Detoxification

Detoxification is a process of managing withdrawal, which takes place either during the patient's hospitalization or in the doctor's office (regular daily attendance of the patient at the office according to an agreed plan). The presence of detoxification is one of the essential features of substance withdrawal. These signs are divided into physical and psychological. The severity of detoxification varies from one addictive substance to another and can sometimes be life-threatening. By managing the withdrawal, we mean primarily the acute phase. This is recognized by the most obvious signs. In the following weeks or months, we may already notice chronic signs. However, these usually do not require special treatment. Chronic symptoms include, for example, anxiety, insomnia, lack of appetite, etc.

Approaches used in detoxification
The structure of rehab programs may vary from one health facility to another. However, we always use a combination of three approaches - medical, psychotherapeutic and social work approaches.

Medical approach
By medical approach we mean e.g. nursing care, pharmacotherapy, laboratory tests, etc. This approach mainly focuses on performing a routine physical examination of the patient and relieving their withdrawal signs and symptoms. The medical approach also seeks to prevent the development of complications during detoxification and initiates therapies to treat other health problems.

Psychotherapeutic approach
The psychotherapeutic approach focuses primarily on the relationship between patient and therapist. It also focuses on promoting motivation to continue the therapeutic program even after the most severe withdrawal states have passed.

Social work
Social work procedures address especially the most urgent social difficulties due to the destabilisation of the patient's situation. It also arranges for continuing medical care after detoxification.

Methods of detoxification
The purpose of detoxification is to make the relapse more manageable, not necessarily to suppress all symptoms. There are many methods and schemes of detoxification. They can be long-term (multi-week), medium-term or ultra-short-term (combined detoxification). Some of the most used methods include e.g. detoxification by methadone, clonidine, bufrenorphine, symptomatic detoxification, or detoxification without medication.

Alcohol
Withdrawal state in alcolohol abuse can be very serious and life-threatening. It occurs after only a few hours of alcohol absence, peaking on the second day and resolving in the following five days. 3-5% of patients develop convulsions or delirium.

Symptoms of detoxification: trembling tongue, eyelids, or hands, sweating, insomnia, headache, nausea or vomiting, tachycardia or hypertension, restlessness, drowsiness, weakness, visual, auditory, or tactile hallucinations and illusions, grand mal spasms

Opiates and opioids
The withdrawal state after opiate and opioid withdrawal often looks dramatic. The patient has a strong craving for the drug, and often exaggerates the signs and symptoms in an attempt to get stronger doses of the drugs. In principle, however, withdrawal should not be life-threatening.

Symptoms of detoxification: irresistible craving for the drug, nasal discharge, sneezing, watery eyes, muscle pain or cramps, nausea or vomiting, diarrhea, pupil dilation, restlessness, sleep, tachycardia or hypotension

Sedative and hypnotic drugs
The withdrawal syndrome after withdrawal from sedatives and hypnotics is very similar to alcohol withdrawal.

Symptoms of detoxification: trembling tongue, eyelids, or hands, nausea or vomiting, restlessness, headache, insomnia, drowsiness, weakness, auditory, visual or tactile hallucinations, tachycardia, grand mal seizures

Stimulants
Withdrawal from stimulants (mostly meth or cocaine) tends to be less pronounced than detoxification from alcohol or opioids. Depression is the greatest threat, and suicidal tendencies may be present. For prolonged depression, antidepressant therapy is indicated.

Symptoms of detoxification: lethargy, fatigue, increased appetite, insomnia or hypersomnia, restlessness, unpleasant dreams, irresistible drug cravings

Other addictive substances
Other, not very commonly used substances for which detoxification is used include : benzodiazepines, barbiturates, cannabinoids and hallucinogens. The main principle of detoxification of these substances is gradual dose reduction. The risks of withdrawal are not severe enough to warrant users seeking professional help. Of course, the specific detoxification is always guided by the patient's current clinical condition.

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