Aftercare

After the patient has completed detoxification, he or she needs further treatment either at an outpatient, inpatient, residential, or day hospital program in order to remain drug-free for the long term. Patients are treated by trained health care professionals, and some patients are also counseled by people who are recovering from addiction themselves. Many patients also benefit from 12-step programs or self-help groups, such as Alcoholics Anonymous (AA) or Narcotics Anonymous (NA).

Most opioid users are treated with ambulatory or outpatient detoxification or residential treatment followed by outpatient counseling. Some people who have abused opioids and have undergone detoxification and counseling are able to remain drug-free. Many, however, relapse, even after receiving psychotherapy. People recovering from opioid addiction can receive methadone or LAAM as maintenance therapy to prevent relapse. Similar to the aid these medications can give patients during detoxification, when taken daily as a therapy, they continue to "act" as heroin, keeping the withdrawal symptoms from appearing. Methadone maintenance therapy can be provided through either residential or therapeutic communities and outpatient drug-free programs. Methadone maintenance treatment therapy is controversial, however, because it does not cure the person's addiction— it replaces it with another substance. Proponents of methadone maintenance therapy argue that people receiving methadone are able to function much better in society than people addicted to heroin. Because their drug-seeking behavior is reduced, these patients are able to become productive at work and their interpersonal relations improve.

People recovering from alcoholism can also benefit from counseling and support after detoxification, and a maintenance therapy is available to them, as well. Disulfiram (Antabuse) is a medication that interferes with the body's breakdown and processing of alcohol. When alcohol is consumed while a patient is taking disul-firam, the medication makes the effects of the alcohol much worse than the patient would normally experience—facial flushing, headache, nausea and vomiting occurs, even if alcohol is consumed in a small amount. In order for disulfiram to be effective, the patient must want this kind of reinforcement to maintain abstinence and must be committed to it. Patients also must note that any form of alcohol can trigger the undesired effects, including cooking wine or mouthwash with alcohol.

Risks

When benzodiazepines are the drug to which a person is addicted, they have to be discontinued and cannot be given on an outpatient basis because of their potential for abuse. For all patients undergoing detoxification, ben-zodiazepine use must be monitored carefully because of the potential for new addiction. Elderly patients undergoing detoxification and receiving benzodiazepines must be monitored closely because they are more sensitive to the sedating effects of these drugs, and are also more prone to falls while receiving these drugs. If benzodiazepines are not discontinued gradually, patients can have withdrawal symptoms such as irritability, poor sleep, agitation and seizures. Ultra-rapid opioid detoxification under anesthesia/sedation remains a new and serious procedure. Patients have died receiving this procedure, and this procedure is still being researched.

It should also be noted that many of the substances used in detoxification can themselves cause addictions. An example of this risk has already been given with ben-zodiazepines—these medications ease withdrawal symptoms during detoxification, but patients can get addicted to these medications, as well.

Normal results

Normal results for a well-managed detoxification would include freedom from the drug of addiction and ability to enter long-term treatment.

Success rates vary among people recovering from substance abuse. As might be expected, patients who successfully complete a full treatment program after detoxification (that includes counseling, psychotherapy, family therapy, and/or group therapy or some combination of those therapy types) achieve higher rates of success at remaining drug-free. Patients who were addicted for shorter periods of time and patients who spend longer periods in treatment are generally more successful at remaining abstinent from drugs over the long term.

Studies indicate that people who abuse alcohol and who want to stop have a higher chance of success if they undergo inpatient detoxification versus outpatient detoxification.

Abnormal results

One abnormal result that may occur is that patients who received nasogastric or tracheal tubes for opioid detoxification under anesthesia may experience adverse effects or complications. These patients are at risk for: trauma to their lips, vocal cords, larynx, teeth; nose bleeds; high blood pressure; elevated heart rate; irregular heartbeat; and vomiting, which can lead to aspiration pneumonia.

An additional abnormal result would be a new addiction as a consequence of the detoxification.

After the detoxification is completed, patients may relapse. Support is critical for patients to continue long-term therapy and successfully overcome addiction.

See also Addiction; Disease concept of chemical dependency; Individual entries on various substances and related disorders

Resources books

Beers, Mark H., M.D., and Robert Berkow, M.D., eds. "Alcoholism." The Merck Manual of Diagnosis and Therapy. 17th edition. Whitehouse Station, NJ: Merck Research Laboratories, 1999. Jaffe, Jerome H., M.D., and others. "Substance-Related Disorders." In Comprehensive Textbook of Psychiatry, edited by Benjamin J. Sadock, M.D. and Virginia A. Sadock, M.D. 7th edition. Philadelphia: Lippincott Williams and Wilkins, 2000. Matthews, John. "Substance-Related Disorders: Cocaine and Narcotics." In Psychiatry Update and Board Preparation, edited by Thomas A. Stern, M.D. and John B. Herman, M.D. New York: McGraw Hill, 2000.

periodicals

Fuller, Richard K., M.D. and Susanne Hiller-Sturmhofel, Ph.D. "Alcoholism Treatment in the United States: An Overview." Alcohol Research and Health 23 (1999): 6977.

Khantzian, Edward J., M.D. "Methadone Treatment for Opioid Dependence." American Journal of Psychiatry November 2000: 1895-1896.

Leshner, Alan Ph.D. "Heroin Abuse and Addiction." National Institute on Drug Abuse Research Report Series. NIH Publication Number 00-4165, Washington, D.C. Supt.of doc. US. Govt. Print. Off., 2000.

Shreeram, S. S., M.D., and others. "Psychosis After Ultrarapid Opiate Detoxification." American Journal of Psychiatry June 2001: 970.

organizations

The College on Problems of Drug Dependency (CPDD).

CPDD Executive Offices, Department of Pharmacology, 3420 N.Broad Street,Philadephia, PA,19140. (215) 7073242. <http://views.vcu.edu/cpdd>.

Institute for Comprehensive Detoxification and Rehabilitation. (877) 704-ICDR (4237). <http://www.views.vcu.edu/cpdd/>.

National Institute on Alcohol Abuse and Alcoholism

(NIAAA). 6000 Executive Boulevard, Willco Building, Bethesda, MD, 20892-7003.<http://www.niaaa.nih.gov>.

National Institute on Drug Abuse (NIDA). 6001 Executive Boulevard, Room 5213, Bethesda, MD, 20892-9561. (301) 443-1124. <http://www.nida.nih.gov>.

Susan Hobbs, M.D.

Body Detox Made Easy

Body Detox Made Easy

What exactly is a detox routine? Basically a detox routine is an all-natural method of cleansing yourbr body by giving it the time and conditions it needs to rebuild and heal from the damages of daily life and the foods you eat and other substances you intake. There are many different types of known detox routines.

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