My article was titled "Management of Drug and Alcohol Withdrawal". It was a broad overview of the different treatments and their effectiveness for the three different classes of drugs: sedatives, opioids, and stimulants. In my mentorship, I get to witness the process of withdrawals from many drugs, and I have to wonder if people knew how painful withdrawals are, would they even take the drug in the first place? I have decided to do my mentorship project on withdrawing from substances, and this article was a good starting place for that.
Before treating any type of withdrawal, a history should be taken from the patient, including the time of their last use and a toxicologic screening to determine if any other substances are have been taken. The initial symptoms for withdrawal from all three classes of drugs are the same, and include dysphoria(dysphoria, nausea, insomnia, tachycardia, and hypertension. But there are different complications to withdrawal for the different drug classes, so treatment differs among them.
Sedatives consist of alcohol or benzodiazepines (ex: Xanax, Valium). Benzos are meant to treat anxiety, and alcohol achieves the same effect, but both can be abused and are addictive. The difference in withdrawals between the two is that withdrawal from alcohol is much more dangerous than withdrawal from benzos. Alcohol withdrawal can be complicated by seizures and delirium, so it is best to undergo withdrawals supervised by an experienced doctor. The symptoms for alcohol withdrawal are monitored with the Clinical Institute Withdrawal Assessment(CIWA), and high scores indicate the need for medication. In studies, it has been found that benzos are the best treatment for alcohol withdrawal, starting at a higher dose and tapering off dosages as symptoms decrease. The main problem with treating with benzos is that they obviously are addictive, too, and using them must be monitored.
Withdrawal from benzos produces more autonomic nervous system signs, but the symptoms aren't as dangerous as alcohol withdrawal. To treat withdrawal from benzos, the dosage of the drug being abused must be either tapered or replaced with a longer acting benzo.
Opioids are drugs like Heroin, Morpine, or Lortab that are meant as pain killers, but are very addictive, and withdrawing from them is a very painful and dangerous process. It is similar to a severe case of influenza. If a person chooses withdraw in an inpatient facility, they will most likely be treated with opioid medications like methadone or buprenorphine, and the dosages of these drugs will be tapered over a period of several days. If a patient is withdrawing in an outpatient setting, they will be administered nonopioid medications, like clonidine or lofexidine. It was found in studies that the optimum treatment for outpatient treatment of withdrawals was buprenorphine combined with clonidine or lofexidine. There are also rapid and ultra-rapid detoxification methods of withdrawing from opiates. The most effective rapid withdrawal treatment was a combination of buprenorphine, clonidine, and naltrexone. The withdrawal takes place in three days, but is very costly. Even more costly is the ultra-rapid detox, which requires the patient to undergo anesthesia. They are then given naloxone, which causes the acute withdrawal symptoms to occur. The opioid will be out of their system in 24 hours, but the withdrawal symptoms will most likely persist.
Stimulants like cocaine or amphetamines increase alertness, energy, and attention. They stimulate your body, so withdrawal will do the opposite. Symptoms of withdrawals from stimulants include symptoms normally seen in patients with depressive disorders. Unfortunately, no one treatment has been deemed effective in reducing the symptoms of stimulant withdrawals, although some studies have shown certain drugs work for specific types of withdrawals.
It is also important to note that substance-dependent patients typically have other health problems, albeit medical or behavioral, so it is important to screen them for nicotine dependency, HIV, liver disease, appropriate immunizations, and abuse, among other things.
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