As discussed in the Philadelphia newspaper The Inquirer, teenagers in the 13-16 age group are the main users of over-the-counter highs like dextromethorphan, an ingredient in cough suppressants. According to the paper, it is estimated that one in every 10 teenagers has abused an over-the-counter cough suppressant to get high.
Psychoactive side effects of dextromethorphan include but are not limited to hallucinations, the sense of being out of one’s body, euphoria, and an altered perception of sounds and colors. It has been reported that these effects can last as long as six hours. Easy access to this drug and the high it can confer at high doses make it a drug of abuse. The good news is the treatment is available for anyone affected by dextromethorphan abuse.
For people who are concerned about their dextromethorphan or abuse, or for personally interested third parties, like parents, it is helpful to understand the symptoms of physical dependence. Dextromethorphan is an addiction-forming drug. Depending on the volume and length of abuse, a person who regularly uses this over-the-counter (OTC) drug will develop a physical dependence on it. The main hallmarks of physical dependence are tolerance and withdrawal, and these biological phenomena are significant in the treatment process.
The more individuals take an addiction-forming drug like dextromethorphan, the more of the drug they will need, because of the body’s naturally occurring tolerance-building process. Unfortunately, however, the more a person takes a drug, the greater the risk of developing adverse reactions, or side effects. Should the use of dextromethorphan or another drug stop, or if the familiar dosage is significantly diminished, the person will go into withdrawal. Dextromethorphan withdrawal symptoms include but are not limited to:
- Dramatic weight loss
- Upset stomach
For chronic users who have a history of taking this drug in high doses, withdrawal can include toxic psychosis, a condition that can feature confusion, loss of identification with reality, physiological troubles, and behavioral problems.
To ensure safety in the withdrawal process, there is a universal advisement that anyone who has a physical dependence on dextromethorphan should gain admission to a medical detox program at a rehab center, dedicated detoxification facility, or hospital. At present, it is important to note that the US Food and Drug Administration has not approved any medications that specifically target dextromethorphan abuse.
Though targeted medications are not available, during medical detox, the attending team of addiction treatment specialists can provide the recovering person with palliative and other general medications like muscle relaxers (for example, in order to stop stomach pain). The addiction specialists can also provide important support in the form of nutritional meals, adequate hydration, vitamins, minerals, and the comfort of a safe environment.
Importantly, the presence of a treatment team serves as a layer of indemnification against a person leaving before the detoxification process is complete, as may happen if a person is going it alone “cold turkey” at home or in any other environment that may be rife with drug use cues. Medical detox can get a person who is seeking to recover from dextromethorphan abuse off to an effective start. After detox is complete, the recovering person then moves into primary care for the dextromethorphan abuse issue.
Primary Addiction Treatment Services for Dextromethorphan Abuse
Much of the treatment literature published on dextromethorphan abuse focuses on teens in recovery. However, individuals who are newcomers to addiction treatment topics should understand that recovery services are not usually drug-specific. In other words, rehab centers provide a host of services that target the psychological and emotional factors that underlie addiction. As a result, a rehab program can simultaneously treat teens and adults with different singular or multi-drug use disorders (known as polydrug use). In short, the way a treatment program helps to heal drug use disorders has less to do with the drugs of abuse than addressing the complexities of drug addiction in general.
Most programs that offer a full continuum of treatment services share a similar skeletal structure that features primary programs and complementary ones. The following is a simplified overview of the types of primary services that most rehabs offer, including for the treatment of dextromethorphan abuse:
- Individual counseling: This covers therapist-led sessions that involve research-based therapies, such as Cognitive Behavioral Therapy (CBT), which have been shown to be effective in the treatment of substance use disorders. The approaches a therapist takes depends largely on their overall treatment philosophy.
- Group counseling: Also therapist-led, these sessions rely on the particular therapy approach that the therapist uses, such as CBT, as well as the healing possibilities of the group dynamic. Group counseling is different from group recovery meetings.
- Family counseling: As addiction is a family disease, some rehab programs provide family counseling, led by a therapist, as a staple of their programming. The therapist can lead the family and moderate discussions to help everyone shift into a new consciousness – one geared toward healing the addiction and building a new family life rather than repeating old, ineffective patterns and family dynamics.
- Group recovery meetings: These meetings are usually modeled after the faith-based 12-Step model or non-faith-based alternatives. These meetings are not therapist-led. Individuals in recovery often continue to attend group recovery meetings for months, years, or even decades.
Some services are considered supportive rather than primary, though the designation depends on the rehab center. For instance, a publicly funded program may dedicate the brunt of its limited resources to providing individual and group counseling, and not be able to provide clients with supportive services such as music and/or art therapy, extensive drug counseling, other educational programs, family days (i.e., social events on site that involve family members), and family education on drug abuse. Typically, only well-funded private programs have the means to offer what are called complementary services, other forms of supportive service. Complementary services can include yoga, acupuncture, massage, animal therapy, and nutritional guidance. Rehab centers that have a gym on site will include exercise breaks in the treatment schedule to encourage client wellness. If the treatment program has attractive grounds, clients may also be encouraged to walk around, in lieu of going to the gym, doing yoga, or a different type of wellness activity.
A Note on Treatment Services for Teens
Again, as it appears that the majority of Americans who abuse dextromethorphan are adolescents, it is useful to reference treatment services that are dedicated to this demographic. In an effort to help individuals in a parental role vis-a-vis a teen or young adult who is abusing dextromethorphan or other drugs, the National Institute on Drug Abuse (NIDA) has published the Principles of Adolescent Substance Use Disorder Treatment: A Research-Based Guide. Again, many of the methods that are effective for adults can also be effective for teens and young adults. However, there are treatment programs that are specifically tailored to treat teens and young adults, and these programs are apt to offer those research-based services that, after research trials, have been expressly indicated for use in this demographic. But note, these programs are still likely to incorporate into their curriculum those primary and secondary services that are shown to generally be effective for drug abuse treatment.
The NIDA guide referenced above points out to the public, especially concerned parents, the methods that are known (through research efforts) to work for teens in recovery from drug abuse. The following is a list that highlights some of those treatments:
- Addiction medications: Medication-assisted therapy involves the use of FDA-approved medications to treat addiction to opioids, alcohol, and benzodiazepines; however, these medications have not been approved for use in adolescents. If a doctor who specializes in addiction treatment for adolescents uses these medications in treatment, then that is considered off-label use. At present, there are no FDA-approved medications for treatment of abuse of cocaine, marijuana (cannabis), or methamphetamine. Research continues in this area.
- Behavioral approaches: These approaches include Cognitive Behavioral Therapy (separate group and individual sessions), peer-group meetings, Adolescent Community Reinforcement Approach (A-CRA), Contingency Management, 12-Step facilitation therapy, and Motivational Enhancement Therapy (MET).
- Family-centered approaches: These family-centered approaches include Family Behavior Therapy (FBT), Brief Strategic Family Therapy (BSFT), Functional Family Therapy (FFT), and Multi-Systemic Therapy (MST).
- Recovery support services: These include Assertive Continuing Care (ACC), Peer Recovery Support Services (PRSS), Mutual Help Groups (MHG), and Recovery High Schools (RHS).
One of the most insidious aspects of drug abuse is that it affects numerous youth, a demographic that is among the most vulnerable in the US. Adolescents who are looking for a high may not have the acumen and experience to seek out a drug dealer, but as statistics on cough syrup abuse indicate, they do have the wherewithal to consume a high volume of dextromethorphan with the goal of experiencing psychoactive effects, like hallucinations. Dextromethorphan is often mixed with other agents that, at high doses, can cause nausea and even more serious problems, like organ damage.
Treatment for addiction to dextromethorphan not only intervenes on a serious health problem (the addiction itself and its attendant harmful consequences) but can also help to prevent long-term damage to the body, legal troubles, and behavioral problems. There is a universal recommendation that anyone who is experiencing dextromethorphan abuse should consult a qualified addiction counselor or other qualified professional. Recovery from dextromethorphan is possible – for teens, young adults, and adults alike.