The development of physical dependence is considered to be a significant symptom of a substance use disorder, although having physical dependence on any drug is neither necessary nor sufficient to diagnose any individual with a substance use disorder. Having physical dependence on a specific drug of abuse is problematic for individuals in recovery because when the individual stops taking their preferred drug, they begin to experience withdrawal symptoms that in some cases can be life-threatening but in nearly all cases are extremely uncomfortable. Relapse rates during withdrawal from alcohol or drugs are especially high because one of the quickest and most effective means of stopping the withdrawal process is to begin taking the drug of choice again.
The development of physician-assisted withdrawal management programs has resulted in the ability of professional treatment programs to reduce relapse rates during the withdrawal process and to safeguard individuals in the early stages of recovery from any potentially dangerous issues associated with withdrawal. However, there are a number of approaches to managing withdrawal symptoms that are controversial and even dangerous, such as “rapid detox.”
Detox vs. Withdrawal Management
There is a difference between the terms detox (detoxification) and withdrawal management. The detoxification process is actually an ongoing physically based process that occurs in everyone. Waste products and toxins are eliminated from the body mainly through the liver, and even individuals actively using alcohol or drugs are constantly undergoing the process of “detox.” The term medical detox is commonly used by treatment facilities and laypeople; however, it is no longer used by professional organizations, such as the World Health Organization or the American Society of Addiction Medicine.
Detox describes a natural physical mechanism associated with metabolites. Any efforts to speed up the normal process of detoxification are typically fruitless as a person’s system can only detoxify itself at a specified rate. Some very minor alterations may occur when individuals drink lots of water or use substances designed to facilitate detoxification; however, most of these products are not worth the cost. Instead, the preferred term to describe the process used by physicians to assist an individual in dealing with their withdrawal symptoms is withdrawal management. A physician-assisted withdrawal management program is a self-descriptive term that indicates that a professional addiction medicine physician institutes a medically based program to help an individual in recovery to negotiate the withdrawal syndrome.
What Is Rapid Detox?
A process often termed ultra-rapid detox, rapid detoxification, or rapid detox is actually an accelerated form of withdrawal management. Rapid detox programs are most often targeted at individuals who have opioid use disorders, but some programs are extending this to some other substance use disorders. The procedure is delivered while the patient is under anesthesia and has a number of features that distinguish it from traditional withdrawal management programs.
- The patient undergoes the procedure in an intensive care unit of a hospital or as an inpatient in a hospital or clinic.
- General anesthesia is administered to the individual under the supervision of a physician and medical staff.
- When the person is anesthetized, they are administered opioid blockers like naloxone, which are drugs that reverse the symptoms of opioid drugs by attaching to the receptor sites in the brain where these drugs have their effects and knocking off any remaining drugs on those sites. Other drugs, such as medications to address nausea, muscle tension, and other withdrawal symptoms, are also administered.
- The administration of naloxone helps to eliminate any opioid drugs in the central nervous system and occupies the receptor sites, such that withdrawal management process can be maintained. The procedure is reputed to work in an extremely short period of time compared to the normal withdrawal process occurring as a result of an opioid use disorder; in many cases, claims are made that the procedure takes 5-10 hours to complete, whereas traditional methods of withdrawal management can take weeks or months to complete, particularly if opioid replacement medications are used.
- When the individual recovers from anesthesia, they are observed to make sure that there are no complications and can be released from the clinic or hospital shortly afterward if there are no issues.
- According to the claims of these programs, the withdrawal process is complete under this procedure.
The use of opioid antagonist drugs is not new. Naloxone is a drug that is often used to reverse the symptoms of overdose to opiate drugs like heroin, and other drugs that are opioid antagonist, such as naltrexone, can reduce cravings in individuals who are in recovery. There is also nothing new about “quick fix” attempts to recover from a substance use disorder. There are hundreds of different types of “self-detox” or other programs listed online, in books, and via a number of treatment programs that are reported to have miraculous effects in reducing the hardships associated with recovery from a substance use disorder. Individuals who have developed substance use disorders by their very nature are often seeking “quick fixes” to their issues. This group of individuals is especially vulnerable to using methods that have lofty promises and are not associated with mainstream thought. However, these programs typically are not supported by empirical evidence, and there may be dangers associated with a number of them. The old saying, “If it sounds too good to be true, it probably is,” applies to many of these programs, including rapid detox procedures.
Risks Associated with Rapid Detox Programs
There are a number of concerns associated with use of the rapid detox procedure.
- There is really no research evidence that reliably concludes that use of the rapid detox technique is advantageous over traditional withdrawal management techniques regarding recovery rates from substance use disorders. Research indicates that claims made by rapid detox programs that these techniques are more effective than traditional withdrawal management programs are not supported.
- Rapid detox programs do not address aftercare issues. Once the patient leaves the inpatient unit, they are on their own. These individuals still need to become involved in a formal aftercare program just like any other patient in any other recovery program addressing withdrawal symptoms.
- Formal statements by national and international organizations, such as the Centers for Disease Control and Prevention, indicate that the rapid detox procedure is associated with a number of potential dangers. Individuals are at risk for developing serious issues, such as pneumonia, heart attack, serious metabolic problems, and pulmonary edema as well as other issues, such as flulike symptoms and dehydration. There are also a relatively high number of fatalities associated with the use of rapid detox procedures, indicating that these programs are not safe.
- Because the procedure requires the use of an intensive care unit and ICU staff, it is extremely expensive compared to traditional withdrawal management programs. Many insurance companies will not pay for the rapid detox procedure because it has not shown to be advantageous over traditional withdrawal management, and there are a number of dangers associated with using these techniques. The majority of professional organizations and treatment providers strongly advise against using the procedure.
One advantage to the rapid detox program is the use of intensive care unit staff to supervise the procedure as these individuals are highly trained and can handle a number of medical emergencies; however, this advantage is easily outweighed by the number of potential disadvantages associated with the procedure. This is in contrast to a number of “self-detox” or “natural detox” programs advertised online and in other sources that do not offer any medical supervision at all.
Because there are a number of dangers associated with withdrawal, anyone who is attempting to discontinue use of drugs or alcohol should consult with a physician before stopping the substance completely. The withdrawal process for some drugs, such as benzodiazepines and alcohol, can be potentially fatal due to the development of seizures. For other drugs of abuse, such as opiates and stimulants, withdrawal can lead to issues with judgment, depression, and even suicidality that can be potentially dangerous. Anyone can develop potentially serious physical conditions as a result of withdrawal, such as dehydration or infections.
What Actually Constitutes Recovery from a Substance Use Disorder?
Despite volumes of literature and numerous statements by professional organizations, such as the American Society of Addiction Medicine, the National Institute on Drug Abuse, and the Substance Abuse and Mental Health Services Administration there still remains an impression that simply going through the withdrawal process or going through detox is a sufficient program of recovery from a substance use disorder. In fact, nothing could be further from the truth. Detox is not a program of recovery. It is a necessary first step in developing a recovery program for some individuals.
All of the major organizations associated with researching and developing treatment protocols for substance use disorders make the following general claims regarding recovery:
- Simply getting through the withdrawal process is not an approach to recovery from a substance use disorder. Individuals who do not engage themselves in a program focusing on their substance use disorder after they negotiate the withdrawal syndrome relapse at rates that are near 100 percent.
- Physician-assisted withdrawal management programs are often successful and can reduce the risk of relapse during the withdrawal process.
- Medically assisted treatment, such as the continued use of medications to deal with cravings for drugs or to promote abstinence, is a useful adjunctive treatment in recovery from a substance use disorder, but it is not sufficient to promote recovery.
- Participation in a formal substance use disorder treatment program that includes therapy and participation in other interventions is associated with a greater probability of a positive outcome in recovery and higher rates of recovery.
- Getting support from others, such as friends, family, or other individuals in recovery, is extremely useful.
- One key component of a successful recovery program is remaining in treatment for a sufficient length of time. There is no specific identified time period that constitutes a successful treatment program; however, in general, individuals need to be involved in treatment for years after they discontinue drugs or alcohol in order to be successful. Typically, it is estimated that individuals need to be involved in ongoing treatment, such as support group participation, for between five and seven years following discontinuation in order to ensure long-term success.
- There is no specific approach that works for everyone. While individuals need to be involved in therapy and get support from family and friends, the specific therapist, type of therapy, and type of support group used will often vary depending on individual needs.
- Support groups, such as community support groups, 12-Step groups, other social support group, etc., are excellent sources of long-term participation in a recovery program. Formal therapy is often time-limited, and while it typically last for months and even years, individuals still need to participate in some recovery-related activity following the completion of formal therapy.
- Individuals in recovery need to be treated for any co-occurring disorders they have. Because people diagnosed with substance use disorders often have other co-occurring mental health conditions or disorders, it is important to address these issues at the same time.
What about Testimonials Promoting Rapid Detox?
The advertisements for rapid detox programs found online and in other sources always include testimonials from “satisfied” or “successful” patients. Despite being presented with numerous research studies and statements from formal organizations that these programs are not effective and can be dangerous, many will still attempt to justify use of these programs based on these testimonials. Quite frankly, these endorsements are extremely unreliable and, in many cases, fabricated. In addition, there may be a number of unsatisfied patients, or patients who completed the procedure and relapsed, that are conveniently left out of these advertisements.
The use of any type of withdrawal management program represents an attempt by an individual to cope with an identified medical condition. Physical dependence is an identified medical condition that consists of both physical and psychological symptoms. Individuals who attempt to be treated for medical conditions should opt for treatment from licensed medical personnel who use empirically validated techniques (techniques and procedures that are proven in research studies and in practice). There will always be a number of sham programs offered to individuals who are looking to “beat the odds” by not engaging in conventional approaches to treatment. However, the vast majority of these programs are untested, ineffective, and unsafe.
Rapid detox is basically an ineffective approach to recovery and potentially unsafe. The risks of getting involved in a rapid detox program far outweigh any potential benefits. These programs cannot be recommended under any circumstances.