Blu By the Sea Drug Rehabilitation Blog

The Ways People Withdraw from Drugs

A Huge Issue in Today’s Society

Drug abuse is all too common, with an estimated 9% of Americans age 12 or older needing treatment for using alcohol, drugs or tobacco (1). Drug abuse costs the United States over $600 billion each year (2). Costs stem from lost productivity from absenteeism and poorer work performance, crime, and healthcare costs from treating drug-related injuries, cases of overdose, infectious disease treatment, and related health concerns that result from drug use. One of the main reasons that much of this abuse continues is because many addicted individuals do not hove the opportunity to withdraw from drugs in a safe, controlled setting.

Beyond the economic costs of drug abuse, health consequences can include increased risk for:

  • cardiovascular disease
  • impaired mental health
  • gastrointestinal
  • musculoskeletal problems
  • liver and kidney disease
  • infectious diseases such as HIV/AIDS and hepatitis (3).

Most individuals are familiar with many or all of these risks, and may want to become sober. However, most people with drug addictions do not complete treatment programs. Only 1 in 9 people with addictions, or 2.6 of the 23.5 million individuals with addictions, receive treatment at a specialty facility (4). Furthermore, 40-60% of those who complete drug rehab programs relapse (5).

Some reasons for not completing drug rehab programs are lack of money, fear of failure, anxiety over the process, a feeling of losing face by seeking help or admitting the possibility of an addiction, or not knowing where to go. Contacting our experts at Blu By the Sea Drug Rehabilitation can help clients address these and other concerns.

Fear of Withdrawal is Common

Dread of the withdrawal process can be another significant barrier to initially seeking treatment and maintaining sobriety. During withdrawal, clients are not permitted to have access to their drugs. This gives their bodies the chance to eliminate all traces of the chemicals in drugs from their systems, thus allowing them to continue the drug rehab program in sobriety. After withdrawing from drugs, physical and psychological cravings for the substance can be decreased, making ongoing treatment easier.

Initial Withdrawal Symptoms can be Harsh. Symptoms can Include:

  • agitation
  • anxiety
  • muscle aches
  • insomnia
  • sweating and yawning.
  • abdominal cramping
  • diarrhea
  • dilated pupils (6).
  • Mood swings
  • fatigue
  • loss of appetite
  • nausea and vomiting(7).

Because withdrawal is a necessary step in achieving sobriety, clients and loved ones cannot ignore it. Instead, progress can be made by investigating the various ways that people can withdraw from drugs. Finding a personalized solution can calm fears and encourage those who need it to seek help for their addictions. Many options are available for drug withdrawal, and clients and loved ones should continue to investigate their options and speak with experts until they are confident that they know which options are the most comfortable for them.

Prescription Drugs and Medical Treatment

Medically-supervised drug withdrawal programs can offer clients prescription medications to reduce the discomfort associated with withdrawal symptoms. For opioid addictions, buprenorphine and clonidine are common choices (8). For alcohol, drug and benzodiazepine dependence, trazodone helps relieve depression and sleep disorders associated with the withdrawals (9). Trazodone is a serotonin antagonist and reuptake inhibitor, so it enhances the positive effects of serotonin, thus making the client happier than they would be during withdrawal.

Potential Side Effects of a Drug based Withdrawal Treatment

A concern with using prescription medications for drug withdrawal is that all drugs have side effects.

Buprenorphine can lead to these side effects:

  • blurred vision
  • confusion
  • difficulty breathing
  • weakness
  • drowsiness

Trazodone can cause these effects plus:

  • constipation
  • muscle tremors
  • anxiety

Methadone has similar side effects, and is unsafe for people with certain heart conditions, severe asthma, or a bowel obstruction, or ileus. In addition, prescription medications used for withdrawal can interfere with other medications that the patient might be taking for chronic physical or psychological conditions. Although these medications do have their own drawbacks, the effects are far less than continuing to use the drugs that caused the addiction initially. So the choice to use these drugs can easily outweigh the side effects and lead the client back down the safe road of sobriety.

Tapering is another strategy to relieve withdrawal symptom inconvenience. In this approach, clients receive progressively smaller doses of a drug, such as methadone to treat heroin addiction, until they have completed heroin withdrawal and are weaned off of the tapering drug (10).

Treatment for Co-Occurring Conditions

Additional medical treatment can be necessary during withdrawal from drugs, since the process can exacerbate existing conditions or lead to additional concerns. Clients may become violent and require restraint to prevent them from harming themselves or others. Signs of psychosis can surface, and physicians and psychiatrists should be on hand to manage these as necessary. This may include additional medications.

Also of concern are any co-occurring conditions that clients may have in addition to drug addiction. These can include physical conditions, such as gastrointestinal, cardiovascular or pulmonary disorders. In addition, they can include psychiatric conditions.

The following examples are listed with their estimate rates among those who seek treatment for drug abuse (11).

  • Depression5 to 25%. Symptoms include sadness, feelings of hopelessness, loss of interest in usual activities, and changes in appetite or sleeping patterns.
  • Attention deficit disorder (ADD)12% (12). Symptoms include inability to control one’s behavior, inability to concentrate for long periods of time, and being overly active.
  • Bipolar disorders – 30 to 60%. Symptoms of manic periods include hyperactivity, trouble sleeping, and taking part in risky behaviors, while symptoms of depressive periods are similar to those of depression.
  • Anxiety disorders – 5 to 20%. Symptoms include trouble concentrating, excessive fatigue, and poor sleep.
  • Psychotic disorders – 40 to 80%. Many types exist. Schizophrenia is one example. Symptoms include irritability, anxiety, insomnia, and emotional and behavior troubles.

Treatment for co-existing conditions must be individualized for each patient. Physicians and psychiatrists assess the clients to determine whether medications should be prescribed. They must also examine any medications that the patient may already be taking and determine whether medications should be continued during the withdrawal process. Constant monitoring of the client throughout withdrawal is crucial for avoiding drug interactions as well as for insuring the client’s safety and well-being.

Traditional and Alternative Medicines

Traditional and alternative medicines are most commonly used as supportive therapies for drug withdrawal. Some of the benefits of traditional Chinese medicine are that it often has few side effects and can be used together with conventional medications and treatments, such as low-dose narcotic withdrawal drugs such as buprenorphine and methadone (13).

Acupuncture is a safe method that may be effective in reducing withdrawal symptoms. Its use for opioid withdrawal dates back to 1972 in Hong Kong and 1983 in New York. In particular, transcutaneous electric acupoint stimulation (TEAS) has been tested for opioid (14) and alcohol withdrawal (15). After three 30-minute sessions per day for 4 days plus use of the prescription drugs buprenorphine and naloxone, those who received TEAS had a 29% relapse rate and return to opioid use after two weeks. In comparison, 65 of those who only had prescription drugs without TEAS relapsed in two weeks (16). This study demonstrates the possible effectiveness of TEAS for drug withdrawal. The way that acupuncture may be effective in the body because it works through the opiate system, or the brain’s reward system that is activated by drug and alcohol use.

Some herbal supplements can also be effective in reducing withdrawal symptoms during withdrawal. Passionflower, for example, improved mental symptoms during withdrawal among individuals who were also being treated with the prescription drug Clonidine. Similarly, adding Rosmarinus officinalis (rosemary) to a regimen of methadone led to fewer symptoms of insomnia, bone pain and perspiration (17).

Another supplement, acetyl-L-carnitine, has been shown to reduce withdrawal symptom severity among those with methadone dependence. Those who took acetyl-L-carnitine had a lower score on the Short Opiate Withdrawal Scale (SOWS) in which clients report feeling sick, stomach cramps, muscle spasms, aches and pains, yawning, runny eyes, insomnia, heart pounding. A physician should always approve of and supervise the use of herbal supplements and other traditional medicines.

Sedation is an Option to Withdraw from Drugs

Rapid withdrawal under sedation is another way that people can withdraw from drugs. The procedure, also called the ultrapid withdrawal technique, takes place as clients are unconscious from general anesthesia (18). Physicians administer medication that prevents receptors in the brain from taking up opiate. The principle is that the most severe withdrawal symptoms take place while clients are unconscious so that their discomfort is minimized.

The National Institute on Drug Abuse notes that since most insurance policies do not cover rapid withdrawal procedures, information on how common and effective they are is scarce. The use of general anesthesia during withdrawal can lead to complications, including stroke, heart attack, and death. The risks from anesthesia are higher among people with heavy alcohol or drug use, and those with diabetes, heart disease, or certain infectious diseases, such as HIV/AIDS or hepatitis. Other complications that can occur during rapid withdrawal can include pulmonary and psychiatric complications.

Rapid withdrawal can be the best option for some individuals, but it unfortunately does not always reduce symptoms compared to conventional withdrawal methods, such as using buprenorphine, clonidine, or other prescription medications to ease discomfort. Furthermore, relapse rates among those who had rapid withdrawal may be similar to those who use only prescription medications for reducing withdrawal symptom severity. Seeking guidance from a knowledgeable and trusted expert on drug withdrawal can help people make the best decisions based on their individual situations.

Drug Withdrawal is Just One Step to Sobriety

Regardless of the method used for drug withdrawal, achieving lasting sobriety requires a comprehensive treatment program. Inpatient residential treatment programs are intensive. Clients are under nearly constant supervision in highly controlled environments. They have frequent contact with trained staff and have access to physicians and psychiatrists when needed. No drugs or alcohol, or cues to their use, are present. The environment reinforces the gains made during the actual drug withdrawal process.

Intensive Outpatient Programs

Some clients can take advantage of intensive outpatient programs, which can be as effective as residential treatment programs when carried out properly. To participate in day programs, clients live off-site and commute daily to the treatment facility. They need to have reliable transportation, as well as a home or other residential environment that is guaranteed to be free from substances that could lead to abuse.

Phone Counseling Programs

Phone counseling is a less comprehensive approach to supporting the results of drug withdrawal, but it is less time-consuming and expensive than full-blown treatment programs, and it can support withdrawal. Another advantage of phone counseling is that clients can sometimes be more comfortable using the phone when they feel a crisis coming on than they might feel if they had to visit with a professional in person each time they were concerned about relapse.

Treatment strategies in inpatient residential programs and outpatient day programs can include group and individual counseling and therapy, family counseling, and educational seminars. Clients may also be involved in spiritual or religious programs. One example is the well-established 12-Step Program used in Alcoholics Anonymous and many other substance abuse programs. Psychological testing, and treatment of co-occurring conditions should also take place at this time.

As they approach program completion, clients work with case managers and other professionals to develop plans for a successful transition back to real life. Avoiding relapse prevents the need for another drug withdrawal process.

Withdraw from Drugs to Start A New Life

Substance abuse can cause health problems, interfere with normal social and work activities, harm personal relationships, and cause psychological distress. Individuals who are addicted to drugs and alcohol and the people who are around them may want the substance abuse to stop, but the barriers to becoming sober can be overwhelming. A common obstacle is dread of drug withdrawal because of the potential discomfort from withdrawal symptoms. While symptoms can be painful, the wide range of ways that people can withdrawal from drugs should provide encouragement that all clients can choose the best option for them.

Substance abuse can prevent people from leading the fulfilling lives that they deserve. Individuals who use drugs and those who are close to a substance abuser should not let withdrawal be a barrier to seeking help. A far better alternative is to look at all of the options. Contact our experts at a Blu by the Sea treatment center and we can guide you or your loved one to the customized treatment program that will work.

 

Sources:

(1) NIDA (March, 2011): http://www.drugabuse.gov/publications/drugfacts/treatment-statistics

(2) NIDA (December, 2012). Trends and statistics. http://www.drugabuse.gov/related-topics/trends-statistics

(3) NIDA (December, 2012). Medical consequences of drug abuse. http://www.drugabuse.gov/related-topics/medical-consequences-drug-abuse

(4) NIDA (March, 2011):  http://www.drugabuse.gov/publications/drugfacts/treatment-statistics

(5) NIDA (December, 2012): http://www.drugabuse.gov/publications/principles-drug-addiction-treatment-research-based-guide-third-edition/frequently-asked-questions/how-effective-drug-addiction-treatment

(6) A.D.A.M. Editorial Team. (2012): http://www.nlm.nih.gov/medlineplus/ency/article/000949.htm

(7) Dugdale, D.C. (2013): http://www.nlm.nih.gov/medlineplus/ency/article/000764.htm

(8) Ziaaddini, H., Nasirian, M., & Nakhaee, N. (2012). Comparison of the efficacy of buprenorphine and clonidine in withdrawal of opioid-dependents. Addiction & Health, 4(3-4):79-86

(9) Funk, S. (2013. Pharmacological treatment in alcohol-, drug- and benzodiazepine-dependent patients – the significance of trazodone. Neuropsychopharmacologia Hungarica, 15(2):85-93.,

(10) Amato, L., Davoli, M., Ferri, M., Ali, R. (2004). Methadone at tapered doses for the management of opioid withdrawal. The Cochrane Database of Systemic Reviews, 18(4).,

(11) Center for Substance Abuse Treatment. (2006): http://www.ncbi.nlm.nih.gov/books/NBK64105/

(12) Huntley, Z., Maltezos, S., Williams, C., Morinan, A., Hammon, A., Ball, D.,…Asherson, P.J. (2012). Rates of undiagnosed attention deficit hyperactivity disorder in London drug and alcohol units. BMC Psychiatry, 12:223.,

(13) Shi, j., Liu, Y.L., Fang: (2006): http://onlinelibrary.wiley.com/doi/10.1111/j.1745-7254.2006.00431.x/abstract

(14) NCCAM (January 1, 2010): http://nccam.nih.gov/research/results/spotlight/010410.htm.,

(15) NCCAM (October 1, 2008): http://nccam.nih.gov/research/results/spotlight/022609.htm.,

(16) NCCAM (January 1, 2010): http://nccam.nih.gov/research/results/spotlight/010410.htm.,

(17) Akhondzadeh, S., Kashani, L., Mobaseri, M., Hosseini, S.H., Nikzad, S., & Khani, M. (2001). Passionflower in the treatment of opiates withdrawal: a double-blind randomized controlled trial. Journal of Clinical Pharmacy and Therapeutics, 26(5):369-73.,

(18) Whitten, L. (October 1, 2006): http://www.drugabuse.gov/news-events/nida-notes/2006/10/study-finds-withdrawal-no-easier-ultrarapid-opiate

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