Information on detoxification
If you have withdrawal symptoms it is not advisable to stop drinking
on your own. It is important that you talk to your doctor about options
for detoxing safely
*What
is Detoxification, or "Detox"?
Detoxification is the process of allowing the body to rid itself of a
drug while managing the symptoms of withdrawal. It is often the first
step in a drug treatment program and should be followed by treatment with
a behavioral-based therapy and/or a medication, if available. Detox alone
with no follow-up is not treatment.
What is Withdrawal? How Long Does
it Last?
Withdrawal is the variety of symptoms that occur after use of some drugs
are reduced or stopped. Length of withdrawal and symptoms vary with the
type of drug. For example, physical symptoms of heroin withdrawal may
include: restlessness, muscle and bone pain, insomnia, diarrhea, vomiting,
and cold flashes. These physical symptoms may last for several days, but
the general depression, or dysphoria (opposite of euphoria) that often
accompanies heroin withdrawal may last for weeks. In many cases withdrawal
can be easily treated with medications to ease the symptoms, but treating
withdrawal is not the same as treating addiction.
*http://teens.drugabuse.gov/drnida/drnida_general2.asp
Inpatient vs. outpatient
detox? Criteria for deciding
Alexander
DeLuca, M.D., FASAM.
Copyright © 1999, 2000, 2001. All rights reserved.
Revised: March 13, 2001.
Inpatient vs. outpatient
detox? Criteria for deciding
(see also: "Outpatient Detox - Is This Really a Good Idea?
Patients who should not have outpatient detox procedures:
Not all patients are appropriate candidates for outpatient detoxification.
The American Society of Addiction Medicine (ASAM) have developed guidelines
to help ensure that critical errors in referral are avoided. Please see
the full text of these guidelines which are published by ASAM as the Patient
Patient Criteria (PPC).
Here follows a brief discussion highlighting some of the criteria that
suggest that the appropriate referral is to an inpatient hospital detoxification
setting:
-Patient is at high risk for complicated
withdrawal
-Current overdose-in-progress compromising vital signs, mental status
or cardiac function, or life-threatening stupor.
-Head trauma, seizure, hallucinations, or symptoms of delirium tremens
within the past 24 hours.
-History of seizures, hallucinations or delirium tremens when withdrawing
from similar amounts of alcohol/sedatives; or history of recurrent or
multiple seizures.
-Pregnant patient in need of detoxification.
-Daily use of sedative medications in doses above therapeutic levels for
greater than one month, or in therapeutic doses but in combination with
alcohol for greater than six weeks.
-CIWA >= 20, BAC >= 0.3, BAC >= 0.1 plus symptoms of alcohol
withdrawal syndrome.
-CIWA = 10-19 plus pulse > 110 or BP > 160/110.
-Patient is at high risk for biomedical complications:
-Presence of biomedical problem(s) requiring inpatient diagnosis and treatment,
such as, impending hepatic decompensation, acute pancreatitis or other
condition requiring parenteral therapy, active gastrointestinal bleeding,
cardiovascular disorder requiring monitoring, etc.
-Chemical use gravely complicating existing biomedical condition, or worsening
of a condition making immediate abstinence critical to avoid severe morbidity
or mortality.
-Patient is at high risk for psychiatric or behavioral complications:
-Uncontrolled behavior endangering self or others
-Impairment of cognitive function, mental confusion or fluctuating orientation,
or extreme depression such that activities of daily living are impeded.
-Evidence of disorientation to self, alcoholic hallucinosis, or toxic
psychosis within the past 24 hours or currently.
-Chemical use gravely complicating existing psychiatric condition, or
worsening of a condition making immediate abstinence critical to avoid
severe morbidity or mortality.
Patients who are good candidates
for outpatient detoxification
To look at the issue from the opposite perspective, we can say that patients
are appropriate for outpatient detoxification if they do not meet criteria
for inpatient detoxification:
-Patient is at minimal risk of severe withdrawal:
-CIWA < 10 after 4-8 hours abstinence, or, BAC = 0.0 with minimal or
no medication that might mask signs or symptoms of withdrawal.
-Reliable history that use of substances in combination does not pose
a significant risk of complicated withdrawal.
-Patient is likely to complete detoxification and accept referral:
-History of completion of outpatient detoxification and entry into continued
treatment.
-Presence of support services to ensure commitment to complete detoxification
and enter treatment.
-Patient has, and responds positively to, emotional support combined with
treatment, and evidences decreased emotional symptoms by closure of initial
treatment session.
-Patient and caretaker clearly understand instructions for care.
-Home environment able to provide adequate reality, reassurance and respect.
For further discussion of inpatient and outpatient detox see: "Outpatient
Detox - Is This Really a Good Idea?" www.doctordeluca.com
Alcohol Withdrawals
Can Be Mild, Moderate or Severe
Alcohol withdrawal refers to a group of symptoms that may occur from suddenly
stopping the use of alcohol after chronic or prolonged ingestion.
Not everyone who stops drinking experiences
withdrawal symptoms, but most people who have been drinking for a long
period of time, or drinking frequently, or drink heavily when they do
drink, will experience some form of withdrawal symptoms if they stop drinking
suddenly.
There is no way to predict how any individual
will respond to quitting. If you plan to stop drinking and you have been
drinking for years, or if you drink heavily when you do drink, or even
if you drink moderately but frequently, you should consult a medical professional
before going "cold turkey."
Withdrawal Symptoms:
Mild to moderate psychological symptoms:
Feeling of jumpiness or nervousness
Feeling of shakiness
Anxiety
Irritability or easily excited
Emotional volatility, rapid emotional changes
Depression
Fatigue
Difficulty with thinking clearly
Bad dreams
Mild to moderate physical symptoms:
Headache - general, pulsating
Sweating, especially the palms of the hands or the face
Nausea
Vomiting
Loss of appetite
Insomnia, sleeping difficulty
Paleness
Rapid heart rate (palpitations)
Eyes, pupils different size (enlarged, dilated pupils)
Skin, clammy
Abnormal movements
Tremor of the hands
Involuntary, abnormal movements of the eyelids
Severe symptoms:
A state of confusion and hallucinations
(visual) -- known as delirium tremens
Agitation
Fever
Convulsions
"Black outs" -- when the person forgets what happened during
the drinking episode
Source: National Institutes of Health
*What
Is Rapid Detox?
Also known
as 'ultra rapid opiate detox', rapid detox is exactly what it says,
rapid detoxification
for opiate based substances and addictions.
Some of the narcotic opiate based
drugs that are treatable with the rapid detoxification
process are:
Heroin Detox
Codeine Detox
Vicodin Detox
Oxycontin Detox®
Methadone Detox
Morphine Detox
Fentanyl Detox
Percocet Detox
Lortab Detox
Darvocet Detox
Dilaudid Detox
Norco Detox
*http://www.rapid-detox.org/
Articles
concerning opiate based detox from the American Journal of Psychiatry