TREATMENT FROM A-Z

The withdrawal timeline of the withdrawal management (detoxification) process varies from drug to drug and even within drug classes. Generally, the emergence and resolution of alcohol and drug withdrawal symptoms are impacted by the half-life of the substance (which influences the average duration of drug effects), the mode of administration, the frequency of use, and the average dose used. (7) While you might feel symptoms right away for some drugs, others will not produce immediate withdrawal symptoms:

• Stimulant withdrawal symptoms typically appear within a few hours to a couple days after the last dose.

• Sedative withdrawal symptoms may appear as quickly as a few hours after or as delayed as several days following last use. For someone who is addicted to Xanax, withdrawal symptoms may appear within 6-8 hours of the last dose and improve by the 4th or 5th day. Meanwhile, Valium may produce withdrawal symptoms a full week after the most recent dose, which may not resolve for 3-4 weeks.

• For opioid drugs, such as heroin and painkillers, symptoms typically emerge within 6-12 hours after the most recent dose and subside within 5-7 days.

• Long-acting opioid drugs, such as methadone, may have a longer and more delayed timeline, with symptoms appearing 2-4 days after the last dose and taking longer to dissipate entirely.

• Alcohol withdrawal symptoms tend to emerge within a few hours to several days after quitting or reducing consumption.

The severity of withdrawal varies between individuals. Physiology, age, gender, and mental and physical health all influence the severity and duration of symptoms. Similarly, the various types of interventions may affect the duration of alcohol and drug withdrawal symptoms, as medication administration in a medical withdrawal management (detox) setting may lengthen the withdrawal management (detoxification) process. In contrast, a social withdrawal management (detox) program does not intervene medically.

Social withdrawal management (detoxification), a non-medical form of withdrawal management (detoxification), entails a complete cessation of substance use under the supervision of treatment professionals. This social model of withdrawal management (detox) involves professionals providing emotional and psychological support to the patient throughout the withdrawal process but not administering medications to treat symptoms or complications.

Although this method can help people withdraw from psychoactive substances successfully, it is not without its challenges. The potential for an unpleasant withdrawal syndrome is one of the most significant difficulties associated with a natural withdrawal management (detox). A person must endure several potentially unpleasant withdrawal symptoms as their body adjusts to the absence of drugs.

Depending on the drug, withdrawal symptoms can be severe, causing the individual considerable distress and, in some cases, posing a medical risk. Consequently, individuals may return to use to alleviate their symptoms and substance cravings.

Overdosing is one of the most significant dangers associated with recurrence. During a lengthy period of abstinence, a person's tolerance will substantially decrease, meaning they will require less of a drug than before. Many individuals who return to use often use the same amount or dose as before, which can result in accidental overdoses that can be fatal.

Involvement in a natural withdrawal management (detox) program carries additional risks, including the potential development of psychological issues during withdrawal and, consequently, a diminished capacity to manage these issues effectively. Frequently, withdrawal symptoms from various substances, such as opioids, stimulants, and benzodiazepines, are accompanied by mental health symptoms, including melancholy, suicidal ideation or attempts, anxiety, delirium, emotional blunting, and insomnia.(8)

There may be medical complications during withdrawal. Generally speaking, due to humanitarian and safety concerns, natural or social withdrawal management (detoxification) is typically not recommended to manage withdrawal from alcohol, benzodiazepines, barbiturates, or opioids.9 The symptoms that emerge when an individual stops using these substances are often painful and, with the exception of those associated with opioids, potentially fatal.(8)(9)

Unlike the "natural" method, medical withdrawal management (detoxification) programs provide patients with medication and medical withdrawal management (detoxification) treatment to prevent and treat complications. As previously stated, alcohol, benzodiazepines, and barbiturates withdrawal can be hazardous if attempted alone due to the risk of severe withdrawal symptoms. For example, seizures that necessitate immediate medical treatment may not be available in social withdrawal management (detoxification) programs. In addition, withdrawal can cause delirium, a state of confusion and agitation characterized by hallucinations and dangerous, unpredictable behavior.(10)

Consciousness and cognition disturbances can result in accidents, erratic behavior, and even violence. If you are dependent on one of these substances, a medical detoxification program can ensure your safety during withdrawal. For instance, medical intervention with medications such as benzodiazepines or anticonvulsants may be initiated to prevent some of the complications of alcohol withdrawal.(14)

While withdrawal from opioids such as heroin is generally not medically hazardous, it can cause severe discomfort, so much so that many individuals return to use to alleviate the pain. Opioid addicts can benefit from medical withdrawal management (detoxification) for this reason. Medication-assisted treatment (MAT), which entails the administration of medications to mitigate withdrawal symptoms and cravings, is a crucial component of medical opioid withdrawal management (detox). The medications are used to alleviate withdrawal symptoms, curb cravings, and prevent medical complications. (11)(12)(13) They include:

• Methadone: This full opioid agonist binds to and activates opioid receptors in the brain, thereby reducing cravings and withdrawal symptoms. Methadone is administered as an orally disintegrating wafer, an oral concentrate liquid, or a tablet for the treatment of opioid dependence. It is only available through narcotic treatment programs (OTP).

• Buprenorphine: This partial opioid agonist has a weaker opioid effect than a full agonist, such as methadone. Doctors who are authorized to treat opioid dependence with buprenorphine can prescribe it. Suboxone is a combination of buprenorphine and naloxone, a medication that inhibits the effects of opioids. This combination formulation inhibits medication misuse.

Both methadone and buprenorphine may be used solely as withdrawal management (detoxification) medications, or they may be continued as part of reoccurrence or return to use maintenance management. Naltrexone is another MAT substance used for maintenance purposes. This opioid antagonist counteracts the euphoric effects of opioids. If an individual taking naltrexone utilizes an opioid, they will not experience euphoria. It is available as a capsule or Vivitrol, an intramuscular suspension with extended release. Combined with behavioral therapy, continued use of opioid dependence medications can aid in preventing relapse and fostering long-term abstinence.

If you are interested in entering a withdrawal management (detox) program but do not know where to start, ask your doctor or therapist for referrals to local centers. However, after receiving recommendations, you will need to investigate the various withdrawal management (detoxification) services available.

It is essential to determine your priorities in terms of withdrawal management (detoxification) treatment to find the program that best suits you. You may wish to ask the following questions when contacting various withdrawal management (detoxification) programs:

• What withdrawal management (detox method_ is utilized (social vs. medical)?
• What is the typical length of the program?
• What is the price of the program?
• Does the program accept health insurance? If so, which plans?
• What are the credentials of the staff members?
• What amenities and services are offered?
• Are rooms private or shared?
• Does the treatment team help patients transition into addiction treatment?

You are not limited to the above questions, but they should serve as a starting point for your search for the withdrawal management (detox) program that best meets your requirements. Each program will have both benefits and drawbacks.

People frequently conclude a withdrawal management (detox) program and then, with the assistance of their treatment team, transition into a comprehensive addiction treatment program that can address the underlying causes of substance use disorder. The program may provide referrals or even assist you in enrolling in a program to ensure a seamless transition into treatment.

If you still need to complete a withdrawal management (detox) program and are seeking an addiction treatment program, you can seek advice from any medical or mental health professional. Before deciding, you may also want to contact your insurance company (if you have insurance) to find out what your specific plan entails. To restrict your search, you can acquire a list of treatment programs that accept your insurance.

Once withdrawal management (detox) is complete, you will likely be deemed stable enough to proceed with the remainder of drug rehabilitation. It is essential to note that this is NOT addiction treatment. The completion of withdrawal management (detoxification) indicates that only physical dependence on substances has been eliminated, not psychological dependence.

To maintain sobriety over many months and years, you must also address the thoughts, emotions, and behaviors that led to substance misuse; this is accomplished through SUD counseling and therapy. 

Similar to the wide variety of withdrawal management (detoxification) programs, there are numerous recovery programs with varying intensities. These are the most prevalent forms of recovery pathways. 

Medication is used to treat substance use disorders, sustain recovery, and prevent toxicity. Combining medication with counseling and behavioral therapies provides a "whole patient" approach to treating substance use disorders. FDA-approved medications are clinically driven and individualized to suit the needs of each individual patient. According to research, a combination of medication and therapy can effectively treat substance use disorders, and in some cases, medication can aid in recovery maintenance. Medications are also used to prevent or reduce opioid overdose. The ultimate objective is full recovery, which includes the capacity to lead an independent existence. This treatment strategy has been demonstrated to:

• Improve patient survival.
• Increase retention in treatment.
• Decrease illicit opiate use and other criminal activity among people with substance use disorders.
• Increase patients’ ability to gain and maintain employment.
• Improve birth outcomes among women who have substance use disorders and are pregnant.

Research also shows that these medications and therapies can contribute to lowering a person’s risk of contracting HIV or hepatitis C by reducing the potential for returning to use or reoccurrence. Learn more about substance misuse and how it relates to HIV, AIDS, and Viral Hepatitis.

• St. Mary’s Health System

• Well Spring Maine

• Pine Tree Recovery

• Milestone Recovery