Detoxification from addictive substances

Detoxification from addictive substances

A. Tom Horvath, Ph.D., ABPP

Detoxification (“detox”), or withdrawal, is the period of time it takes your body to adjust to being without a substance which it used to have regularly.  During this time period a previous bodily “homeostasis” is restored, one based on not using the substance or substances.  This restored homeostasis is similar to the one you had before you started using the substances regularly.

Homeostasis refers to the body’s maintenance, by an ongoing balancing act, of a stable internal condition.  If you go scuba diving to a depth of 100 feet, your body adjusts to having that much additional weight pressing upon it.  We could say that the body is pressing back as much as the weight of the water is pressing in, thereby allowing the body to maintain its internal functioning.  If you come to the surface too quickly, however, your body cannot re-adjust fast enough.  You get “the bends” (decompression sickness).  Proper scuba diving therefore involves coming to the surface slowly enough that you do not get sick.  The time taken to come to the surface corresponds to the time it takes for detoxification from addictive substances.

Detoxification can also refer to the removal of toxic substances from the body.  To the extent addictive substances are toxic this definition also applies.  In addiction, however, the primary meaning of detoxification is the readjustment of the body’s homeostasis.

Some classes of substances create more concern about detoxification than others. Stimulants (cocaine, methamphetamine, Ritalin, nicotine, caffeine, etc) do not need medical supervision for withdrawal.  The withdrawal syndrome can be uncomfortable (much like having the flu) but is not potentially fatal.  Hallucinogens and marijuana may have no withdrawal symptoms or only minor ones.  Therefore, with any of these substances, one can stop use completely at any time.  Tapering off is not needed.  For substances not listed here it would be wise to seek medical consultation if you are using them on a daily basis.  If you use a substance intermittently, with days between uses, then you already know what it feels like when you take off a few days.

The two primary classes of substances for which detoxification is a concern are depressants—as in central nervous system depressants (including alcohol, benzodiazepines such as Valium, sedatives, tranquilizers, and some sleep aids)—and opiates/opioids (including heroin, methadone, opium, Vicodin, and Suboxone).  Detox takes 3 to 10 days typically, depending on the substance and your history with it, your overall health, your age, and other factors.  Detox is often accomplished in a hospital ward devoted to detox only.  People get medical detox for two reasons: 1) prescribed medications can make the process easier, and 2) simply going “cold turkey” (stopping your addictive substance suddenly) can make you very sick or even kill you.  Therefore, even if you do not wish to have treatment for the addictive behavior itself, it is safest to seek medical attention for the detox process.

Tapering off your substance, perhaps over several weeks, is a reasonable approach from a medical perspective, but is often a poor approach in practice.  If you have the ability to taper off, you might not have become physically dependent in the first place!  Tapering off has more chance of working if your dependence on the drug is primarily physical not psychological.  This condition might have arisen, for instance, if you were taking a pain medication for a long time, but never developed a psychological dependence on it.