” that patient has probably addicted to alcohol, has not had alcohol recently and is therefore exhibiting withdrawal symptoms. The signs and symptoms of acute alcohol withdrawal generally start 6 to 24 hours after the last drink.
Believe it or not, alcohol withdrawal can begin even if you have significant blood alcohol concentrations. In other words, you can be technically drunk and your body starts to feel withdrawal. The signs and symptoms may include the following: insomnia and/or nightmares, restlessness, irritability, anxiety, and agitation. In addition as the body metabolizes the alcohol you may experience nausea, vomiting, hand tremors, elevated heart rate, and increased blood pressure. As if that wasn’t enough, the poor brain is going through some trauma of its own. Additional symptoms include: poor concentration, impaired memory, increased sensitivity to sound, light, and tactile sensations, and possibly, hallucinations and paranoid delusions.
Something else to be aware of is what is known as “the kindling effect.” Originally coined to describe how epileptic seizures seem to get worse (more often, longer episodes) with each seizure, the term has been co-opted for use in other areas. Since alcohol has a huge impact on the brain and in fact seizures can be one of the worst parts of alcohol withdrawal, it is easy to see how medical folks could make the leap from epilepsy to alcohol withdrawal. Over time the term has expanded to describe the phenomenon of diminishing returns with alcohol detox. In other words, when you try to kick the bottle, every time you fail, it gets harder. Alcohol addiction, in particular, has a high rate of binge behavior so drinking and drying out is the worst behavior to exhibit as the kindling effect brings full force to hamper the recovery process.
The physical addiction to alcohol is devastating. The brain, when deprived of its former levels of alcohol goes into this hyper state and that’s what causes the anxiety and tremors.
It’s the physical symptoms that can trigger the almost obsessive thoughts about drinking. So again, the kindling effect come full circle: the body is without its chemical and so the physical discomfort begins. This in turn triggers the desire to introduce alcohol back into the body and so on. To make matters worse, the brain can be conditioned in a Pavlovian way so that even being at the same clinic for another attempt at detox can trigger the kindling effect even before true symptoms can manifest.
Some people want to try to detox from alcohol on their own. It can be done, but there are some really basic things to consider. First and foremost – is this a first attempt? If so, remember the kindling effect; you want this to be a successful because next time it will be harder. Some basic care helps keep the worst of the withdrawals at bay. Fluids and electrolytes need to be constantly available. Diarrhea, vomiting, and sweats may affect the patient, so fluids are essential. For some people using Xanax or Valium is not uncommon. These drugs actually decrease the likelihood of seizures during withdrawals. Of course they also help with anxiety and tremors. These things will help. But nothing is going to beat getting true medical help for alcohol detox. You want to get sober once and for all and the best way to do that is at a clinic.
Brain image credit: Wellcome Library, London
Heroin Detox
Heroin withdrawal symptoms are not necessarily medically dangerous, but they can be distinctly unpleasant. All opiates (heroin, morphine, oxycodone, codeine, and methadone) produce similar withdrawal symptoms. How bad the withdrawal symptoms are depends on several factors.
For instance, heroin withdrawal typically begins 8 to 12 hours after the last heroin dose and subsides within a period of 3 to 5 days. If someone is trying to detox on their own, without medical aid, it might be longer than the normal 3 to 5 days. Unlike alcohol detox, uncomplicated heroin withdrawal is not life-threatening. Certainly symptoms like vomiting and diarrhea can lead to dehydration, but most people can be treated with fluids, especially fluids containing electrolytes. If the person has a history of heart trouble, that could be cause for concern because of increased blood pressure and pulse rate that tends to come with withdrawal.
A fever could seem like the least of your worries as you deal with heroin detox, but a fever should be treated seriously, particularly with intravenous users, because of possible HIV infection, viral hepatitis, abscesses and/or infected injection sites. Also, any painful injuries, back aches or tooth aches somehow get worse as you go through withdrawal. It’s always going to be better to seek medical help with detox and treatment, but here’s how to handle the general aches and pains…. Headache, muscle aches, and bone pain can be managed with aspirin, or ibuprofen as needed. Maalox can be administered for gastric complaints and Pepto-Bismol for diarrhea. Constipation usually can be managed with milk of magnesia.
Any doctor will tell you that the only way to achieve lasting recovery from heroin is with a medically controlled detox. The most common way is with methadone. US federal regulations almost completely restrict the use of methadone to specially licensed programs. While methadone is most frequently used, a newer medication, buprenorphine is often used. Studies have shown it may be more effective for long term results. The drug clonidine is often used to treat the racing pulse and high blood pressure that can accompany heroin detox. It doesn’t, however, help with the insomnia, body aches and headaches.
Be wary of any “ultrarapid” detox solutions. People always want a quick solution. There’s no data to prove that rapid methods of opiate detoxification help in long term sustained recovery. But who doesn’t want this to be shorter and easier? For the medical profession this is because they want more people in treatment (fewer than one in five people with substance use disorders in the United States are in treatment at any time). There’s also a long standing belief that detox is most of the cure. So you shoot through the detox and you’re done. It’s somehow cemented itself into our culture, this idea that once the toxins are gone, the body will run like a well oiled machine. It’s not so simple and yet, anyone who’s kicked a drug habit knows that surviving detox is half the battle and if you get that far, why stop? Keep on keeping on.
Photo credit: swanksalot
All stats come from this document:
Detoxification and Substance Abuse Treatment
by Norman S. Miller, M.D. & Steven S. Kipnis, M.D.
http://download.ncadi.samhsa.gov/prevline/pdfs/DTXTIP45%283-30-06%29.PDF