When a person chronically uses alcohol or drugs, there are a number of different effects that occur with the continual absorption of these substances into the person’s system. These effects include both physiological adaptations and psychological/emotional adaptations. A person’s system strives to maintain an optimal level of functioning that allows it to operate efficiency with the least amount of stress. The system naturally monitors and attempts to maintain levels of hormones, neurotransmitters, and other regulatory substances and systems. This range of values where the system operates efficiently without taxing itself is known as homeostasis (a system of balance).
Using drugs or alcohol for even short periods of time results in alterations to this sense of balance, and the system adjusts to compensate for the presence of alcohol and/or drugs. Likewise, one’s emotional state normally moves toward a state of balance where there are no significantly fluctuating emotions or extreme emotions expressed. Drugs and alcohol alter this level of emotional balance as well. For most drugs, using the substance over time results in diminished effects, and individuals find that they will need to use more of the drug to achieve the effects that were achieved at lower doses previously. This is the development of tolerance.
Individuals who have used substances for significant periods of time and then suddenly stop using them, or cut down on the amount they are using, throw off the new level of homeostasis. This results in a number of reactions that will lead to unpleasant physical and emotional effects. These reactions represent withdrawal symptoms.
The development of both tolerance and withdrawal result in the notion of physical dependence, and individuals can also develop psychological dependence on drugs based on their emotional effects.
The term detox refers to the detoxification process that occurs when an individual stops taking drugs or alcohol. The body slowly eliminates the amounts of substances in its tissues, and the alcohol and drugs are metabolized by the liver and excreted. Medically assisted detox is a process that helps individuals negotiate the withdraw process in such a manner to produce the least amount of discomfort as possible.
- How long the person used in the substance and the amount typically used: These factors play an important part in the length of the detox process as well as in the intensity of any withdrawal symptoms. Individuals using drugs or alcohol for lengthy periods of time or in greater amounts will typically experience longer and more intense withdrawal symptoms, and a subsequently longer detox process.
- The type of substance a person used: Some substances, such as alcohol, benzodiazepines, and narcotic medications, are associated with particularly high levels of physical dependence when chronically abused. Others, such as certain amphetamines, cocaine, and even marijuana, have less potential for severe physical dependence, but they do produce emotional and psychological issues during the withdrawal process.
- Method of ingestion: Certain individuals inject or snort drugs. Some individuals take them orally. Because tolerance develops more quickly with more direct means of administration, such as injecting and snorting, individuals who use these methods will often face more complicated withdrawal issues.
- Individual differences in emotional makeup and physiology: These can result in significant differences in the length of withdrawal and the intensity associated with the detox process. Many times, individuals with similar abuse backgrounds will demonstrate quite different experiences during detox.
- Method of discontinuation: Quitting drug use altogether will result in a more intense reaction compared to slowly tapering down the amount used over time. Obviously, individuals who participate in a medically assisted detox program may find that the detox process takes a little bit longer than a “cold turkey” approach, but it will be less severe and, in many cases, far less dangerous.
Narcotic or opioid medications make up a large class of drugs that are primarily used to control pain, such as OxyContin, morphine, Dilaudid, Vicodin, etc. This class also includes drugs that are primarily drugs of abuse, such as heroin. These drugs are known for their ability to quickly produce physical dependence in individuals and for the uncomfortable withdrawal effects that occur upon discontinuation. In general, the timeline for detox from these drugs follows this course:
- Depending on the drug, symptoms can begin to appear within 12 hours of discontinuation. The first 24-48 hours are often the most difficult, where withdrawal symptoms are the most intense. Individuals will be tempted to start using the drug again during this time, and relapse rates during the early stages of unsupervised detox are very high. Although not life-threatening, the symptoms are uncomfortable and include pain (in the muscles, joints, and even severe headaches), gastrointestinal issues (nausea, vomiting, diarrhea, and abdominal cramps), insomnia, chills, fever, runny nose, dilated pupils, mood swings (including extreme anxiety and/or depression), and confusion.
- Shortly after the second day, the symptoms begin to subside. The individual may still experience gastrointestinal issues, pain, chills or goosebumps, and occasional anxiety or depression. Cravings may also continue.
- Following the sixth day, there may be some queasiness and residual depression and anxiety, but for the most part, the severe withdrawal symptoms have subsided, and the detox process is nearly complete. Individuals will still experience intermittent cravings for months and, in some cases, even years. Also, individuals may experience issues with anxiety, depression, lack of motivation, etc.
Chronic uses of cannabis (marijuana) leads to mild physical dependence and more severe psychological dependence. There is an associated detox process with cannabis use that is considered relatively mild compared to narcotic medications; however, very heavy users of marijuana may experience extreme issues during the detox process. A general timeline for cannabis detox/withdrawal follows:
- Symptoms generally appear 24-72 hours after discontinuing marijuana. These initial symptoms are typically emotionally based but include some physical symptoms. The symptoms include irritability, restlessness, changes in appetite, nausea, insomnia, fatigue, mild perspiration, mild headaches, chills, issues with anxiety, potential depression, and, in some cases, more severe emotional symptoms, such as severe mood swings or even hallucinations in rare cases. Of course, the person will begin to crave cannabis.
- The symptoms typically peak within 1-2 weeks and then begin to subside. Cravings and insomnia may linger, and some individuals will continue to experience mood issues.
- Following the end of the second week, many individuals will notice a significant decrease in these issues; however, for heavy users, the detox process may take months.
The detox process from cocaine use produces significantly distressing emotional effects. This is because using cocaine results in drastic increases in the neurotransmitters dopamine and norepinephrine, both of which are associated with the experience of reward and reinforcement (this is especially true for dopamine). When the individual stops using cocaine, the levels of these neurotransmitters drop sharply, and the person begins to experience severe depression, apathy, lack of motivation, and severe cravings for more cocaine (this is known as the cocaine crash).
The detox process from cocaine is not associated with severe physical effects; however, there may be some that occur in heavy users. In general, the process follows this timeline:
- Symptoms being within the first three days after discontinuation. Feelings of irritability, restlessness, fatigue, severe drowsiness, increased appetite, flat or depressed emotions, a lack of motivation, and severe cravings for cocaine may occur.
- Following the fourth day, the symptoms will begin to level off, but individuals will still have issues with cravings, irritability, restlessness, and fatigue, and may still have increased appetite. The symptoms may last as long as two weeks.
- From about the third week on, the symptoms will have abated, but some individuals still find themselves feeling anxious or depressed, and experience cravings for cocaine.
- Some very chronic users of cocaine who mix cocaine with alcohol or other drugs may experience seizures.
One of the most dangerous substances to detox from is alcohol. This is because chronic use of alcohol produces a severe physical dependence syndrome. In cases of severe physical dependence, the withdrawal process from alcohol is associated with life-threatening seizures as well as other issues, such as severe confusion and hallucinations. It is very hard to predict who will develop severe reactions during the detox process, and anyone who has chronically abused alcohol should consult with a physician before trying to quit drinking.
The actual detox process depends on the severity of the individual’s alcohol use disorder. Individuals with severe alcohol dependence may experience entirely different detox processes than those with less severe dependence. A very general description of detox from alcohol follows:
- Individuals will typically experience withdrawal symptoms 8-24 hours following discontinuation. These can include headaches, nausea, vomiting, sweating, irregular heartbeat, fatigue, issues with sleep, anxiety, shakiness and or tremors, hallucinations, and the development of seizures in heavy users.
- After about 24-72 hours, individuals will experience increases in blood pressure, heart rate, respiration, body temperature, sweating, irritability, and confusion. Severe users may experience potential confusion, agitation, hallucinations, and seizures.
- In most cases, symptoms will taper off after 5-7 days; however, in individuals who have severe addictions to alcohol, symptoms may last for up to two weeks and seizure potential may continue.
Anyone undergoing detox from alcohol who develops confusion, hallucinations, and/or what appears to be seizure-like activity requires immediate medical attention. It cannot be stressed that it is very hard to predict based on history of use who will develop these potentially dangerous symptoms. Again, individuals wishing to discontinue chronic alcohol use should first consult with a physician.
Rapid detox programs for any of the above drugs or any other drugs are not recommended, as they increase the potential for harm associated with the detox/withdrawal process. Instead, engaging in a legitimate medically assisted detox process with an addiction medicine physician or psychiatrist is recommended.
Briefly, the process of medically assisted detox uses specific types of medications and/or a tapering process to assist an individual in detoxing drugs from their system. In some cases, such as when an individual is on a tapering program, this may lengthen the overall time period associated with the detox process because the physician will slowly taper the dosage of whatever medication or drug is being used over a specific time period. This will allow the person’s system to slowly adjust its level of homeostasis and will significantly decrease any discomfort and the potential dangers associated with withdrawal. This type of program should only be performed under the supervision of a licensed physician who has experience in addiction medicine or psychiatry. Attempting to negotiate a self-induced medically assisted detox program can be potentially dangerous.