Physical dependence occurs when someone experiences withdrawal symptoms when they suddenly stop using their drug of choice.
Withdrawal symptoms can be severe and even fatal with some substances. They are nearly always responsible for relapse in the early stage of recovery.
Medical detox is the use of medically assisted treatments to help a person detoxify from drugs or alcohol.
There are several different types of medications that are used to reduce the discomfort associated with withdrawal symptoms and to lower the risk of relapse in the early stages of recovery. The medication used will depend on the type of substance you have abused and other factors.
In most cases, the medications are administered on a tapering schedule, meaning that once a beginning dose is established, the physician will slowly taper you off the drug as your body adjusts to living without your drug of abuse. This processes requires medical supervision, so you should only use these medications under the direction of a physician.
Physical dependence occurs after you have developed tolerance to a specific substance. Your body has become accustomed to its presence at a particular dosage, so you must increase the dosage to feel the same effects.
When you suddenly stop using the substance or cut down on using it, you experience withdrawal symptoms. This means that your body has learned to function efficiently only when the substance is in your system at certain levels. Removing the substance suddenly throws your body out of balance.
Due to physical dependence, the withdrawal process can be one of the trickiest parts of recovery. Someone who has developed physical dependence may begin to experience severe discomfort, pain, nausea, fever, chills, and other symptoms that motivate them to use their drug of choice. Withdrawal symptoms can often disappear rapidly if the person begins using again. Hence, relapse is likely during withdrawal.
Medically assisted withdrawal management treatments (a subset of medically assisted treatments where medicines are used in conjunction with other nonmedical interventions) can greatly reduce the risk of relapse during the early stages of recovery.
There are numerous medications that can be used during recovery and medical detox. These medications control cravings, lessen insomnia, combat lethargy, and promote overall balance.
There are also specific medications that are regularly used to directly control withdrawal symptoms from some types of drugs and alcohol. These groups of medications include:
The class of medication used will depend on the substance from which you are withdrawing.
Benzodiazepines include some familiar medications like Valium (diazepam) and Xanax (alprazolam).
Librium (chlordiazepoxide) is a benzodiazepine that is commonly used to address withdrawal from alcohol. Valium is also commonly used to address withdrawal symptoms related to alcohol.
Alcohol withdrawal can be potentially fatal. According to the American Psychiatric Association (APA), the symptoms of alcohol withdrawal can be mild, or they can be moderate to severe. Mild alcohol withdrawal symptoms will most commonly include:
Moderate to severe alcohol symptoms include the above with much more intensity. They can also involve:
Benzodiazepines, particularly Valium and Librium, can be used to counteract the withdrawal symptoms of alcohol and to control potentially fatal seizures.
Be aware that benzodiazepines are drugs of abuse themselves. As a result, they should only be used under doctor physician during a medical detox protocol. Using a long-acting benzodiazepine on a tapering schedule (see below) is one of the preferred methods to deal with benzodiazepine withdrawal, which is very similar to withdrawal from alcohol.
Severe withdrawal from stimulants, like cocaine and methamphetamine, can also be managed with benzodiazepines.
Antidepressant medications can be used during detox to counteract severe apathy or depression that occurs during withdrawal from stimulants. They are usually used to address depression that is long-lasting and continues well after withdrawal symptoms have subsided.
Opioid drugs are medications that are derived from the opium in the Asian poppy plant. Many of these drugs, like morphine, Vicodin (acetaminophen and hydrocodone) and OxyContin (oxycodone), are prescribed to control pain.
When abused, these drugs stimulate the brain’s reward system and lead to euphoric effects. This prompts the desire to continue using them to combat stress, pain, and even anxiety.
The opioid epidemic in the United States has drawn much media attention due to increasing numbers of fatal overdoses from opioids. Large numbers of prescriptions are written for potentially dangerous opioid drugs.
Withdrawal from opioids is not considered to be life-threatening like withdrawal from alcohol or benzodiazepines, but it may produce significant emotional distress that could lead to suicidality or overdose. Opioid withdrawal symptoms typically consist of anxiety, aches and pains, fatigue, nausea and vomiting, elevated blood pressure, headaches, and other very uncomfortable symptoms, including severe cravings.
Medically assisted treatments for opioid withdrawal are typically either opioid agonists or non-opioid agonists.
An agonist binds to the receptors in the brain and mimics the effects of the drug but does not have the same full effect. For instance, methadone is an opioid agonist that is used to treat withdrawal from heroin and other opioids. It mimics the effect of heroin and other opioids, but it does not produce the same level of euphoria. It can produce physical dependence, so its use in recovery is carefully monitored.
If you are using methadone to treat heroin withdrawal, the methadone attaches to the same receptors in the brain that heroin attaches to. Even though you do not get the same effects that you get when using heroin, you do not experience heroin’s withdrawal symptoms.
Non-opioid agonists include medications like clonidine.
Clonidine is a blood pressure medication that reduces levels of adrenaline. High levels of adrenaline are associated with the withdrawal syndrome from opioids and even alcohol. As a result of its ability to lower adrenaline levels, clonidine can assist in controlling withdrawal symptoms.
Another medication that can produce similar effects is the beta blocker propranolol, which is commonly used to treat high blood pressure. It can also be used to control withdrawal from stimulants like cocaine.
A partial opioid agonist is a drug that attaches to the same receptors in the brain that other opioids do, but it activates them less strongly than full opioid agonists (like heroin, Vicodin, and even methadone) do.
One of the most common partial opioid agonists used in the treatment of opioid withdrawal symptoms is buprenorphine, the opioid found in medications like Suboxone. When you take buprenorphine, your brain acts as if it is receiving your opioid of choice; therefore, you will not experience withdrawal symptoms. If you do happen to experience any withdrawal symptoms, they will be greatly lessened in intensity.
In addition to controlling withdrawal symptoms, buprenorphine also curbs urges to use opioids.
Opioid antagonists block the opioid receptors in your brain. When you take these drugs, they prevent the brain from being stimulated when you take any opioids. These drugs effectively counteract the euphoria produced by opioids.
While they are most often used after medical detox, they may be used during a detox program. The drug in this class most commonly used during detox is naltrexone (ReVia or Vivitrol), a drug that can reduce cravings for opioids and alcohol. It may also be used for long-term addiction management.
The opioid antagonist naloxone (Narcan) is not used in the treatment of withdrawal since it may actually trigger a withdrawal response. It can reverse the effects of opioids, and it is commonly used to reverse the effects of an opioid overdose.
The major medications used to treat withdrawal from opioids are opioid substances themselves. In 2018, the Food and Drug Administration (FDA) approved the first non-opioid medication for the treatment of opioid withdrawal.
The medication, Lucemyra (lofexidine hydrochloride), is a non-opioid drug that is approved for the treatment of opioid withdrawal, but only for a short time (up to 14 days). It is not approved to treat opioid withdrawal for longer periods of time. Other medications should be used in conjunction with it, so it is not a primary treatment for opioid withdrawal.
When medications like benzodiazepines, opioid agonists, and partial opioid agonists are used during the withdrawal process, the supervising physician will often use a tapering method. This involves beginning with a dose of the medication that controls your withdrawal symptoms. Then, at specific points in time, they will slowly decrease the amount of the medication.
Most of these medications can produce physical dependence. Thus, it is not safe to totally stop them at once. Instead, the tapering process allows you to slowly be weaned off the drug while controlling your withdrawal symptoms.
Some medications, like methadone, must be prescribed in a clinic setting, whereas others like benzodiazepines or buprenorphine may be prescribed outside a hospital, inpatient unit, or clinical setting. No matter how you are receiving the withdrawal medication, you must be under the supervision of a physician while you are taking it.
The idea of taking a pill that effectively manages detox or recovery sounds great, but it’s not that simple. Medications can be critical to the withdrawal process, helping you to successfully make it through and avoid relapse, but there is no cure for addiction.
The ultimate goal is to gradually wean off these medications. While they can be critical during withdrawal and the early stages of new recovery, the work you do in therapy will form the foundation of your life in recovery.
Following detox, you should be involved in a treatment program that focuses on therapy, to learn how to manage triggers and stress without turning to drugs or alcohol. In a comprehensive treatment program, you’ll address recovery from many different angles. And you’ll only move to a lower, less intensive, level of treatment when you are ready.
Look for a treatment program that guides you through each transition in recovery, ensuring you have a solid support network in place to set you up for success.