How many people are getting treatment for substance abuse? The Substance Abuse and Mental Health Services Administration (SAMHSA) reports that in 2013, 24.6 million Americans aged 12 and older were current drug users and 136.9 million Americans used alcohol. Of them, 22.7 million people needed treatment for a drug or alcohol problem, but only 2.5 million people received treatment at a specialty facility.
Why don’t people get treatment?
SAMHSA surveyed people who felt they needed treatment for substance abuse and made an effort to get treatment, but wound up not receiving treatment. They asked about the reasons for not receiving treatment and found that:
- 3 percent said that they had no health coverage and could not afford the costs of treatment
- 5 percent were not ready to stop using
- 9 percent did not know where to go to find treatment
- 2 percent had health coverage, but found it did not cover the costs of treatment
- 8 percent had no access to transportation to get to treatment or found that treatment was otherwise too inconvenient to manage
- 6 percent feared that seeking treatment would have a negative effect on their job
- 6 percent felt that they could handle their problem without treatment
- 5 percent did not feel that it was the right time for treatment
For people without health insurance, some clinics may offer sliding scale pricing based on one’s ability to pay. Withdrawal from certain types of drugs can be highly disruptive, unpleasant, or even life-threatening (see below), and endangering yourself by trying to withdraw from them on your own just isn’t worth it. Detox treatment is generally cheaper than a hospital bill.
For less disruptive drugs, detoxing at home has some apparent advantages:
- No inherent cost
- Comfortable and familiar surroundings
- Usual self-soothing mechanisms to distract from the unpleasantness of withdrawal, such as access to music collections or videogames
- Social support from family and friends
- Ability to continue day-to-day activities, like holding down a job or caring for children
- Greater freedom in activities
However, it also carries a number of serious drawbacks:
- Easy access to drugs to tempt relapse
- Familiar surroundings may include cues associated with drug use
- Drug-using friends may encourage drug use
- Stressful family, work, or home situations can hinder rather than help recovery
- No additional treatment for co-existing psychological problems that may be driving drug use
- No medical supervision in case of withdrawal-related medical emergency
- No access to medications that may ease withdrawal symptoms
- Severe withdrawal symptoms can disrupt work, costing wages and endangering employment
Research in Alcoholism: Clinical & Experimental Research found that among people with alcohol problems who were able to resolve their problem on their own, 57 percent of the people did so by reappraising the pros and cons of drinking, making a more realistic evaluation of the impact that alcohol had had on their lives. Spousal support was listed as the greatest reason why they were able to maintain abstinence from alcohol use.
In outpatient detox, patients live at home but come into the clinic for detox treatment during the day or evening. The intensity of treatment may range from a single intake session and a series of brief daily follow-up sessions to intensive outpatient treatment or day hospitalization, which can provide many hours of treatment each day. Outpatient detox treatment usually ranges from three to 14 days, according to an article in Alcohol Health & Research World.
Advantages of outpatient detox can include:
- Lower costs than inpatient treatment
- Familiar surroundings, healthy distractions, family, and friends
- Flexibility to schedule treatment around work or other activities
- Peer support from meeting others with similar struggles in group therapy
- Access to therapy to prevent relapse and to address any coexisting mental disorders
- Access to medications that can help ease withdrawal symptoms
Potential disadvantages include:
- Continued access to drugs and to friends who enable drug use
- Continued exposure to stresses at home, work, or with family
- No round-the-clock medical supervision in case of medical emergency
In-patient medical detox
In this highest level of treatment, patients receive 24-hour-a-day services from trained medical staff. Patients with the most severe medical needs can detoxify in an inpatient hospital setting, while patients with less severe symptoms can detoxify in residential, non-hospital housing. In addition to detoxification services, patients also receive intensive individual and group therapies to help them get to the root causes of their addictions as well as to treat any co-occurring disorders. These traditional therapies may be combined with dietary counseling, fitness training, recreational therapy, complementary therapies, and other treatments to bring patients back to full health and wellness. Alcohol Health & Research World reports that inpatient detox usually lasts from five to 14 days.
Advantages of inpatient detox can include:
- Highest level of care and therapy, accelerating treatment and recovery from addiction and any co-occurring mental disorders
- Structured day-to-day living to provide a context of stability for recovery
- Removal from access to drugs or from friends who encourage drug use
- Removal from stressful work, home, or family situations
- Support from meeting peers in group therapy who are going through a similar ordeal
- Access to medications that can ease withdrawal symptoms
- Round-the-clock medical supervision to keep patients stable and safe during withdrawal, as well as to address any other medical needs
Potential disadvantages of inpatient detox include:
- Higher costs
- Isolation from family and friends
- Little unscheduled time
- Lost wages or other work-related consequences
The danger of ultra-rapid detox
Some clinics may offer ultra-rapid detox, in which the patient is sedated under general anesthesia and given drugs to cause accelerated detoxification. Purportedly, this allows the patient to detox quickly and painlessly. However, research described by theNational Institute on Drug Abuse (NIDA) suggests that withdrawal symptoms are just as severe for such patients and that ultra-rapid detox poses no benefits. In fact, it may even pose additional risks, such as:
- Problems related to anesthesia, such as lingering cognitive slowness
- Accumulation of fluid in the lungs
- Metabolic complications of diabetes
- Worsening of any underlying bipolar disorder
- Increased risk of anesthesia-related adverse events in patients with a wide range of pre-existing conditions, including:
- Psychiatric conditions
- High blood sugar
- Insulin-dependent diabetes
- Past cases of pneumonia
- Heart disease
- Vomiting, which can cause a patient unconscious from anesthesia to choke and die
According to MedlinePlus, ultra-rapid detox has resulted in several deaths.
The dangers of detoxing
In general, the withdrawal symptoms of a drug will be the mirror of the effects of the drug, so people withdrawing from depressants may find themselves overstimulated, and people withdrawing from stimulants may experience depressed mood, thinking, and body functions.
The specific dangers of detoxing will depend on the severity of you addiction to the drug, and the nature of the drug itself.
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- Anxiety, irritability, or jumpiness
- Mood swings
- Vivid dreams or nightmares
- Shakiness or tremors
- Pale or clammy skin
- Clouded thinking
- Loss of appetite, nausea, or vomiting
- Rapid heart rate
- Enlarged pupils
Severe alcohol withdrawal, called delirium tremens, can be life-threatening. Its symptoms can include:
- Extreme confusion
These seizures can be fatal if not properly monitored by doctors. The administration of benzodiazepines can help ease withdrawal symptoms as well as prevent seizures. Inpatient medical care is also appropriate for patients who have alcohol-related health problems that need to be stabilized, such as disease of the pancreas or liver, or gastrointestinal bleeding.
However, most alcohol withdrawal is not nearly so severe. Alcohol Health & Research World reports that fewer than one in 10 of patients going through alcohol withdrawal will need inpatient medical supervision. Outpatient medical supervision is still advisable, to medicate and to monitor withdrawal symptoms as well as to treat any co-occurring mental health disorders.
- Intense cravings
- Runny nose
- Muscle aches
Later symptoms can include:
- Wide pupils
- Goosebumps and clammy skin (hence the term “cold turkey”)
- Nausea and vomiting
- Abdominal cramping and diarrhea
Because of the severity of opiate withdrawal symptoms, it is highly advisable to go through the process in an inpatient medical setting. Although the symptoms can be weathered on your own, this suffering is entirely unnecessary – a range of medications exist to treat opiate withdrawal. These include:
- Clonidine, which reduces agitation, anxiety, sweating, runny nose, muscle aches, and cramping
- Methadone, which can replace other opiates and can then be tapered off gradually
- Buprenorphine (Subutex), which can not only replace other opiates, but also shortens the length of detoxification, according to MedlinePlus
By seeking professional care, patients also gain access to drugs like naltrexone, which promote abstinence by blocking the pleasurable feelings caused by opiates. They can also receive therapy to promote abstinence from opiate use and to address any other co-occurring physical or mental health disorders that might have been driving opiate use.
- Muscle pains
- Loss of appetite
No medications are available to treat marijuana withdrawal, and there are no life-threatening symptoms, making do-it-yourself detox a viable option. However, people with a co-occurring mental health disorder will still benefit from medical treatment, and the structure of an inpatient program can help patients avoid seeking drugs and relapsing.
- Restlessness and anxiety
- Trembling or shaking
- Elevated body temperature
- Circulatory failure
Barbiturate withdrawal can be life-threatening, making it important to detox from barbiturates under inpatient medical supervision. To prevent withdrawal symptoms, doctors can prescribe a dosage of phenobarbital that gradually tapers down over a period of three days, described the article in the Canadian Medical Association Journal.
- Lack of pleasure
Over time, these symptoms can give way to longer-term symptoms that can last for months, according to MedlinePlus:
- Agitation and restlessness
- General feeling of malaise
- Increased appetite
- Unpleasant or vivid dreams
- Difficulty with motivation and activity
- Suicidal thoughts
Although withdrawal from cocaine is not life-threatening, the elevated risk of suicide makes it wise to undergo the process with some form of medical supervision. There also exists a risk of overdose from returning to cocaine use after tolerance has dropped, as well as a risk of using depressant drugs to self-medicate the symptoms of withdrawal, leading to a new addiction.
In addition, MedlinePlus reports that over half of people addicted to cocaine have a mental health condition, often depression and ADHD, which should also be treated by professionals. Treating these conditions drastically reduces relapse rates.
- Intense cravings
- Problems concentrating
- Tension, restlessness, or frustration
- Insomnia or drowsiness
- Nightmares or bad dreams
- Increased appetite
- Weight gain
Nicotine replacement therapy involves products like gum, inhalers, or skin patches containing low doses of nicotine but none of the carcinogens or toxins found in smoke. These come in variable doses and are available without a prescription, allowing patients to taper off on their own. Other medicines, such as bupropion (Wellbutrin), can be prescribed by doctors to help patients quit.
- Difficulty concentrating
- Tension, restlessness, or irritability
- Loss of appetite
- Aching muscles
- Sensory disturbances, like a metallic taste in the mouth, prickling sensations, or sensitivity to light or sound
To safely withdrawal from benzodiazepines, doctors can prescribe a tapering dose of the same benzodiazepine, gradually weaning the patient off the drug over six to eight weeks. The Canadian Medical Association Journal advises that this begin in an inpatient setting until symptoms are suppressed.
- Increased sleep
- Vivid, unpleasant dreams
- Increased appetite
- Loss of feelings of pleasure
- Poor concentration
- Slowness of movements
- Depressed mood
Although these feelings can be unpleasant, they are not life-threatening. As methamphetamine is highly addictive, NIDA recommends that recovering patients receive therapy from a professional. The structure of an inpatient program may also be helpful for most addicts. There are no proven medications to help the symptoms of methamphetamine withdrawal, although NIDA reports that some research supports the usefulness of bupropion (Wellbutrin) to reduce cravings.
Learn more about detoxification programs
If you’d like to learn more about the process of detoxifying from drugs or alcohol, you’ve come to the right place. We can walk you through our progressive treatment plans and help you find the best level of treatment for you or your loved one. Call us today to learn more.