There are multiple ways to go through heroin detoxification. Depending on the user’s length and level of abuse, he may not even have to stay at a treatment center as he gets clean.
Other patients may require closer monitoring. When comparing an outpatient heroin detox program to an acute one, it’s important to consider the addict’s mental and physical well-being; this will help a doctor determine the best heroin treatment method of care to impart.
Addiction and Detox
A heroin addiction broadly manifests itself in two ways: the physical need to use heroin and the mental need to feel heroin’s effects. Helping a patient overcome the physical aspect of the addiction is achieved through a process known as detoxification.
Simply put, detoxification entails guiding a patient through a very structured and safe period of withdrawal, where they are denied heroin. Withdrawal is an obviously unpleasant experience, but detox is absolutely necessary for eventually controlling heroin abuse.
Withdrawal presents clear dangers to a weak and vulnerable patient, which is why detox should never be attempted without proper medical supervision. A doctor at a treatment center may feel that a patient needs to be observed overnight, or for a few days (or even longer), to ensure that the detox can be completed without significant harm. In other cases, a patient may not need anything more than a few hours of observation and a prescription.
Acute detoxification is defined as a form of treatment where a patient weans off the abused drug under a doctor’s supervision. The patient will have to be in inpatient status in order for this to happen. By definition, a stay of more than two consecutive days would qualify for “inpatient” status, a threshold that becomes very important when health insurance is factored into the cost of treatment.
One reason for a doctor’s supervision during acute detox is that he may see fit to prescribe medication to help the patient through the detox process. Drugs like Suboxone, while effective at weaning a patient off heroin, can be addictive in their own right; a patient trying to self-medicate while in a susceptible state is not in a position to judiciously administer even beneficial drugs. A doctor, on the other hand, has the benefit of experience and clarity with which to choose medications that can help the patient through detox, and the knowledge of when to taper off those medications, to prevent the patient developing an addiction to the detox drugs.
Acute Detox Medications
Some of the most commonly used drugs to help addicts through heroin detox include:
- Chlordiazepoxide (Librium)
- Diazepam (Valium)
- Lorazepam (Ativan)
- Oxazepam (Serax)
Drugs like chlordiazepoxide and diazepam are anti-anxiety medications, which are useful for keeping patients calm and relaxed during the process.
Symptoms of Acute Detox
For patients whose heroin abuse has been chronic or extreme, the services offered by an acute detox program could be the difference between life and death. One of the symptoms of withdrawal from heroin, or other similar opioids, is the user experiencing suicidal thoughts or ideas. The National Institute on Drug Abuse explains that suicidal ideation may be found in opioid abusers even without withdrawal. Major depression also accompanies withdrawal, so it is vital that the patient not be left alone at a time when the patient is going through very difficult periods of mental and physical distress. Acute heroin detox programs provide counselors and therapists on hand, who can offer precise support and encouragement to addicts who are struggling with the transition.
A controversial method of detox, known as “rapid detoxification,” is carried out while patients are under general anesthesia. As USA Today explains, patients effectively “sleep through their withdrawal.” Doctors give the patients injections of medications known as opiate blockers, which put a hard stop on the effects of the heroin in their system, while also administering other drugs, like anti-anxiety medications or muscle relaxants, to help with the withdrawal. This causes rapid withdrawal from the physical effects of heroin. From start to finish, the process can last from 4-8 hours; discharge from the program can be completed 48 hours after recovery from the anesthesia.
Rapid detoxification is a dangerous method, so it is only used for patients who are at risk for their withdrawal symptoms endangering their lives. It may also be employed for patients who do not respond to conventional detox programs.
The ultra-rapid detoxification can is a complete detox in under an hour, but it is very dangerous. The National Institute on Drug Abuse reported on a study from 2006 that found “three serious adverse events” from a patient population of 35. The study concluded that using general anesthesia to sedate patients during withdrawal provided no benefit to treatment, specifically saying that no evidence was found to support claims that rapid detoxification was a “fast and painless method” by which a heroin addiction could be controlled.
Outpatient detox is for patients who have not been addicted to heroin for very long or who abused it in small amounts. For such users, they are likely to have withdrawal symptoms that range from the mild to moderate, enough that they can merely collect their medication from a treatment center and go home.
This offers patients the comfort of enduring the still-uncomfortable symptoms of withdrawal privately if a doctor feels they can do so safely. There is little chance of an impulsive relapse, meaning that the patient’s environment and home situation need to pass an assessment before outpatient detox can be approved. Day-to-day activities, such as school and work, can continue with minimal interruption, opposed to acute detox.
The freedom of an outpatient detox program comes with the responsibility of the patient having a large stake in his own recovery. The Fix explains that visits to the treatment center (for medication replenishment, observation, and tests) have to be regular; for that reason, the visits themselves can be quite lengthy, lasting hours at a time.
Outpatient vs. Acute Treatment Program
While outpatient detox has its benefits, an acute treatment program is the better choice for many.
Patients who stay at a treatment center until their detox is complete are offered protection and distance from the stresses and challenges in daily life that may cue a relapse. Acute programs provide safe, restful places where job frustrations, money problems, and relationship difficulties cannot penetrate. Such a place may be the perfect environment to aid a patient in his recovery.
Additionally, an acute detox program lets the user build relationships with other people who are relearning a newer and healthier way of living. Knowing that there are other people who understand the frustration and fear of leaving heroin behind is a huge boost and motivator when the line between abstinence and relapse seems thin. The connections forged in an acute setting can last for a lifetime.
Therapy After Detox
Regardless of the merits of acute heroin detox versus outpatient heroin detox, neither approach will be very successful without the presence of counseling following the actual detox process. As mentioned earlier, a heroin addiction devastates both the mind and the body. Detox addresses the damage done to the body; counseling addresses the mind.
For an addict in an outpatient detox program, one of the conditions of the freedom of movement is that they have to attend regular counseling sessions. Even though the abuse of heroin was not severe enough to warrant acute treatment, the initial use of heroin suggests that they are still psychologically susceptible to using again. Patients in an outpatient program will learn much the same thing from therapy, which is why it is imperative that everyone who goes through any kind of detox follows it up with counseling. Any detox program, inpatient or outpatient, is incomplete without counseling.
A user going through an inpatient heroin detox program will have a natural transition to counseling, which would be made part of the overall treatment plan. The patient’s acute status implies that they are in great need of therapy, as the heroin would have had to have wreaked a considerable amount of damage for the user to need multiple consecutive days of treatment. In therapy, the patient will gain a deep understanding of the reasons the user turned to heroin, and how they can apply that understanding to learn how to say no, think positively and live clean.
The point is echoed by an August 2014 study published in the Journal of the American Medical Association. Researchers found that opioid-dependent patients who were hospitalized did not use drugs in the first month after they were discharged; similarly, patients in an outpatient treatment group used drugs less than they did before, for up to six months following the conclusion of their treatment. The study concluded that treatment for heroin addiction was most effective if it incorporated both acute and outpatient treatment.
Addiction does not come with a simple on/off switch. It is a complex spectrum, one on which people from all walks of life can find themselves at any number of points. Wherever you are, or however you came to the point where you need help for heroin abuse, The Recovery Village wants you to know that they can help. If you have questions about getting treatment for yourself or a loved one, and whether this treatment involves a period of stay at a facility, or whether an outpatient program can be arranged, they have answers.
Medical Disclaimer: The Recovery Village aims to improve the quality of life for people struggling with a substance use or mental health disorder with fact-based content about the nature of behavioral health conditions, treatment options and their related outcomes. We publish material that is researched, cited, edited and reviewed by licensed medical professionals. The information we provide is not intended to be a substitute for professional medical advice, diagnosis or treatment. It should not be used in place of the advice of your physician or other qualified healthcare provider.