Why use a Detox Facility?
I’ve had clients ask me this question many times during my 30 plus years as an addiction counselor. There are various conditions that can create medical crises for individuals withdrawing from substances. Detox facilities have a staff of professionals trained to clinically assess a person for any potential medical conditions such as pneumonia and other infections, ongoing high blood pressure, ongoing abdominal pain, dehydration, nutritional deficiencies, and severe headaches as these are all conditions a person can experience during the period of withdrawal from substances. For example, severe dehydration has the potential to escalate body temperature and can be mistaken for an infection. Both need to be evaluated by the physician. For those who have long term substance abuse, their nutrition will often have been neglected, so as well as dealing with severe nausea, they require professional advice on how and what to eat in the early days of withdrawal. I remember one client who complained, “Withdrawal is like having the worst case of the flu you have ever had. You think you’re going to die, but you’re not.” This client had abused heroin for years, but such symptoms are also consistent with other substances such as alcohol withdrawal, just with perhaps a lower degree of pain. The pain a person experiences is a sign the human body is attempting to detox itself and in doing so it creates certain symptoms in the process such as tremors, nausea that may include vomiting, anxiety and agitation, high blood pressure and high heart rate, insomnia, and perspiring profusely. The staff at the detox facility is constantly assessing these signs and symptoms, monitoring vital signs and level of withdrawal, providing physician ordered medication and working with the client through the high anxiety or mood swings of withdrawal. Physicians may prescribe medication to be given if the anxiety or agitation is becoming unmanageable. Sometimes no medication is needed! If a client is capable of accepting redirection, staff may try moving them to a quiet room and teaching them relaxation or breathing exercises. There are times when they may just walk with a person on the unit and talk quietly – guiding them away from any loud sounds, bright lights, closing curtains, dimming lights, and providing emotional support based on the medical issues present and the level of anxiety and fear that the client expresses. Just the emotional support itself may decrease the need for medication. Their ability to deal with the symptoms of withdrawal is highly individual and is dependent on the coping skills of the person, as well as the level of withdrawal. For those clients who are attempting sobriety for a first time, I believe more emotional support is required. The biggest concern is for seizures, particularly when withdrawing from alcohol (one of the most dangerous substances). The greatest potential for seizure and DT’s (delirium tremens) is in the first 48 hours. Delirium tremens is a state of confusion, that can be accompanied by hallucination and seizures. Auditory hallucinations can be whispers, someone talking in the same room, or other false perceptions of sound. Visual hallucinations have been described as shadows or seeing deceased or not present family members. Seizures are pretty frightening for anyone who hasn’t experienced or witnessed them before. They can last for seconds or up to five minutes. It involves the full body, sudden unconsciousness, and all muscles contracting and relaxing rapidly. The longer it lasts the more dangerous it becomes, and the person may require hospitalization. The detox staff’s goal is to prevent any of these symptoms from occurring. The likelihood of either depends on the level of intoxication present when the person comes for admission. Their level of intoxication is typically measured using a breathalyzer. Initial assessments include time of last drink, if there is any history of seizures or delirium tremens and medical history along with an assessment of vital signs (extremely high blood pressure is a frequent finding). In the first 12 hours assessments are done every 4 hours or more frequently based on the nursing staff’s judgement. In the next 24 hours, the assessments may decrease, however if they do not seem to be decreasing, the physician is asked to reassess their medical needs. By 48 hours, the client’s condition has usually improved dramatically. Detox is the first big step on the road to recovery.