"It's time for addiction to stand up and demand some respect. Because every time someone is ostracized for being an addict, every time there's a breathless, trumped-up, sensational headline, every time we giggle at a wasted celebrity, and every time addiction is televised as salacious entertainment, yet another addict is shamed into silence."
-Kristen Johnston

It's called "revolving door syndrome" when a drug or alcohol addict completes drug rehab several times but relapses and then returns to treatment once again. This does not happen because rehabilitation doesn't work, or because addicts are not strong enough to change. Revolving door syndrome occurs because sometimes, relapse is simply part of the arduous and never-ending process of recovery.

Relapse happens because addiction, also known as substance use disorder, is a chronic brain disease. It is actually defined that way by both the American Medical Association (AMA) and the World Health Organization (WHO) - as a lifelong chronic illness. As with other chronic illnesses like diabetes and cancer, relapse is always a possibility. The good news is that even after a relapse, there is always the opportunity to detox, heal, and continue with active recovery.

Another ray of hope on an otherwise bleak situation is that advancements in medically assisted addiction treatment can provide more help now than ever before, making relapse much less likely.

Medically assisted treatment, also known as medical detox or medical intervention, refers to the use of specialized prescription medications to help people with substance use disorder achieve recovery. This article will discuss why drug and alcohol withdrawal is so difficult to bear and how medical detox makes the process more tolerable and effective for the long term.

Why Do People Go Through Alcohol and Drug Withdrawal?

Drug and alcohol withdrawal occur when a heavy drinker or drug user attempts to quit. This happens because heavy substance use leads to acute changes in the brain once it becomes dependent on substances to function.

Drugs and alcohol release "happy chemicals" in the brain like dopamine that create feelings of euphoria. With continued use, the brain and body become dependent on the steady influx of these chemicals and make significant changes to sensory processing and neural pathways to compensate for the effects of the substances being consumed. After awhile, these compensations become "the new normal" and the brain no longer remembers how to function without the presence of alcohol or drugs.

Eventually, the now addict will try to quit using or drinking; the brain and body will be flung into a sudden and massive chemical imbalance, and withdrawal symptoms will kick in as the body re-adjusts itself to function without the presence of illicit substances.

Since drug withdrawal symptoms are so incredibly unpleasant, many recovering addicts find them unbearable, eventually giving in to the temptation to have another dose or drink to ease the pain. For this reason, relapse is most common during the withdrawal or detox phase.

In general, drug or alcohol withdrawal lasts about seven days, but it could take longer depending on the severity of the addiction and the user's substance of choice.

Quitting Cold Turkey

Some people insist that quitting drug or alcohol abuse "cold turkey" is the fastest and most thorough way to detoxify the body after addiction. This method is not for everyone, however, and could prove downright dangerous.

The problem with quitting cold turkey is the difficulty and misery of the process. With no medical or therapeutic assistance to help the patient withstand the painful withdrawal symptoms, the process will be even more severe and difficult to complete. Some withdrawal symptoms may even be life-threatening, and without medical assistance to recognize and treat the potential complications, quitting cold turkey may be both very difficult and very dangerous. Relapse is also much more likely during a cold turkey detox.

Below we'll present the different types of withdrawal and how they might feel for someone who decides to quit cold turkey.

Symptoms of Opioid Withdrawal

Opioid withdrawal is unique in that it brings on a range of symptoms that emulate the flu or a stomach virus, so not only is the patient experiencing the psychological symptoms of withdrawal, they are also affected by a physical, debilitating illness at the same time. Here are the symptoms one might expect from opioid withdrawal:

• Fever
• Nausea and vomiting
• Diarrhea
• Stomach cramps
• Goosebumps and "crawling skin" sensation
• Depression
• Intense cravings
• Muscle aches
• Excessive yawning
• Insomnia
• Anxiety and agitation
• Runny nose
• Excessive sweating
• Racing heartbeat
• Hypertension

Besides the severe physical symptoms of opioid withdrawal, the process is also marked by a much higher risk of drug overdose. The reason why has to do with drug tolerance.

Drug tolerance occurs when the brain compensates for systematic drug abuse by attempting to decrease the effects of the illicit substance. Since the user can no longer feel "high" using the same dose, they continually increase the dose they take to gain euphoria, and the body continues to adjust itself to the higher doses. During detox however, opioid tolerance falls at a rapid rate, so if a user relapses to alleviate the painful withdrawal symptoms by using the same large dose as before, they are very likely to overdose because of their now-lowered tolerance.

This is one of several risks during opioid detox, and it is much safer to perform this process under the supervision of trained professionals.

Symptoms of Alcohol Withdrawal

Despite the fact that alcohol is not considered a "hard drug", quitting alcohol leads to one of the severest and most dangerous types of withdrawal. On average, the process lasts seven days, although the length of alcohol detox will depend on the severity of the addiction. In most cases, alcohol withdrawal will consist of some combination of the following symptoms:

• Vomiting and nausea
• Confused thought processes
• Heart palpitations
• Mood swings
• Stomach pains
• Heavy sweating
• Headache
• Seizures
• High blood pressure
• Irritability
• Mental confusion
• Hallucinations
• Tremors in the hands
• Insomnia
• Anxiety

The biggest risk during alcohol withdrawal is the possibility of developing delirium tremens, a dangerous condition associated with accelerated heart rate, intense hallucinations, extreme agitation, and seizures. Without medical treatment, delirium tremens can be fatal, which is why medical supervision is recommended during alcohol withdrawal.

Symptoms of Stimulant Withdrawal

Every substance affects the brain and body differently, so every type of withdrawal is a different experience. Dependence to stimulants like cocaine, meth, and ecstasy causes a wide range of psychological symptoms during withdrawal. This is what one might expect during stimulant withdrawal:

• Hallucinations
• Panic
• Mood swings
• Paranoia
• Apathy
• Suicidal thoughts
• Anxiety
• Exhaustion
• Aches & pains
• Agitation
• Intense Cravings
• Irritability
• Restlessness
• Confusion
• Depression
• Disorientation
• Remorse
• Dysphoria

Because of the psychological nature of stimulant withdrawal symptoms, the greatest risk during this type of detox is suicide or self harm. Even those patients who had no previous indications of mental illness or suicidal tendencies may lose touch with reality during detox. Round-the-clock supervision is recommended for severe stimulant addicts during detox.

What Is the Best Way to Cope with Withdrawal Symptoms?

Managing withdrawal symptoms is key to completing the detox phase successfully, which is why a little help goes a long way. Without therapy, exercise, medical intervention, and support, a patient will have nothing to focus on besides the pain and misery of their symptoms.

That is why relapse is most common during withdrawal; it simply seems too difficult and painful to bear. When relief is only one drink or dose away, many feel that they cannot withstand the process for the full week or more that is required to complete detox. This is where professional assisted detox programs come in.

In a professional detox program, patients have access to a variety of medical prescriptions, treatments, and therapeutic activities to soothe withdrawal symptoms as well as to keep the body and mind focused on healthy diversions. Some of the detox treatments that may be offered in a professional drug and alcohol treatment center are:

• Dietary supplements and vitamin replenishment
• Exercise and workouts with a trainer
• Massage
• Art therapy
• Yoga
• Meditation and mindfulness
• Medical intervention

While some of these treatments could be completed outside of a professional rehab center, medical intervention is considered to be the most beneficial and is only available under close medical supervision.

Professionally Supervised Detox and Rehabilitation Programs

There are a wide range of benefits to be gained by attending a professional detox and rehab center to get clean. For one thing, long-term success rates for those who seek professional addiction treatment are much higher, according to Addiction Journal and the Department of Behavioral Health and Intellectual disAbility Services. Here are some more advantages offered by professional drug rehab centers:

Professional Medical Staff

A quality addiction treatment facility will be staffed by a range of medically trained personnel, including psychiatrists, doctors, nurses, and experienced counselors. Professionals like these will be able to prescribe the the right medications, monitor and analyze progress, and recognize potentially dangerous withdrawal symptoms early on.

With medical professionals to monitor and supervise a patient's detox and recovery process, treatment plans can be made, adapted, and adjusted to match the individual's symptoms and progress.

Dual Diagnosis

Dual diagnosis is the practice of examining the mental, emotional, and social patterns of an individual to determine if any mental illness or disorders may be contributing to their addictive behaviors. More than half of all people with substance use disorder also suffer from other mental, emotional, or social conditions.

If a patient is suffering from co-occurring disorders along with addiction, their chances of recovery are much higher if they are treated for both the addiction and mental illness at the same time. A dual diagnosis will also affect away the patients experience and manage withdrawal symptoms during detox.

The Detox to Rehab Transition

Whether detox is performed with medical assistance or cold turkey, it is not the end of the recovery process. On average, only 15% of individuals who complete detox alone stay clean, while 45% or more of those who complete full rehabilitation programs achieve long-term sobriety.

The reason for this is that detox only eradicates the physical addiction, but substance or alcohol use disorder is much more than a physical condition. Once detox is over, it is imperative to also address the psychological side of addiction and prepare the mind and body for the challenges of a newly sober lifestyle. That is where rehab comes in.

In a full-service drug rehabilitation center, the patient will be slowly transitioned into rehab treatments as the symptoms of withdrawal begin to abate. Day by day, the patient will be given more activities and therapy sessions until, by the time withdrawal is over, they are immersed in a full-time rehab treatment schedule.

For a better chance at success, it is recommended that a recovering addict enter a rigorous alcohol or drug treatment program during or immediately after detox, which is why completing the entire process at a residential care facility is ideal.

What Makes Medical Intervention More Effective?

If recovering from addiction were easy, medical detox wouldn't exist. The fact is, drug and alcohol withdrawal is so painful, difficult, and dangerous that many addicts who attempt it cannot finish successfully on their own. Medically assisted treatment is a way to make the harrowing process safer and more bearable for a higher chance of success.

Medical intervention during drug or alcohol detox can soother the severity of withdrawal symptoms, prevent some dangerous withdrawal conditions like delirium tremens, and reduce cravings, among other things. Dosages and side effects vary from one patient to another however, so it is important to always perform medical detox under the recommendation and supervision of a medical doctor. Below we'll go over some of the different prescriptions that are used to treat withdrawal symptoms.

Medical Detox for Opioid Withdrawal

Since opioid relapse presents the highest risk of overdose, it is especially important to reduce cravings and prevent relapse during opioid withdrawal. For this reason, Opioid Replacement Therapy (ORT) is the most popular form of medically assisted treatment during opioid detox. The medications used in ORT are especially effective in preventing the painful symptoms from becoming severe and reducing the intense cravings associated with opioid withdrawal.

1. Methadone

For decades, methadone has been used to facilitate the opioid detox process because it is useful for alleviating the agonizing symptoms of opioid withdrawal. Since methadone deceives the brain into thinking it is still receiving opioids, full withdrawal symptoms do not kick in as the brain rids itself of its dependence to opioids.

Another benefit of methadone is that it blocks opioid receptors in the brain and prevents patients from gaining any pleasurable high from the use of opioids. This reduces cravings as well. The downside to methadone is that it can be habit-forming and should only be taken under direct supervision. The two brands that produce methadone are:

• Methadose
• Dolophine

2. Buprenorphine

Buprenorphine performs the same functions as methadone but with a slightly milder effect. Because it is not as potent, buprenorphine is not as addictive as its stronger counterpart. Despite this, the medication appears to work equally well in staving off most opioid withdrawal symptoms and cravings during detox, while also presenting less risk of abuse or overdose. There are several different ways to take buprenorphine:

• Sublocade - a monthly injection that could be more useful for outpatient or home use.
• Probuphine - a tiny implant that slowly releases buprenorphine into the body over a six-month period. May be suitable for severe, long-term addicts.
• Subutex - a dissolving sublingual tablet of buprenorphine that has effect for one to two days.
• Suboxone - this blend of buprenorphine and naltrexone can prevent any opiates from causing feelings of euphoria, helping to prevent abuse and relapse due to its disagreeable effects when combined with opiates.

3. Naltrexone

Also used to treat alcohol withdrawal, naltrexone functions equally as well for opioid addicts. The substance binds to opioid receptors and completely blocks the release of happy chemicals in response to opioid use. After a short time taking the medication, the brain will stop associating opioids with pleasure, effectively putting an end to addictive behaviors and cravings. The two brands of naltrexone are:

• Vivitrol - An injection of naltrexone that remains in the bloodstream for several weeks. This choice might assist in long-term recovery efforts.
• Revia - An oral form of naltrexone that is taken daily to address cravings and nullify the effects of opioids on the brain.

Medical Detox for Alcohol Withdrawal

During alcohol withdrawal, medical detox will serve several important objectives; to reduce cravings, to decrease alcohol's pleasurable effects, and to prevent some of the worst withdrawal symptoms from becoming too severe or dangerous:

1. Acamprosate

This mild sedative has a balancing effect on the alcohol-ravaged brain, especially for patients who have long histories of alcohol abuse. Acamprosate counteracts some of the chemical effects that alcohol has on the brain and reduces cravings. Campral is the only known brand name of the medication acamprosate.

2. Naltrexone

Used for both opioid and alcohol withdrawal, naltrexone is gaining great popularity in addiction treatment because of its surprising ability to completely neutralize the effect alcohol has on the brain. By removing the euphoria and pleasure associated with alcohol, naltrexone takes away its addictive power and pacifies cravings. If taken correctly, the medication also greatly reduces the chances of relapse.

3. Disulfiram

Disulfiram is designed to create a negative association with alcohol, in order to decrease cravings and addictive patterns. If a patient drinks alcohol while taking disulfiram, they will soon be afflicted with a range of severe side effects similar to those suffered from a bad hangover - headaches, nausea, vomiting, and weakness. The experience is unpleasant enough that the brain will soon begin to associate alcohol with getting sick and will cease to crave it so badly. The brand name of disulfiram is Antabuse.

4. Benzodiazepines (Benzos)

Benzodiazepines include several types of anti-anxiety medications that be used to treat a variety of withdrawal symptoms. In cases of severe alcohol withdrawal that brings on seizures or delirium tremens, benzos may prevent the symptoms from becoming fatal. Since these medications can also be addictive if abused, they should only be used when needed and under medical supervision. Ideally, benzos would only be used during the worst period of alcohol detox and tapered off quickly as withdrawal symptoms diminish. These are the most common types used during alcohol detox:

• Valium - useful for treating severe withdrawal symptoms like delirium, hallucinations, tremors, and emotional distress.
• Ativan - generally utilized for extreme cases, Ativan suppressed the Central Nervous System (CNS) and can treat severe symptoms of alcohol withdrawal. It may also be used for patients with liver disease.
• Librium - reduces anxiety, headaches, and other painful symptoms in a slow-release format.
• Restoril - helpful in cases with withdrawal-related insomnia.
• Xanax - an effective treatment for insomnia, anxiety, headaches, and nausea in low doses.
• Klonopin - may be the best option to calm or prevent convulsions and seizures.

Medical Detox for Stimulant Withdrawal

Unlike opioid and alcohol addiction prescriptions, no medications have been approved by the FDA to be used specifically for use during stimulant withdrawal. However, there are several solutions that doctors implement to facilitate the detox process for those in recovery from stimulant addiction. By treating some of the specific symptoms of stimulant withdrawal, medical personnel can make the process more bearable. These are some of the medications that can be helpful during stimulant withdrawal:

• Sleep aids - to alleviate insomnia and exhaustion.
• Benzos or sedatives - for those who suffer from anxiety, agitation, paranoia, and mood swings during detox.
• Mild stimulants - a mild stimulant such as modafinil can help addicts with severe "come downs" and unstable, agitated behavior.
• Antidepressants - for cases of serious depression, apathy, anger, or suicidal thoughts.
• Pain relievers - non-narcotic pain relievers for aches, pains, and headaches.

Why Is Medical Intervention Controversial?

Medically assisted treatment has garnered some criticism in the mental health industry because of claims that the practice "replaces one drug for another". Although this is technically true, it is not necessarily a bad thing.

First, it is important to recognize that many of the medications used in medical detox, such as methadone, sleep aids, and benzos, can be addictive. This is the reason that some medical professionals disregard their use as harmful. The fact is, for many recovering addicts, these prescriptions are the difference between success and failure. On average, those that use ORT during drug rehab are 66% more likely to complete treatment and stay sober than those who participate in non-medicated drug treatment, according to a systematic review by the Cochrane Library.

With numbers like that, it's hard to argue with the fact that medically assisted treatment is effective in helping people achieve sobriety. The potential risk of forming a new addiction is not to be discounted, however. Currently, prescriptions of methadone, benzos, and similar medications are only distributed in highly controlled environments and monitored closely. Research on less addictive solutions like Suboxone are also underway.

In full-service drug and alcohol rehab centers where medical detox is part of the program, recovering addicts are able to complete the difficult processes of detox and rehab in a more comfortable and results-driven environment, but doctors are aware of the risks. The goal in most medical detox and ORT treatment plans is to taper off the medications as soon as withdrawal symptoms begin to ebb, with the end goal being that the vast majority of patients are free and clean of any medication dependencies before their release date.

The great exception to this rule are those individuals who suffer from co-occurring mental illness and substance use disorder. For some dual-diagnoses, patients will need to continue taking psychiatric medications to manage their mental illness indefinitely in order to successfully manage their addiction.

Outpatient Medical Detox

Many recovering addicts wish to complete the detox stage "in the comfort of their own homes", but going through withdrawal at home - especially medically assisted withdrawal - is far from comfortable and not recommended for several significant reasons:

• The rate of completing detox successfully is lower when performed at home.
• Successful addiction recovery rates are higher for patients who transition into drug or alcohol rehab during or immediately after detox.
• Without medical personnel present, it will be more difficult to monitor the patient's withdrawal symptoms and adjust dosage levels as needed.
• Abusing the medical detox prescriptions is much more likely without supervision.
• The risk of suicide or self harm is higher during home detox.
• The risk of relapse and overdose is significantly higher at home.

There are some addiction specialists and drug or alcohol addiction treatment centers that do offer medically assisted treatment as an outpatient program, however. If a patient is determined to complete detox at home, it is technically possible, but certain precautions would be necessary for the safety of the patient. For example, some doctors offer monthly injections or similar solutions that have a lower chance of creating addiction or abuse.

For anyone who plans to attempt medical detox at home, the following precautions should be taken for a higher chance of success and to lower potential risks:

• Go in for full a full physical and psychiatric examination to ensure that your mind and body are healthy enough to undergo detox without close supervision.
• Make sure a doctor with experience in medically assisted addiction treatment gives their approval before attempting home detox. All prescriptions and treatment plans should be recommended by an experienced physician.
• Follow the treatment plan and medication dosage recommendations to the letter.Never change dosages or medicationswithout specific instructions from a doctor.
• Stay in touch with medical personnel throughout the process and inform them immediately of any sudden or distressing changes in side effects or symptoms.
• Don't do it alone! Ask your closest (and sober) relatives and/or friends to stay with you throughout the entire process to make sure you're safe, hydrated, and fed. They should also be prepared to call for emergency medical attention at a moment's notice.  
• Do a thorough house cleaning to remove all triggers and temptations from the residence, such as drugs, alcohol, narcotic medications, paraphernalia, or even people who may not be conducive to your recovery plan.

The Next Step: Rehab

If you've read this far, it's safe to assume that you or someone you love may be suffering from drug or alcohol use disorder. Perhaps you've tried different types of treatment but so far, nothing has worked out long term. Medical detox is a viable option for even the most severe addictions, but it is not an end-all solution.

It is important to keep in mind that substance use disorder is a disease without a cure. It will never go away and it will always affect how you live your life. For the best chances of staying sober for the long-term, it is imperative to complete a rehabilitation program as well as detox, ideally during or immediately after the withdrawal period ends. This is because medical detox only addresses the immediate physical side of addiction, but not the deeper psychological addiction that lies beneath.

In order to address the psychological side of addiction, it is necessary to explore the causes of your addiction, the triggers and patterns that exacerbate it, and how to cope with the daily triggers and cravings you will encounter in everyday life. This is accomplished through counseling, therapeutic activities, and a range of rehabilitative treatments; in other words - drug or alcohol rehab. At an alcohol or drug rehab facility, you will undergo some combination of the following treatments:

• Contingency management
• Dialectical behavior therapy
• Educational classes
• Neurofeedback therapy
• Family therapy
• Cognitive behavioral therapy
• One-on-one counseling
• Gender-specific process groups
• Community assimilation outings
• Strength-based therapy
• Balanced diets and vitamin replenishment
• Exercise and movement therapies
• Massage therapy
• Mindfulness and meditation
• Art therapy
• Acupuncture
• Hipnosis
• Yoga
• Bibliotherapy

Along with a dual-diagnosis examination and continued medical intervention (if necessary), treatments like those listed above will transform your attitude and approach towards addiction, giving you the tools and insight you need to fight the daily battle that is recovery. Considering that this is a lifelong journey; it makes sense that getting started requires hard work, dedication, and the right set of tools.

What Kind of Drug or Alcohol Rehab Is Right for You?

Different types of alcohol and drug rehabilitation centers are available at different levels of intensity. The right option for you will depend on the severity of your addiction, your current health status, and your lifestyle. These are some of the most popular options:

• Residential care: Also known as inpatient addiction treatment, residential care provides full living accommodations and a full-time treatment schedule for a standard duration of 28 days. This option is generally considered the most successful since it completely removes the individual from their usual environment.
• Intensive Outpatient: A step-down from residential care, intensive outpatient treatment allows the patients to live and sleep at home while maintaining a heavy schedule of 12 hours per week or more of addiction therapy.
• Outpatient: The least time-intensive option, outpatient treatment works well for individuals with a steady job or a busy family life. In this scenario, the patient attends several hours of addiction therapy per week while continuing to uphold their normal commitments.