smoking and maintain their abstinence.* 28
Alcohol and Other Drugs. Some patients with
addiction involving alcohol and other drugs can
reduce and ultimately cease substance use
without medical supervision, particularly if they
are not physically dependent† on the substances
involved, the disease is not advanced and they
have sufficient personal supports to help them
through the cessation process.
Detoxification ..............................................................................................................
For patients who demonstrate physical
dependence on a substance, cessation of use on
their own may be unsafe and medically
supervised detoxification may be required to
manage withdrawal symptoms and
complications.^29
Detoxification occurs when toxic substances that
come from the ingestion of alcohol or other
drugs are removed from the body via
metabolism through the liver and excretion
through the kidneys.^30 Medically-assisted
detoxification aims to reduce the risk of
discomfort and potential physical harm for
patients who are experiencing withdrawal.^31
The detoxification process often requires the
assistance of medical professionals and may
involve the use of pharmaceutical therapies to
guide people safely through withdrawal.
Medical professionals may collaborate with
supportive, non-medical personnel or with
medical personnel in other health facilities to
facilitate the withdrawal process.^32
Detoxification is an important and often
necessary prerequisite to effective acute
addiction treatment.^33 It should serve as the
catalyst for entry into the treatment system but
does not itself constitute treatment.^34
There are three main components to effective
detoxification:
- These medications are described in more detail later
in the chapter.
† Physical dependence is characterized by symptoms
of tolerance and/or withdrawal (see Chapter II).
- Evaluation. Examine the patient and
determine if symptoms are acutely present--
ideally using standardized instruments to
measure the severity of withdrawal‡ 35 --and
documenting vital signs and other physical
manifestations of withdrawal. Assess for
the presence of co-occurring medical and
mental health conditions and determine,
through the use of drug testing, which
substances are present in the person’s body
or were used recently.^36 - Stabilization. Assist patients through
withdrawal to re-establish a state of
physiological stability with or without the
use of medications.^37 - Facilitation of Treatment Entry. Provide or
connect patients to addiction treatment and a
continuing care plan.^38
Alcohol Detoxification. In alcohol
detoxification services, the cessation of alcohol
ingestion in an alcohol-tolerant individual is
coupled with certain medications to help prevent
the dangerous effects that may accompany
alcohol withdrawal. Withdrawal from alcohol
typically takes up to seven to 10 days, but with
medical management, stabilization can be
achieved sooner.§ 39 During the first six to 48
hours of withdrawal from alcohol, symptoms
may include anxiety, nausea, agitation and
difficulty concentrating.^40 More severe
symptoms can include hallucinations and
seizures.^41 Alcohol withdrawal delirium, also
known as delirium tremens (DTs), is the most
severe and dangerous withdrawal symptom and
usually appears two to four days after the last
drink.^42 Some symptoms of alcohol withdrawal,
including DTs and seizures, can be life-‡ These include the Clinical Institute Withdrawal
Assessment–Alcohol Revised (CIWA-Ar), the
Clinical Opiate Withdrawal Scale (COWS) and the
Finnegan Neonatal Abstinence Score.
§ The duration of detoxification varies with the
severity of addiction and some withdrawal
symptoms, such as sleep disturbances, may persist for
several weeks.