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My family has a story we tell about the time my grandfather went to alcohol detox at Deaconess Hospital in Detroit. It was back in the 1970’s when the approach was “white knuckle”. He was tied to the bed with straps. While his sons held vigil, he stayed awake for an entire week. Riding the horrible crest of the DTs. Hallucinating spiders and snakes crawling down the walls. Suffering without medication or comfort.
Even today when you ask “what is detox?” the concept might conjure up grim mental images. The name is the same, but detox is a very different experience today than the dated memories my family has. These days, detox is made up of a sophisticated combination of medication and testing. From a therapeutic standpoint, it is a time of emotional reassurance. A time to educate those who enter detox that addiction is a disease.
The purpose of detox is to rid the body of alcohol or drugs in a physically safe way. Not everyone who goes into treatment needs to go to detox, but in some cases, medical stabilization is necessary to safely admit someone into an addiction treatment program. Factors that play into the need for detox include: amount, frequency and length of time of substance use. At Sanford House we make these determinations at Screening and Assessment.
So what is detox? Detox is not treatment. Detox is not rehab. In the simplest sense, detox deals with the physical aspect of addiction and treatment deals with the emotional aspect and the emotional pain that underlines substance use.
Sanford House Medical Director says, “Detox usually follows unsuccessful attempts to stop using, and by the time people come to the detox unit they are relieved, because they are getting professional help. Often there is needed a more controlled environment based on science to safeguard physical risk, providing comfort while doing so.”
First of all, detox is conducted in a hospital, clinic, detox center or detox area within a treatment center. These places are often more institutional and medical feeling than treatment centers so they will seem a bit sterile as you are admitted. You will be assigned a bed and you can wear your own clothes and expect to spend 2 to 4 days for alcohol detox and a week or sometimes longer for substances such as heroin, oxycodone or cocaine. Every attempt to provide comfort and distraction will be made, but I’m not going to lie - there will be some tough days (nothing like poor grandpa’s leather straps, however!).
You will be assigned a case manager, and if you have not already determined where you will go for treatment after detox, the case manager will help to determine what type of treatment is most appropriate for you. The detox team is reassuring, but intense therapy does not begin in detox, because memory loss is common and you might not remember many things that took place while there.
There are several scales or inventories that are used to evaluate a person in detox. The first is the Clinical Institute Withdrawal Assessment (CIWA) and the second is the Clinical Opiate Withdrawal Scale (COWS.). These scales determine what medications are given to ease withdrawal.
Abrupt withdrawal from alcohol can result in seizures, cardiovascular events, excessive anxiety and agitation. The CIWA rates things like nausea, tremors, anxiety, agitation, sweating, disorientation, numbness, hallucinations, ability to startle and headaches. With this scale the severity of withdrawal is scored and medications such as benzodiazepines are given as a short term relief to ease symptoms and make the detox experience more tolerable.
COWS looks at body temperature; bone, joint and muscle aches; and sleeplessness. Medications such as buprenorphine can help ease these symptoms. Withdrawal symptoms such as lethargy, memory loss and depression can be related to Vitamin B deficiency. A regimen of B vitamins is often initiated. Vitamin B plays a role in turning sugar into energy.
Withdrawal reduces tolerance. Those who have been through detox, can become effected more quickly and intensely by their substance of choice. They can overdose on a much smaller amount than before detoxing. This is why it is so important to go straight from the detox unit to some type of intensive therapy or program.
When I worked in the detox unit at Pine Rest Christian Mental Health Services, I met men and women of all ages and backgrounds who came through the program. While their time in detox was only a few short days or a week, a tremendous amount of physical healing began to take place. But the physical healing was accompanied by vulnerability and painful awareness of the debris of addiction.
Sanford House Clinical Director, Christine Walkons said something to me the other day that really struck home. She said, “Addiction treatment is like ice thawing. You begin to feel all these emotions and there are a lot of tears… which is part of the process of warming up.”
The thaw begins in detox and continues through treatment…