Detoxification (as defined in Merriam -Webster dictionary):
1: to remove a harmful substance (as a poison or toxin) or the effect of such from b: to render (a harmful substance) harmless
2: to free (as a drug user or an alcoholic) from an intoxicating or an addictive substance in the body or from dependence on or addiction to such a substance
During detoxification a person's body is returning to homeostasis after long-term use of an addictive substance. The medications and strategies used for detoxification may vary widely, depending upon the particular drug(s) the patient is abusing or is addicted to and also any concomitant use of alcohol. Detox can be simple in some individuals but complicated and life-threatening and others. Also, depending upon the drug or combination of drugs/alcohol, detox can be only a few short days or may last several weeks. Using alcohol as an example, detoxification (detox), abrupt discontinuation of alcohol is coupled with the substitution of cross-tolerant drugs that occupy key brain receptor sites to prevent or reduce withdrawal symptoms. The medications may or may not be necessary during detox depending upon the individual's age, medical status, and history of alcohol intake. So a young man, for instance, who binge drinks and enters a treatment center one week after his last use of alcohol may not require any detoxification. When medications are required, benzodiazepines are the most commonly used drugs for this purpose. Examples would include chlordiazepoxide (Librium), diazepam (Valium), lorazepam (Ativan) or oxazepam (Serax). If the patient is allergic to benzodiazepines, phenobarbital is commonly used for detoxification from alcohol. Other medications may also be required as adjunctive treatment to manage physical or mental symptoms of detox. Some patients may be so ill that they require admission to a medical/surgical hospital for detox. So detoxification strategies can widely vary depending on the patient's condition and medical history. Key components of the pre-detox evaluation should include whether the patient is using drugs in addition to alcohol, the patient's physical condition, patient's medical history, psychiatric history, what medications the patient is taking for physical or mental conditions, what medications the patient is allergic to and what is this patient's history with any previous detoxifications.
Detoxification is always best handled by a medical healthcare provider that has experience in addictive medicine. When symptoms of detoxification linger, this is referred to as post acute withdrawal syndrome (PAWS). PAWS is a complex set of symptoms that can linger after acute detoxification has ended. The condition may persist from 6 to 18 months after the last use of the addictive drug or alcohol.
Symptoms can include:
• Cognitive difficulties such as difficulty with memory or lack of flexibility in thinking patterns. Abstract or conceptual ideas may be more difficult to assimilate. Executive function may be impaired and concentration and attention span may be compromised.
• Emotional problems. Wide mood swings are common. Hyperactivity and hypersensitivity can be problems. There may be hyper-somnolence or insomnia. Lingering depression is very common. Generally speaking, PAWS symptoms progressively diminish over time. If symptoms persist beyond 18 months, these may represent permanent impairments as a result of alcohol or drug use.