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What is Detox?
Detox usually refers to managing the withdrawal effects from a substance. The intention is to help the addict get of their drug. It is to make the addict as physically and comfortably as possible during the process of withdrawal.
In general, withdrawal syndromes are characterised by symptoms opposite to those of the main effects of the drug itself, occurring as a result of neuroadaptation which itself results from prolonged and regular exposure to the drug. Withdrawal syndromes of Central Nervous System (CNS) depressant drugs, e.g. alcohol, benzodiazepines, are potentially life-threatening with the exception of opiate withdrawal. Withdrawal syndromes from CNS stimulant drugs, e.g. cocaine, amphetamine, are not directly life-threatening, although the associated dysphoria (low mood) may acutely increase suicide risk.
The management of withdrawal essentially involves the amelioration of withdrawal symptoms by the prescription of appropriate medication - detoxification. However, if detoxification is to be successfully completed and abstinence maintained, the process must be planned and the patient psychologically prepared.
A ‘stand-alone’ detoxification will usually end in relapse to substance misuse, either before completion of the detoxification, or soon afterwards.
An aftercare plan aimed at preventing relapse should be formulated in advance of the detoxification and may include residential or community options.
Detoxification should be planned for in advance wherever possible. Urgent in-patient psychiatric admission may be indicated for the management of suicidal risk, or urgent in-patient medical admission for the management of medical complications; detoxification may then take place as a matter of course once the patient is already admitted.
However, if the primary goal is to achieve and maintain abstinence, then the process should be planned. This process can be enabled by referral to local specialist services.
Decisions will need to be made regarding the setting for the detox (community or in-patient detoxification), the agent to be used, adjunctive medication to be prescribed, and the necessary degree of monitoring during detoxification. In general, in-patient as opposed to community detoxification is indicated in the following circumstances:
- There is a past history of delirium tremens or fits during withdrawals.
- There is concurrent severe medical illness.
- There is concurrent severe psychiatric illness or suicide risk.
- The patient has cognitive deficits.
- The patient has insufficient social support available at home.
- There is a past history of failed community detoxification.
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