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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.”
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.
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 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.
There are a number of concerns associated with use of the rapid detox 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.
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:
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.