When considering the necessity of medical detox for substance use problems, detox from heavy alcohol use tops the list of substances with the highest medical risk surrounding withdrawal. In fact, alcohol withdrawal can literally kill people (Trevisan et al., 1998). As people develop physiological dependence on alcohol with regular, heavy use, the body changes and adapts by increasing one’s tolerance to alcohol. This is why some individuals with alcohol dependence might drink an amount of alcohol in one day that could actually be fatal to someone who doesn’t regularly consume alcohol, due to alcohol poisoning. Through physiological tolerance, the body protects the alcohol user from alcohol to some degree – though alcohol poisoning/overdose can still lead to death in heavy alcohol users, too (Yoon et al., 2014). However, because of these long-term effects of alcohol on the body, when alcohol intake is reduced, alcohol withdrawal effects can be particularly unpleasant and possibly even medically severe.
Alcohol withdrawal syndrome involves major changes at the physiological level that arise due to the sudden removal of alcohol from the body, leading to electrolyte imbalance and central nervous system hyperactivity that can result in seizures, tremors, tachycardia, hypertension, nervous system damage, and even death (Carleson et al. (2012). Severe alcohol dependence symptoms can complicate things further, with issues like delirium tremens arising (also called “DTs”). Delirium tremens is when in the course of early alcohol withdrawal among heavy, chronic drinkers, people will experience altered mental status, severe confusion, and hallucinations, and DTs are also associated with odds of mortality during withdrawal (Trevisan et al., 1998). If you are struggling with alcohol use and want to stop, I highly recommend consulting medical expertise before attempting to reduce alcohol intake. Fortunately, with medical management, the dangers of alcohol withdrawal are dramatically reduced, and the detox experience can be made much more tolerable.
In summary, detoxing from alcohol outside of medical supervision is extremely dangerous!
(e.g., heroin, fentanyl, morphine, hydrocodone)
When people think of severe withdrawal, or media depicting detox situations, opioid withdrawal is often depicted due to the notorious unpleasantness of opioid withdrawal effects. For example, the movie Trainspotting (1996) depicts Ewan MacGregor in his character’s struggle with heroin addiction, part of which involves a solo attempt at detox in which he locks himself away and suffers through severe opioid withdrawal. Despite the vivid depictions of unpleasant suffering from opioid withdrawal, opioid withdrawal is not as dangerous as alcohol withdrawal, though in some cases medical complications can arise. Rather, the major risk with opioid withdrawal is that it can be so unpleasant that people return to using opioids when in withdrawal and inadvertently die via overdose (Darke et al., 2019). Thus, opioid withdrawal is dangerously unpleasant, with core symptoms including: aches/pain, muscle tension/spasms, tremors, abdominal cramping, nausea, vomiting, diarrhea, anxiety, irritability, hot flashes/chills, heart-pounding, uncontrollable crying, running nose, and excessive sweating (Kosten & Baxter, 2019). Fortunately, medically supervised opioid detox can provide the safest environment to overcome opioid withdrawal, and carefully selected medications can ease the discomfort.
Furthermore, given the severity of opioid withdrawal, the highest chances of a successful detox are going to be found in a medical setting.
Withdrawal from methamphetamine is most severe during the 24 hours following most recent use and residual withdrawal symptoms can last around two weeks (McGregor et al., 2005). Common symptoms of “crashing” off meth, a stimulant drug, include: increased sleeping and eating, depressed mood, suicidal ideation, anxiety, agitation, fatigue, dry mouth, and occasionally psychotic-like symptoms such as hallucinations, paranoia, and delusions. In the case of meth withdrawal, the most dangerous symptoms are suicidal ideation and potential psychotic experiences, which can both lead to dangerous behaviors harmful to oneself and others. Therefore, even if the withdrawal symptoms of meth are tolerable, I’d advise patients to do a medically supervised detox to ensure they don’t harm themselves or others in the process.
Cocaine and Crack Detox
Withdrawal from cocaine and cocaine-derivatives like Crack follows a similar pattern as methamphetamine because all fall under the category of “stimulants” and have similar qualities. Accordingly, the primary withdrawal effects of cocaine and crack include: fatigue, vivid, unpleasant dreams, insomnia, hypersomnia (sleeping too much), increased appetite, agitation, difficulty concentrating, chills/tremors, suicidal ideation, and psychomotor retardation (slow movement)(Sofuoglu et al., 2005). Again, while potentially manageable, given the risk of suicidal behavior and other potential complications, medically supervised detox is also recommended here.
Compared to some of the other drugs discussed, the severity of benzodiazepine “benzo” withdrawal is relatively calm, but still highly unpleasant and potentially dangerous in its own fashion (Authier et al., 2009). Bezno withdrawal comes with a long list of symptoms including: anxiety, insomnia, irritability, restlessness, hand tremors, muscle spasms, headache, sweating, racing pulse, hyperventilation, nausea or vomiting, aches and pains, panic attacks, hypersensitivity to light and touch, skin-crawling, depression, difficulty concentrating, hallucinations (auditory, tactile, or visual), feelings of unreality, delirium, confusion, and potential grand mal seizures. Given the issues with depressed mood, confusion, and potential for seizures, a medical environment to detox from benzos is safest (Authier et al., 2009).
Furthermore, in a medical setting, patients can work with medical staff to taper down doses, reducing the severity of withdrawal and increased odds of success.
Cannabis (Marijuana) Detox
A common myth abounds that cannabis (marijuana) does not cause withdrawal symptoms (Budney et al., 2004). However, this is inaccurate, and chronic, heavy use of marijuana can cause multiple withdrawal symptoms, including: mood changes, irritability, depression, insomnia, disturbing dreams, headaches, diminished appetite, potential weight loss, difficulty concentrating, sweating and cold sweats, chills, tremors, fever, and abdominal pain. Cannabis also has a longer withdrawal timeline, with symptoms peaking approximately 7-10 days after stopping use and then declining for another 2-3 weeks. Although cannabis withdrawal symptoms are not life-threatening, given the duration of symptoms and the mood effects, including potential suicidal ideation, supervised medical detox is advised for heavy cannabis users.
Benefits of Medical Detox
To reiterate, the biggest benefit of undergoing medical detox, versus medically unsupervised detox, comes down to safety. Detoxing outside a medical setting could lead to serious health consequences and in some cases medical problems associated with withdrawal can be fatal. Furthermore, withdrawal is a difficult experience, and in a medical setting, prescriptions can be provided to ease the experience as much as possible. Finally, success is going to most probable in a medical setting providing pharmacological and therapeutic support, especially when followed by a transition into rehabilitation treatment for overcoming addiction long term.