Detoxification, also known as detox is a medical intervention/treatment for people diagnosed with physical drug dependence.
The principle is generally the same for all drugs although there may be variations between treatments depending on which drug a patient has become addicted to.
In essence, detox is the systematic elimination of the harmful chemical traces of a drug from the human body. This is achieved by prescribing patients decreasing amounts of the drug (or substitute drug) over a period of 1-3 weeks so they no longer experience withdrawal symptoms.
Heavy drug users will have constantly highly toxic elements of the drug in their bloodstream, which will slowly increase as they take more of the drug.
It is the high blood levels of the drug that predominantly cause a wide range of unpleasant withdrawal symptoms when a person stops taking the drug. (2)
A medically assisted drug detox is a pharmacological treatment to help eliminate the harmful effects of drugs from patients’ bodies. A medically assisted detox is not available for all drugs, heroin and fast-acting benzodiazepines do have medical detox treatment options available but cocaine and cannabis do not.
Practitioners carrying out medically assisted detox treatment utilise substitute drugs which are chemically similar but that are not physically addictive nor capable of producing positive psychological states such as pleasure and relaxation.
The idea is to slowly reduce the level of the drug in the body and to control the severity of withdrawal syndrome experienced by the patient. (5)
All psychoactive drugs that people become addicted to require a period of detox, however, it is mainly opioid drugs such as heroin and prescription drugs from the benzodiazepine group that have pharmacological medication available to facilitate the detox treatment.
Other drugs such as stimulant drugs (e.g. cocaine) and cannabis do not have any pharmacological interventions available to assist the detox process and in these cases, it is all about withdrawal management and overseeing the patients’ progress by monitoring their physical and psychological health during the early stages of detox and intervening when necessary.
People take drugs to seek a different experience, mainly to improve their mood and psychological state.
The drugs people become addicted to are psychoactive which means they contain chemicals that alter the biological processes within the central nervous system which changes our internal and external experiences by altering our mood, behaviour, thought processes and emotional state and the way we perceive the world around us.
Recreational drugs such as cocaine, heroin and cannabis are very highly used because they provide users with euphoric feelings, a relaxed state and bursts of physical and mental energy, all of which are very rewarding and will therefore reinforce the likelihood that the drug will be consumed again.
There are many people who become dependent on and addicted to prescription drugs, whether they are painkillers or have a calming, anxiety-reducing effect on them such as benzodiazepines.
Detox is required when a person has been diagnosed with. or showing symptoms of drug dependence, particularly when they report experiencing withdrawal symptoms when they stop suddenly taking the drug after a period of heavy use.
The heavier a person’s drug consumption the sooner the withdrawal symptoms will appear when they cease consumption. (2,3)
Substance users experience withdrawal symptoms because many of the toxic effects of the drug are present in their bloodstream and it is a high level of toxicity in the blood that causes withdrawal symptoms when the drug consumption is stopped.
So, it is important to eradicate the high chemical contents of the drug from the body to treat their physical dependence.
This is very much down to the individual as several factors determine this, including the duration and pattern of drug use and how long they have been taking drugs and the amount of the drug they consume on average each day.
Another important consideration in determining how long detox takers is the patient’s individual characteristics such as age, gender and medical history and their individual physiology which is determined by their genetic structure.
For the majority of patients, detox will take 1 week to 10 days on average, but it must be stressed that the severity of a client’s substance use disorder (SUD) will also determine the length of time their detox will take.
Someone who has been taking drugs for years and who has been diagnosed with a severe SUD may take longer to detox due to the strong withdrawal symptoms they are experiencing. In extreme cases, patients diagnosed with a severe heroin addiction may be on a course of methadone maintenance for several months.
The drug detox process can also take longer for dual diagnosis patients and patients with underlying health conditions that may impact their treatment schedule. (2,3)
Initially, medical staff must conduct a full, comprehensive assessment of each patient’s circumstances and needs, including patterns and duration of drug use (and other drugs and alcohol used if applicable) to assess their level of intoxication.
It is also necessary to carry out detailed medical and mental health assessments and to check for any underlying conditions that need to be accounted for when organising the detox treatment. (2,5)
To help patients with a heroin or benzodiazepine addiction there are pharmacological interventions available that facilitate the detox process making it both safe and efficient.
As soon as doctors have established the most suitable medication and dose level for patients they can then begin to start taking their medication to help make the withdrawal process more comfortable.
Most patients who enter an inpatient treatment programme and undergo detox will be monitored very carefully during the early stages of withdrawal (1-4 days) to ensure the patient does not experience any unforeseen adverse reactions. (2,5)
Not all drugs have the option of pharmacological assistance to help clients through withdrawal syndrome.
Therefore, the priority of medical staff overseeing the care of patients with cocaine and cannabis addiction will be to support and advise them when they begin to enter the early stages of treatment and are experiencing the effects of withdrawal.
This involves offering expert medical care in helping them deal with individual physical symptoms as and when they arise, and any withdrawal symptoms can be alleviated with over-the-counter medication.
Rehab staff can also help clients deal with symptoms such as stress and insomnia by recommending specific strategies on stress management and good sleep hygiene.
Drugs such as cocaine and cannabis can produce psychological withdrawal symptoms that can cause a deterioration in clients’ mood and mental health due to the consequences of withdrawing from a drug that produces “highs” and a positive mindset.
To counter this psychiatrists tend to prescribe anti-anxiety and anti-depressant medication if they are concerned the person is at risk of self-harm and a mental health crisis during the first few days of withdrawal. (2,3,5)
The withdrawal effects that substance users experience when they cease consumption of their drug of choice can vary depending on which substance they have been consuming excessively, bearing in mind that the withdrawal symptoms people experience tend to be opposite to the main effects of the drug.
This will usually be to experience a positive psychological state such as euphoria or to relax, or in the case of stimulant drugs gain more physical and mental energy to improve their performance.
Each person has their own unique biology and will therefore respond in different ways to the form of the drug they have been consuming, each of which has a unique chemical balance, and this is the reason why drug withdrawal symptoms can vary between patients. (2,5)
Below are the withdrawal symptoms associated with different types of drugs:
The withdrawal symptoms patients experience when coming off cannabis after a period of sustained use include:
The physical symptoms associated with cocaine withdrawal include irritability anxiety, risk of severe depression low mood, and risk of suicide in the early days of withdrawal as cocaine is a stimulant drug that can lead to mood swings, fatigue, need for sleep, hunger, insomnia and headaches. (4,5)
Heroin is a highly addictive drug and a high percentage of people who attempt to detox from the drug tend to relapse back into heroin use.
As part of the treatment procedure for heroin detox medical practitioners use substitute drugs such as methadone and buprenorphine because there are chemically very similar to heroin but they are not so toxic to the human body, and neither do they generate euphoric feelings which is one of the main reasons why heroin is so addictive.
Both methadone and buprenorphine are long-acting drugs unlike heroin and their chemicals are slowly absorbed by the body and can keep withdrawal symptoms away for at least 24 hours which means they only need to be taken once a day.
People who become addicted to heroin may be at the stage where they take it several times a day as heroin is a much faster-acting drug with a shorter half-life and users may need to take the drug several times a day to keep withdrawal symptoms under control.
The doses of the substitute drug are gradually reduced over time with the patient prescribed the smallest dose possible to satisfy withdrawal symptoms until they no longer experience withdrawal symptoms.
Long-term heroin users diagnosed with a severe opioid use disorder may be required to take methadone for months if not years to keep their withdrawal symptoms at bay.
This is a safe and established medical treatment and all patients on a methadone maintenance programme are regularly monitored by medical practitioners fully experienced in substance use treatment.
NICE (National Institute for Care Excellence) issues extreme caution for medical professionals when they are contemplating this form of detox for patients with opioid use (heroin addiction) disorder.
This process involves placing patients under heavy sedation/anaesthetic and purposely stimulating withdrawal symptoms to begin the process, which in total takes as little as 24 hours.
However medical complications have been known to arise and Ultra Rapid Detox is not freely offered to all patients in need of detox, and those patients who are considered for this treatment will be subjected to rigorous medical examinations before treatment is approved. (8)
Below is more information about the different types of detox:
There is no pharmacological treatment available to help clients withdraw from cocaine. However, it may be deemed necessary by doctors to medically monitor clients during the early stages of detoxification as they are vulnerable to experiencing a significant decline in their mental health during the early part of withdrawal.
Any uncomfortable withdrawal symptoms that are experienced by patients will be alleviated by appropriate medication or symptom management advice.
There are no medicines available to facilitate the detox process for cannabis dependence although it is unlikely patients will experience any harmful withdrawal symptoms when giving up the drug, and neither is there any significant risk to their health as there is with alcohol or heroin withdrawal.
If the symptoms become unpleasant then they can be alleviated through symptom-specific medicine or self-management techniques, depending on the symptom.
However, it is still recommended that no one attempts to give up cannabis suddenly after prolonged use without consulting with medical professionals.
Even though the symptoms associated with cannabis withdrawal are fairly mild in the majority of cases some patients may have underlying health conditions that may cause complications during withdrawal.
Also, some cannabis forms do contain high levels of a psychoactive chemical called THC, and not every cannabis user will smoke doses containing high levels of THC in them.
Because THC is a strong psychoactive chemical cannabis users are also at risk of developing psychotic symptoms and a depressed mood due to their cannabis use so it is important they are monitored carefully during the early stages of treatment.
It has been known for cannabis users to experience feelings of anger, irritation and irritability when experiencing withdrawal syndrome so it may be necessary for them to be offered benzodiazepines to address this in the short term. (10,11)
Benzodiazepines are a class of drugs that possess chemicals that can have a calming effect on the body, ease anxiety and relax muscles. As well as being prescribed to help people relax it is used to treat insomnia.
Benzodiazepines are prescription-only drugs and can be split into two distinct categories, hypnotics and anxiolytics. However, there are many types of benzodiazepines and it is common for people who take drugs such as temazepam for sleeping problems to become addicted to the drug.
This is because some benzodiazepines such as temazepam are highly addictive and have a short half-life of around 8-15 hours, which makes it a fast-acting drug that the body processes quickly which means a user will build up a tolerance to it quickly and therefore vulnerable to taking it more often and before long they will develop a physical dependence on the drug and suffer withdrawal symptoms when they stop taking the drug. (1)
The detox treatment procedures for benzodiazepine dependence involve doctors prescribing a slower-acting benzodiazepine with a longer half-life such as diazepam to help patients slowly come off the drug.
This will be carried out by gradually reducing the dose of the drug over a period of 6 weeks to 3 months to ensure that patients do not experience any unpleasant withdrawal symptoms.
Diazepam has a half-life of up to 100 hours so its chemicals are released slowly into the body to ensure the toxic presence of the drug will slowly be reduced in the body and the patient will only be required to take diazepam once a day. (1)
Medical practitioners treating ecstasy addiction tend to be on hand to prescribe anti-depressant medication to patients attempting to detox from the drug. This is necessary to help them deal with the depressed mood, anxious feeling and panic attacks that can occur when coming off ecstasy.
Regular consumers of ecstasy who stop taking the drug suddenly are likely to experience strong psychiatric withdrawal symptoms if they do not take ecstasy for over 12 hours, these symptoms do not remain for too long though and slowly disappear within a few days.
Because of the risk of these strong psychiatric withdrawal symptoms medical professionals do advise that clients detoxing from ecstasy should be carefully observed during the first few days of the withdrawal period, which tends to be around 3-5 days as they may be at risk of brain damage and psychotic symptoms due to the way in which ecstasy interacts with our brain chemistry. (6)
There are home detox treatments available for opioid (heroin) addiction which can be organised by your GP or local drug and alcohol team but all patients seeking to undergo detox will initially be medically assessed to establish their treatment plan, which includes where the location of the detox would take place.
It is difficult to predict how psychoactive drugs will affect each person as even the same drug can vary in terms of the balance of its chemical constituents and every person has a unique biological makeup which determines to what degree it is affected by a certain drug.
Each person’s medical and psychiatric background will need to be assessed first and other factors such as support network, underlying health conditions and severity of their addiction need to be considered before medical practitioners decide whether clients need to be monitored closely in a residential setting whilst going through detox. (5,14)
A thorough assessment is needed to establish each client’s physical and mental state and level of intoxication before they begin detox treatment.
Some patients use more than one substance and the dose and chemical balance of all drugs are different, so it’s important to obtain an overview of each client’s substance consumption as this needs to be factored into the detox treatment schedule to ensure there are no medical complications.
There is also the slight chance that some patients’ mental health may deteriorate when going through detox as withdrawing from drugs has been known to generate unpredictable psychological withdrawal symptoms which can mean some clients may be a suicide risk because of the significant decline in their mood/mental state.
It is also possible that some patients with as-yet undiagnosed health conditions may have unpredictable physical reactions affecting their main organs, and the cardiovascular respiratory system.
It cannot be stressed enough that detox is NOT a cure for addiction, it is only part of a drug rehab programme that also includes psychosocial interventions and educational components.
Any substance users that just undergo detox are likely to relapse immediately as on their own detox treatment is not sufficient enough to help patients recover.
After detox is over patients need to engage fully in a course of psychological therapies to help them process the traumatic and unpleasant emotional experiences in their lives which led them to drug use.
Rehab programmes usually last 28 days (excluding time for detox treatment) and once the detox treatment has been completed they have an individual therapy programme to work through which will include:
Cold turkey is a very basic approach to giving up psychoactive drugs, it involves substance users simply suddenly stopping the consumption of the drug and dealing with the consequences on their own without any medical assistance rather than slowly reducing their use of the drug over a period of weeks (tapering).
The term cold turkey has been used to represent the goosebumps people withdrawing from some drugs get on their skin days after they stop taking the drug, which resembles the appearance of a Turkey after some time in the refrigerator.
This is not as easy as it initially appears though as the body faces physical consequences when it stops taking a drug it has become dependent on and these withdrawal symptoms can be very difficult to deal with and in some cases cause a significant decline in health.
In many cases, the cold turkey approach is unlikely to be unsuccessful as the strong cravings generated by the withdrawal process will seriously test the mental discipline of substance users as the quickest way to alleviate these symptoms would be to take the drug, which only keeps the addictive cycle going.
Anyone who has reached the stage of having withdrawal symptoms when they stop using a drug should not withdraw without consulting with a medical professional familiar with the process of drug dependence.
If anyone does attempt to go cold turkey research has indicated that receiving emotional/psychological support can be a great source of comfort and can help to maintain patients’ motivation and determination especially if this support is provided by counselling services.
If you are ready to enter residential treatment for drug detox then call Rehab 4 Addiction today. Drug addiction treatment could save your life.
Call today on 0800 140 4690 or complete the enquiry form.
(1) Brett, J., Murnion, B. (2015) Management of benzodiazepine misuse and dependence. available@ Management of benzodiazepine misuse and dependence – PMC (nih.gov)
(2) Coombs, R.H. (ed) (2004) Handbook of Addictive Disorders: A practical guide to diagnosis and treatment. John Wiley & sons. New Jersey.
(3) Herie, A. & Skinner, W. (ed) (2014) Fundamentals of Addiction Treatment: A Practical Guide for Counsellors. CAMH. Canada.
(4) Kahan, M. (2014) Physical Effects of Alcohol and Other Drugs. In Herie, M. & Skinner, W. (ed) Fundamentals of Addiction: A Practical Guide for Counsellors. CAMH. Canada.
(5) Moss, A., Dyer, K. (2010) The Psychology of Addictive Behaviour. Palgrave McMillan. New York.
(6) National Institute for Drug abuse (2022) MDMA and Ecstasy abuse available@https://web.archive.org/web/20230416201147/https:/nida.nih.gov/publications/research-reports/mdma-ecstasy-abuse/how-are-mdma-use-disorders-treated
(7) Narcotics Anonymous (2022) Narcotics Anonymous UK. Available@Welcome to UKNA | UKNA | Narcotics Anonymous in the United Kingdom
(8) National Institute for Health and Care Excellence (2007) Drug Misuse in Over 16s: Opioid detoxification available @Drug misuse in over 16s: opioid detoxification (nice.org.uk)
(9) NHS (2022) Methadone. Available@ Methadone – a medicine used to treat heroin dependence – NHS (www.nhs.uk)
(10) Royal College of Psychiatrists (2022) How does cannabis affect mental health? available@ Cannabis and mental health – for young people | Royal College of Psychiatrists (rcpsych.ac.uk).
(11) Stoner, S. (2017) Effects of marijuana on mental health. Alcohol and drug abuse institute, University of Washington. Available @ 2017mjdepression.pdf (uw.edu)
(12) Wills, S. (2005) Drugs of Abuse. Pharmaceutical Press. London.
(13) Wild, T.C., Wolfe, J. (2009) The Clinical Course of Addiction Treatment: The Role of Non-Specific Therapeutic Factors in Miller, P. (ed) Evidence-Based Addiction Treatment. Academic Press. London.
(14) Yoon, R. (2014) Opioid Addiction, in Herie, M. & Skinner, W. (ed) Fundamentals of Addiction: A Practical Guide for Counsellors. CAMH. Canada.
