Eric Patterson, MSCP, NCC, LPC
Eric Patterson, MSCP, NCC, LPC, is a professional counselor who has been working for over a decade to help children, adolescents, and adults in western Pennsylvania reach their goals and improve their well-being. Along the way, Eric worked as a collaborating investigator for the field trials of the DSM-5 and completed an agreement to provide mental health treatment to underserved communities with the National Health Service Corp.
Recent contributions of Eric Patterson, MSCP, NCC, LPC
When you struggle with addiction, both making the commitment to stop using and admitting that you might need help to do so are two of the more important decisions you can make. However, you need to make an informed decision when you do so, taking into account the risks involved. Some substances are not associated with any severe withdrawal symptoms, but quitting others, such as alcohol, may result in serious and, in some cases, life-threatening complications when left unmanaged. One of the more significant complications of alcohol withdrawal is a condition called delirium tremens, or DTs. Even though it is potentially very serious, it can be managed well in professional medical detox settings with trained staff. No matter your situation, recovery is achievable. What Is Delirium Tremens (DTs)? Delirium tremens is one of the most severe consequences of alcohol withdrawal.1 Delirium tremens (DTs) represents a collection of many possible symptoms affecting the person’s mental health and mental state.1 For a person to receive a diagnosis for DTs, they must be experiencing both alcohol withdrawal and delirium, which is an acute, fluctuating change in normal attention and cognition.2 Separately, either one of these conditions may introduce setbacks to early recovery, but when combined, their potential negative impact increases. Other issues like head injury, infection, and illness might additionally increase the likelihood of DTs in individuals with a history of significant alcohol abuse.1 Typically, the term "delirium tremens" refers specifically to alcohol withdrawal delirium, though withdrawal from other drugs (e.g., benzodiazepines and other sedatives) may also be associated with delirium. What Causes Delirium Tremens? Understanding delirium tremens requires understanding the effect of alcohol on the brain. With steady drinking over time, the brain adapts to the presence of alcohol in the system by adjusting the activity of certain brain chemicals.3 In this manner, when the brain balances itself to the point that the person is no longer well without alcohol, such an individual is said to have developed physical dependence. After significant levels of alcohol dependence develop, a person must drink simply for their body to maintain "normal" operations, or homeostasis. When they stop drinking, the brain’s new chemical balance set point is disrupted, which triggers the emergence of withdrawal symptoms.3 Delirium Tremens Risk Factors It might be impossible to forecast exactly who will experience DTs, but there are some risk factors, the biggest of which is heavy consumption of alcohol for extended periods of time.1 People who have been heavily drinking for more than 10 years are at greater risk of DTs, but symptoms may even occur after a few months of regular binge drinking.1 Other factors linked to higher rates of alcohol-related DTs are:2 Recent withdrawal seizures. Previous symptoms of delirium during withdrawal. Advanced age. Recent use of other depressant drugs, including sedatives and opioids. Electrolyte issues, including low levels of magnesium and potassium. Low platelet counts. Respiratory conditions. Preexisting or worsening cardiac problems, especially high blood pressure and higher pulse during withdrawal. Gastrointestinal disease. Symptoms of Delirium Tremens As mentioned, DTs are marked by both a delirium and other symptoms common to the acute alcohol withdrawal syndrome. The most common symptoms of someone suffering from delirium tremens are:1 Delirium – rapid onset of severe confusion Cognitive problems Tremors Agitation Increased sensitivity to sounds, touch, and light Rapid mood shifts Unexpected bursts of energy, restlessness, and excitement Extreme fatigue and sleepiness Sleeping for extended periods, e.g., more than a day Hallucinations In the case of alcohol withdrawal, symptoms come about very quickly and represent a significant shift from a person’s normal level of functioning.4 It will be important to be sure there is no evidence of another neurological condition, such as an underlying dementia, capable of producing these symptoms.4 In some instances, isolated seizures may occur without the presence of the other symptoms above. Seizures are more common in people with previous complications experienced during alcohol withdrawal.1 The type of seizures most commonly associated with alcohol withdrawal are described as generalized tonic-clonic seizures (i.e., grand mal seizures).4 Addiction professionals may recognize the phenomenon of delirium tremens based on medical history and clinical observation alone; however, there are some tests and labs which support the diagnosis, such as:1 Blood chemistries (e.g., complete metabolic panel, serum magnesium, serum phosphorus) Toxicology screening Electrocardiogram (ECG) Electroencephalogram (EEG) The Dangers of Delirium Tremens Delirium tremens, while a risk in alcohol withdrawal, is rare, affecting approximately 3-5 percent of those hospitalized for alcohol withdrawal.2 What makes delirium tremens so serious? As many as 4 percent of people with the condition will die.2 This statistic is alarming. Particularly when you consider that it only takes into account those patients who received inpatient treatment for withdrawal delirium.2 It is possible that many more who do not receive proper treatment, such as at home, will suffer the ill effects of DTs as well. During DTs, people may endure:2 Hyperthermia – overheating of the body Irregular heart rhythms Problems related to seizure activity Worsening of preexisting medical conditions Because the confusion and irritability associated with delirium can be so great, someone experiencing DTs may be aggressive toward others during this time or may hurt themselves. This is another reason it's important to detox from alcohol in a safe environment under medical supervision.2 [self-assessment] How Common is Delirium Tremens? Alcohol use problems are quite prevalent throughout the world, with an estimated 20 percent of men and 10 percent of women in Western societies meeting the criteria for an alcohol use disorder at some point in their lives.2 About half of these people will experience some withdrawal symptoms when they try to stop or cut down their drinking.2 The majority of these people won't experience life-threatening symptoms and only about 5 percent of these people will experience seizures, delirium, or both.2 Estimates show that between 3 percent and 5 percent of people receiving inpatient care for alcohol withdrawal progress to a state of withdrawal delirium.2 Because very severe symptoms can arise unexpectedly, inpatient detox is the safest route for alcohol-dependent individuals who want to quit. While you are more likely to experience more common symptoms of alcohol withdrawal such as:1,4 Headache Fever Increased sweating Quickened heart rate Heart palpitations Nausea and vomiting Insomnia Anxiety Shakiness and feeling “jumpy” Mood swings Depression you should still take the possibility of experiencing delirium tremens seriously due to its dangerous characteristics. How Long do Delirium Tremens Last? Alcohol withdrawal follows a fairly predictable schedule, with symptoms beginning about eight hours after the blood alcohol content decreases in the body. Symptoms peak during day three and then gradually resolve after about a week of sobriety.2 However, the specific DTs timeline is a bit different. DTs often start approximately three days after last alcohol use.2 Delirium tremens can last anywhere from 1 to 8 days, but the average duration is 2-3 days.2 [vob-aktify-cta title="Does your insurance cover alcohol detox?" subtitle="Check your coverage online or text us your questions for more information"] How to Prevent Delirium Tremens Oftentimes, delirium tremens may result during the alcohol withdrawal process, and the focus is often on how to mitigate the symptoms. The best way to prevent delirium tremens is drink alcohol responsibly or not at all. The US Department of Agriculture and the Department of Health and Human Services advise in their dietary guidelines that those who do not drink should avoid starting.12 Generally speaking, delirium tremens is associated with higher rates of alcohol consumption, particularly in the weeks prior to initiating alcohol detox.6 Treatment for Delirium Tremens Those at risk of delirium tremens should seek withdrawal treatment in a medical setting, such as a hospital or inpatient medical detox center.6 Only these settings afford the acuity of care—including round-the-clock monitoring and interventions—needed to ensure safety and stability during the withdrawal process. Professionals in these settings will work to reduce symptoms, minimize complications, and prevent serious death or harm.1 These goals can be accomplished by frequently monitoring vital signs to track symptoms and progress through withdrawal, conducting lab work to identify possible risk factors, administering other medications orally and intravenously, like acamprosate or disulfiram, administering antipsychotic medications, like haloperidol, to mitigate agitation, aggression, and hallucinations, and offering supportive care in a quiet, non-stimulating environment.2 What to Expect During Treatment for Delirium Tremens The primary treatment at this stage of recovery will be the administration of benzodiazepines, usually intravenously, to reduce the severity of delirium-associated agitation and insomnia and to lower seizure risk.2,6 Using medications like diazepam or lorazepam, physicians will usually begin with a high dose before gradually lowering over time.6 This period of detoxification is hugely valuable for someone withdrawing from alcohol or other drugs, but continued substance abuse treatment (e.g., inpatient rehab, residential programs, or outpatient treatment settings) is often needed to best maintain sobriety and begin an extended period of recovery.11 By participating in therapy, medication management, and support groups, recovering alcoholics can:11 Begin to return their brain to previous levels of functioning. Lower ongoing withdrawal symptoms and cravings for more of the substance. Identify and understand the reasons for previous substance use. Increase motivation for recovery. Build coping skills to avoid relapse. Create a supportive network of sober individuals. Longer periods of treatment are linked to longer periods of recovery.11 Addiction may not be cured, but it can be managed. If you or someone you know is at risk of withdrawal delirium from any substance, seek emergency medical treatment. It truly is a matter of life or death. [accordion title="Rehab at American Addiction Centers"] Laguna Treatment Hospital Adcare - Boston Sunrise House Desert Hope Greenhouse Oxford Treatment Center Recovery First River Oaks [/accordion][accordion title="Rehab insurance coverage"] Ambetter American Family Beacon BHO Blue Cross Blue Shield Cigna Connecticare Geisinger HCSC Harvard Pilgrim Highmark Kaiser Permanente Magellan Magnacare Meritain Health Medicare and Medicaid Optum Oxford Health Providence Qualcare Sierra Health Tricare Triwest Tufts United Healthcare UPMC Zelis [/accordion][accordion title="Rehab near me"] Alabama Alaska Arizona Arkansas California Colorado Connecticut Delaware Florida Georgia Hawaii Idaho Illinois Indiana Iowa Kansas Kentucky Louisiana Maine Maryland Massachusetts Michigan Minnesota Mississippi Missouri Montana Nebraska Nevada New Hampshire New Jersey New Mexico New York North Carolina North Dakota Ohio Oklahoma Oregon Pennsylvania Rhode Island South Carolina South Dakota Tennessee Texas Utah Vermont Virginia Washington West Virginia Wisconsin Wyoming [/accordion][accordion title="Rehab"] Couples rehab Court ordered rehab COVID-19 and rehab Dual-diagnosis rehab Helping a loved one go to rehab Preparing for rehab State-funded rehab Teen rehab Veterans rehab [/accordion][accordion title="Detox"] 24/7 detox hotlines Outpatient detox The cost of detox [/accordion] [sources] U.S. National Library of Medicine: MedlinePlus. (2017). Delirium Tremens. Schuckit, M.A. (2014). Recognition and Management of Withdrawal Delirium (Delirium Tremens). New England Journal of Medicine, 371, 2109-2113. Medscape. (2017). Withdrawal Syndromes. American Psychiatric Association. (2013). Diagnostic and statistical manual of mental disorders (5th ed.). Arlington, VA: American Psychiatric Publishing. Medscape. (2017). Withdrawal Syndromes. Substance Abuse and Mental Health Services Administration. (2015). Detoxification and Substance Abuse Treatment. Medscape. (2017). Inhalants Clinical Presentation. Bosshart, H. (2011). Withdrawal-induced delirium associated with a benzodiazepine switch: a case report. Journal of Medical Case Reports, 5, 207. Sharma, R. C., Kumar, R., Sharma, D. D., & Kanwar, P. (2017). Opium Withdrawal Delirium: Two Case Reports. Psychopharmacology Bulletin, 47(1), 48–51. Raj, B. N., Manamohan, N., Hegde, D., Huded, C. B., & Pradeep, J. (2017). A Rare Case of Complicated Opioid Withdrawal in Delirium Without Convulsions. Indian Journal of Psychological Medicine, 39(2), 191–193. National Institute on Drug Abuse. (2018). Principles of Drug Addiction Treatment: A Research-Based Guide. U.S. Department of Agriculture. (2020, December). Dietary Guidelines for Americans 2020-2025. [/sources] ...Read more
Alcohol addiction is commonly accompanied by certain imbalances in the chemicals in the brain, changed behaviors, and obtrusive thoughts that center around getting and drinking more alcohol. For people who are ready to end their addiction, alcohol withdrawal treatment is used to help them get sober and to prevent them from drinking alcohol in the future. Successfully completing alcohol withdrawal through a professional detoxification program is a huge accomplishment, but it does not ensure sustained recovery. To boost the odds of long-term abstinence, many in the early stages of recovery will integrate the use of acamprosate to help restore normal brain function and prevent relapse. What is Acamprosate? Acamprosate is the generic name for a prescription medication recommended for people in recovery from alcohol dependence.1 Historically, the drug has also been marketed under the brand name Campral.2 The drug is normally administered via tablet, and can be taken up to three times a day depending on the size of the dose.1 Alcohol abuse, dependence, and addiction create numerous changes to the brain and the way it operates. Acamprosate helps reverse some of these changes and return more healthy, balanced functioning to the brain, potentially increasing a person's chance of maintaining abstinence and staying in recovery.3 What is Acamprosate Used for? To understand what acamprosate is used for, you first need to understand how alcohol impacts your body. Alcohol is carried through the bloodstream into the brain where it impacts certain key neurotransmitters in the brain.4 As steady use continues, the brain tries to adapt, producing some predictable results.4 Acute Alcohol Withdrawal Symptoms While withdrawal will differ with each person, a typical timeline may look like this:5 Withdrawal begins only hours after the last drink. Symptoms spike during day two. Symptoms improve after approximately 4-5 days. First, the person will develop a level of tolerance, so they will need to drink more alcohol more regularly to produce the expected effect.4 Second, they may eventually become dependent, needing a steady supply of alcohol to keep the neurotransmitters in balance.4 Without alcohol, the new equilibrium is disturbed, and serious withdrawal symptoms, such as the following, may arise.4,5 Rapid pulse Sweating Insomnia Nausea Vomiting Anxiety Hallucinations Hand tremors Seizures Delirium tremens Post-Acute Alcohol Withdrawal Symptoms Chronic alcohol use alters the brain in ways that can't be reversed over the course of a week. For many, recovery remains a challenge long after this period of acute alcohol withdrawal passes. When it is taken out of the equation, the brain has a chance to begin moving slowly back toward healthy functioning, but it can take months or years to find a new balance.5 During this slow transition, the recovering individual can experience protracted, or post-acute, withdrawal. This refers to symptoms that persist beyond the initial, expected withdrawal period. Potentially persisting symptoms might include:5,6 Anxiety Mood swings Irritability Hostility Insomnia Fatigue Problems thinking and concentrating [self-assessment] How Does Acamprosate Work? Acamprosate does not prevent or lessen the effects of acute withdrawal. Rather, it is used to manage the effects of protracted withdrawal.3 The exact way that acamprosate works in the brain is unclear. Most likely, it works to return some balance to neurotransmitter systems affected by alcohol abuse.1 By doing so, it reduces the occurrence or severity of protracted withdrawal syndromes, Reduces occurrence or severity of protracted withdrawal syndromes, and alleviates alcohol cravings.3 In this way, acamprosate helps lower relapse rates and extend the period of sobriety.1 Acamprosate reaches its full effectiveness after you have been using it for between 5 and 8 days. Though the safety and efficacy of acamprosate therapy have only been evaluated for up to one year, the length of time that any given person remains on acamprosate therapy should be determined on a case-by-case basis, with input from treatment providers and the patient alike. 7 Acamprosate Side Effects Acamprosate can have a handful of side effects, some common and some rare, some mild and some severe.10 If you experience any side effects when taking Acamprosate, it’s important to contact your doctor or treatment team. Some side effects of Acamprosate may include:10 Diarrhea. Intestinal cramps or flatulence. Headaches. Dizziness. Insomnia. Anxiety. Muscle weakness. Changes in one’s libido. Suicidal ideation. Who is Acamprosate for? Since acamprosate has a good safety profile, most people can use the drug without facing serious risks. The ideal candidate for acamprosate therapy is a person who has completed alcohol detox, is highly motivated to quit drinking completely, and is participating in treatment that incorporates psychosocial support.7 Other people who may benefit from acamprosate treatment include: People who have a history of opioid dependence or addiction. Unlike other medications for alcohol dependence like naltrexone, acamprosate does not affect the opioid systems in the body. This makes the medication a great choice for people who receive opioid maintenance treatment with drugs like methadone or buprenorphine, may use or relapse on opioids, or use opioid medications for pain. 7 People with complicated medical histories who are on many medications. Drug interactions with acamprosate are very rare.7 People with liver conditions. Alcohol is known to create serious problems with the liver when used long-term. Acamprosate is not processed in the liver like other medications, so it won't place additional stress on this vital organ.7 Who Should Avoid Acamprosate? Acamprosate treatment will not be appropriate for everyone.1 You should not take acamprosate if you:1,7 Have kidney problems. Since the drug is not processed in the liver, the kidneys work to excrete the substance, which may put extra strain on the organs.7 Are pregnant or breastfeeding. Studies show that animals administered the drug while pregnant were more likely to have still-born fetuses and babies with birth defects. It is not known whether acamprosate is transferred to the baby through the mother's breast milk. Cannot use the medication consistently. Taking a medication three times daily can be a difficult regimen for some people. The medication is only effective when taken as prescribed, so only those committed to taking it should use it. Are not an adult. Acamprosate has not been evaluated for safety in children or adolescents. Acamprosate has not been deemed safe for use among pregnant women. Studies have shown that medication can lead to birth abnormalities and stillbirth in animals. Acamprosate should only be prescribed to pregnant women when the potential benefits outweigh all the risks.1 Using Acamprosate for Alcohol Addiction Treatment Alcohol addiction is a complicated condition but one that can be managed with effective, professional addiction treatment approaches.2 Most effective approaches begin with a period of detoxification, with the goal of safely and comfortably guiding the individual through the acute withdrawal process.2 In cases of severe alcohol dependence, the acute withdrawal period is frequently managed within an inpatient detox setting that provides 24-hour monitoring, stabilization, and support from a team of physicians and other medical professions in hospitals or other detox centers.9 This level of care minimizes the risk of sometimes-dangerous complications that may arise during the acute withdrawal phase. Following the withdrawal, the detox program will refer the individual to a level of care appropriate for them, such as:2 Residential rehabilitation. Rehab for 30, 60, or 90 days is a good option for someone new to recovery. These programs allow the individual to escape the environment that fueled addiction while, at the same time, building needed coping skills with assistance from clinical staff and fellow people in recovery. Some rehab programs, like therapeutic communities, may last for a year. Outpatient treatments. These treatments allow the person to attend individual, group, and family therapy while continuing to live at home, work and manage other responsibilities. Outpatient settings can vary from one hour per month to many hours each day to meet the individual’s treatment needs. [vob-aktify-cta title="Does your insurance cover alcohol detox?" subtitle="Check your coverage online or text us your questions for more information"] Alternatives to Medications for Alcohol Recovery Acamprosate and other drugs used in medication-assisted treatments (MATs) can help with alcohol cravings, but they should not be the only course of treatment. Behavior therapies combined with medications provide the best chance of success. 2 There are a number of treatment methods available for psychological dependencies. Cognitive-behavioral therapy models focus on modifying the thoughts and behaviors associated with the addiction. 2 Motivational interviewing helps to build internal motivation for recovery.2 People in recovery also benefit from practicing increased self-care and exploring other activities to help them cope with cravings and triggers. This may include meditation time, participating in art or music therapy, and engaging in activities with sober supports. Benefits and Risks of Acamprosate Across the U.S. and Europe, various studies have shown acamprosate is safe and effective, can improve abstinence rates, and extend the duration of recovery.7 The best acamprosate outcomes occur with a combination of medication and behavioral therapy. After 6 months of treatment, 48 percent of people who utilized both acamprosate and therapy were still sober, while less than 38 percent of those who took an acamprosate/supportive counseling approach had remained sober at this point.8 Another strength of acamprosate is its minimal risk of overdose. Even at levels exceeding 20 times the normal daily dose, the drug does little to cause serious harm in the body.7 As mentioned, acamprosate has few side effects, the most common of which is mild diarrhea.7 Other less common side effects of acamprosate include:7 Stomach cramps Headache Changes in libido Insomnia Weakness Nausea Itchiness Dizziness. In rare but serious situations, acamprosate can trigger anxiety and depression or worsen existing symptoms. 7 Depression is the most significant concern of the side effects because it can result in suicidal thoughts or suicide attempts. If you've had suicidal thoughts in the past, be open with your doctor. He or she may recommend another medication. Other medication options include naltrexone and disulfiram.8 As always, it is important to explore all of your medication options to find the choice best for you. Myths about Acamprosate Acamprosate is addictive: Acamprosate has no potential for dependence or addiction.1 There is absolutely no evidence to suggest acamprosate is habit-forming at all, so you should feel comfortable trying acamprosate as a tool to aid your recovery. Acamprosate is for alcohol withdrawal: This myth is only partially true. Acamprosate is not for acute alcohol withdrawal that begins hours after the last drink and lasts for about a week. It is for use during the extended, or post-acute, withdrawal period that lasts for many months after last use.3 For this reason, acamprosate is used long-term, after the acute symptoms subside. It's dangerous to take acamprosate during acute withdrawal: Acamprosate can be initiated during the acute alcohol withdrawal period.7 You do not have to wait until withdrawal symptoms subside to begin the medication, but acamprosate will not be effective for the symptoms you experience during this time.7 You aren't sober if you use acamprosate: This myth revolves around the common belief that people in recovery need to be completely free from all drugs, including medications, to truly be sober. Some see the use of drugs like methadone or acamprosate as just trading one addiction for another.2 However, this is not the case, and there are many paths to sobriety, some of which involve only therapy and some of which utilize medications. When Can I Start Using Acamprosate? Prescriptions for the use of acamprosate may begin about 5 days after your last drink, and is usually prescribed by a physician or larger treatment team.7 Generally speaking, acamprosate can be used throughout your recovery provided your treatment team finds it appropriate. [accordion title="Detox at American Addiction Centers"] Laguna Treatment Hospital Adcare - Boston Sunrise House Desert Hope Greenhouse Oxford Treatment Center Recovery First River Oaks [/accordion][accordion title="Detox insurance coverage"] Ambetter American Family Beacon BHO Blue Cross Blue Shield Cigna Connecticare Geisinger HCSC Harvard Pilgrim Highmark Kaiser Permanente Magellan Magnacare Meritain Health Medicare and Medicaid Optum Oxford Health Providence Qualcare Sierra Health Tricare Triwest Tufts United Healthcare UPMC Zelis [/accordion][accordion title="Detox near me"] Alabama Alaska Arizona Arkansas California Colorado Connecticut Delaware Florida Georgia Hawaii Idaho Illinois Indiana Iowa Kansas Kentucky Louisiana Maine Maryland Massachusetts Michigan Minnesota Mississippi Missouri Montana Nebraska Nevada New Hampshire New Jersey New Mexico New York North Carolina North Dakota Ohio Oklahoma Oregon Pennsylvania Rhode Island South Carolina South Dakota Tennessee Texas Utah Vermont Virginia Washington West Virginia Wisconsin Wyoming [/accordion][accordion title="Rehab"] Choosing a rehab center Couples rehab Court ordered rehab COVID-19 and rehab Dual-diagnosis rehab Deciding you need rehab Helping a loved one go to rehab Inpatient rehab Medication assisted rehab Outpatient rehab Preparing for rehab Relapse prevention State-funded rehab Teen rehab Veterans rehab [/accordion][accordion title="Detox"] 24/7 detox hotlines Inpatient detox Outpatient detox Medical detox Dangers of detoxing at home The cost of detox [/accordion] More Information on Acamprosate Acamprosate Information at a Glance1,3 Medication Name, Costs Class of Medicine Generic Name: Acamprosate Generic Name Variations: N/A Chemical Name: Calcium acetyl homotaurinate Brand Name: Only generics available in U.S. Brand Name Variations: N/A Cost/Price: Varies Used to Treat Addiction? Yes Function or Use at Low Dose: Maintenance of abstinence from alcohol following detox Function or Use at High Dose: N/A Chemical Makeup: C10H20N2O8S2Ca Duration of Action: 8 hours Form, Intake and Dosage Interactions and Complications Drug Forms: Delayed-release tablet Administration Routes: Orally (swallowed) Dosage: Two 333mg tabs 3 times daily Overdose: Occurs rarely and at very high doses Alcohol Interaction: N/A Illicit Drugs: N/A Prescription Medications: No significant drug interactions noted Effects and Adverse Reactions Substance Abuse Positive Effect: Treats symptoms of post-acute alcohol withdrawal Adverse Reactions: Diarrhea, insomnia, anxiety, depression, headache, nausea, dizziness Risk of Substance Abuse: Low Signs of Abuse: N/A Physiological Problem Signs and Symptoms Dependence and Addiction Issues Withdrawal Syndrome: None noted Tolerance: No tolerance noted Cross Dependence: N/A Physical Dependence: No dependence noted Psychological Dependence: N/A Legal Schedules and Ratings Controlled Substances Act Rating: Unscheduled [sources] U.S. National Library of Medicine: DailyMed. (2017). Acamprosate Calcium. National Institute on Drug Abuse. (2018). Principles of Drug Addiction Treatment: A Research-Based Guide. Substance Abuse and Mental Health Services Administration. (2005). Acamprosate: A New Medication for Alcohol Use Disorders. Medscape. (2017). Withdrawal Syndromes. American Psychiatric Association. (2013). Diagnostic and statistical manual of mental disorders (5th ed.). Arlington, VA: American Psychiatric Publishing. Substance Abuse and Mental Health Services Administration. (2010). Protracted Withdrawal. Substance Abuse and Mental Health Services Administration. (2009). Incorporating Alcohol Pharmacotherapies Into Medical Practice. Witkiewitz, K., Saville, K., & Hamreus, K. (2012). Acamprosate for treatment of alcohol dependence: mechanisms, efficacy, and clinical utility. Therapeutics and Clinical Risk Management, 8, 45–53. Substance Abuse and Mental Health Services Administration. (2015). Detoxification and Substance Abuse Treatment. Substance Abuse and Mental Health Services Administration. (n.d.). Medications for the Treatment of Alcohol Use Disorder: A Brief Guide. [/sources] ...Read more
While determination and self-sufficiency can be admirable traits, some people may overestimate the likelihood of there being a quick, easy way to conquer their addictions at home without professional assistance. They may believe professional addiction treatment is too inconvenient or too expensive. Some others may be reluctant to admit they need help. In reality, however, addiction is a disease that many struggle to overcome in the absence of treatment. All professional addiction treatments help move people towards recovery, but many people, especially those new to recovery, benefit greatly from inpatient detoxification. And some may require it to avoid certain life-threatening hazards associated with withdrawal from specific substances. Inpatient detoxification is an intensive form of professional treatment focused on applying a set of strategies and interventions that make the early hours and days of recovery as safe and comfortable as possible.1 What Are Dependence and Withdrawal? Substances of abuse, including prescription medications, can change the way your brain operates and often lead to the development of tolerance and dependence with continued use.2 Drugs and alcohol alter certain brain processes in various ways, producing intoxicating effects in the short-term.3 With time and consistent use, these changes upset the normal balance the brain works so hard to maintain. [callout] As the brain adapts to continued substance use, you can develop:3 Tolerance—the need to use a substance more frequently to produce the desired effects – needing 10 beers instead of 5 to feel intoxicated, for example. Dependence—the physiological state in which the drug is needed to maintain the new normal and stave off withdrawal. [/callout] Drug and alcohol dependence is problematic on many levels. As dependence develops, the brain works to establish a new balance as it adapts to a particular substance of abuse. When that substance is no longer available in the same amounts or at all, this new balance is severely disrupted.3 As a result, the dependent individual may experience the onset of withdrawal symptoms that can range from minor to very dangerous.1 Withdrawal symptoms are drug-specific—the symptoms experienced after quitting heroin, for example, will be different from the symptoms experienced by someone attempting to stop drinking.2 Not all drugs are associated with problematic withdrawal symptoms but some, like alcohol, sedatives, and opioids, can be especially distressing and could even present a medical emergency.1 It’s true that many people will not experience medical or mental health emergencies during detox, but it is sometimes difficult to predict who will. 1 Do not put your physical or psychological health in danger. Seek out professional detox treatment if you have been abusing alcohol or other drugs for an extended period. [self-assessment] What Happens During Detox? The main objectives of alcohol and drug detoxification are to reduce the severity of withdrawal symptoms and ease the detoxing person into a substance-free state. [callout] All detox treatments will focus on 3 stages of care:1 Evaluation. Treatment. Linking to additional services. During the evaluation stage, the professional will assess all important aspects of your physical, emotional, and social health, with special attention paid to: 1 The specific drug or drugs used. The amount, frequency, and duration of the substance abuse. Any previous issues with withdrawal symptoms or withdrawal complications. Physical conditions, illness, and diseases affecting your health. Current or past mental health concerns. How much support you have. Any concerning stressors. [/callout] The treatment phase focuses on implementing a plan to safely withdraw based on the information gained during the evaluation. In some instances, such as those involving prescription benzodiazepine abuse, a doctor might gradually reduce the dose of the drug in question over time. In other cases, such as with heroin or alcohol detox, additional medications will be used to stabilize a person in acute withdrawal. 1 Sometimes, a substance will not be tapered but rather stopped abruptly, with detox treatment aimed at treating, rather than preventing, the withdrawal symptoms.1 The administration of medications is not always a part of detox treatment, but it is very common. About 80% of detox treatments feature at least one medication used to alleviate withdrawal symptoms or help prevent relapse.4 The final stage of detox treatment, linkage to other services, is just as important as assessment and treatment, because detoxification, by itself, is rarely sufficient to maintain long-lasting sobriety. 2 To make sure you get the full spectrum of care you need, the detox treatment providers will recommend and refer you to another level of treatment to maintain and continue your path toward recovery. 1 How Will Detox Benefit Me? Entering a professional detox program offers both short-term and long-term benefits. In the short term, detox under the care of medical and addiction professionals helps ensure your health and safety. When your withdrawal symptoms present, the treatment team closely monitors your condition and deals with any issues as they arise.1 Certain medical complications can compromise your health and cause enough discomfort to compel you to relapse, so the staff at these programs may administer medications to help mitigate these problems and increase your comfort.1 Some physical health problems that may arise during alcohol and drug detox include:1 [callout] Dehydration and electrolyte imbalance due to diarrhea and vomiting. Choking on or breathing in vomit, leading to blocked airways or risk of pneumonia. Cardiovascular issues, including changes in blood pressure and heart rate. Seizures. High fevers that could indicate an infection somewhere in the body. Insomnia. [/callout] For someone detoxing alone, these issues can lead to serious problems and may even endanger their life. But in the medically supervised environment of an inpatient detox, they can be addressed immediately.1 Some people withdrawing from drugs and alcohol not only have to suffer through physical symptoms but may also experience potentially debilitating mental health issues including depression, anger, aggression, or even suicidal or homicidal thoughts. 1 Others may endanger themselves or people around them when hallucinations or delusions distort their reality and trigger high levels of distress. 1 Common to most withdrawal syndromes is a strong desire to get and use more of the substance. Called cravings, these compulsions to use drugs can lead to relapse, overdose, and a restarted cycle of addiction and dependence.5 Fortunately, detox programs are well-suited to address mental health concerns as well. By prescribing supportive medications, if indicated, and providing therapeutic and emotional support, a person’s mental health issues may be simultaneously managed alongside their physical health. The staff at the program should also know the best place to refer a patient suffering from specific symptoms in the event that they need further evaluation. In the long-term, detox helps set the stage for lasting recovery. Alcoholics and drug-dependent people who do not go through the detoxification process are more likely to relapse after some period of sobriety.4 Detox and rehab programs employ principles of care that treat the entire person, not only their problems with addiction and dependence. Care can address and increase access to education, employment, housing, and relationships. 2 During treatment, staff may help you build a partnership with those close to you so that they may better understand addiction and learn how to respond and support you appropriately. 1 It is difficult to stay sober without the support of those you love, and when you involve them in your recovery, you may be more likely to stay clean for longer. Inpatient detox programs will also help you create a plan for your treatment once your body is stable enough to move onto the next phase. You might believe that detox is all you need, but while it does offer an invaluable foundation for recovery, it is rarely considered enough to fully address a person’s addiction. A multitude of factors contribute to and perpetuate drug abuse, and these can be worked through in a longer-term treatment program.2 What Is Inpatient Detox? Detoxification can take place in two general treatment settings, inpatient detox and outpatient detox, with smaller subcategories in each group. Overall, inpatient detoxification programs are more intensive than outpatient treatment programs. During inpatient, the person resides inside the treatment facility, and the whole detoxification process is completed within the center.1 Outpatient programs allow you to leave and sleep in your own home at night. Outpatient detox may not be an appropriate treatment setting for managing withdrawal from certain substances where dangerous symptoms can arise at any time or for people who feel unable to avoid relapse in their home environment. Unlike outpatient centers, an inpatient facility provides continuous support for its patients while separating them from environmental and social stimuli that may hinder their recovery. Patients are monitored carefully and supported appropriately with a professional team. Some people may be deterred by the potential cost of inpatient detoxification as compared to outpatient options. However, money should not stand in the way of a safe and progressive recovery. There are 3 separate levels of care within the category of inpatient detox: 1 Medically managed detox. Medically monitored detox. Social detox. Does your insurance cover rehab for substance abuse addiction? We can help - check your coverage instantly or text us your questions to find out more. [vob-aktify-cta] An inpatient detox program can range in time from several days to several weeks, depending on the patient's history and their drug(s) of abuse.5 Medically Managed Detox Of the three, medically managed detox is able to provide the most intense level of care. This form of detox includes medical supervision and treatment in an acute care setting with access to physician services when needed. 1 In addition to physician access, a staff of registered nurses and other substance abuse treatment professionals will be present to provide ongoing observation and intervention. With the access to physical and mental health experts in an acute care setting, medically managed detox is a great option for someone with significant physical and/or psychological issues or who might be at greater risk of experiencing severe or complicated withdrawal.1 Medically Monitored Detox The primary difference between medically managed and medically monitored detox is the setting. Rather than being an acute care environment, medically managed detox occurs in a freestanding detox center. 1 These still offer treatment from physicians, nurses, and other trained staff members but may not be as well equipped to effectively manage severe physical or psychological symptoms of withdrawal. 1 Medically monitored detox centers will be a good option for people who still require some medical intervention without the full intensity of medically managed detox. Someone with successful past detoxes, mild physical complications, and no history of significant mental health issues will do well here. Social Detox Like other inpatient detox settings, social detox provides a substance-free environment with 24/7 supervision and support. 1 However, these programs won’t utilize much, if any, medication, choosing instead to emphasize the guidance and support of caring clinicians. Social detox is a great fit for people withdrawing from substances such as stimulants that pose a relatively low risk of severe withdrawal symptoms. 1 These centers can also help to stabilize the patient's mental state after a period of severe intoxication where aggression or suicidal thoughts may emerge. 1 Which Treatment Features Are Most Important? In 2016, Recovery Brands asked those leaving a rehab center what aspects to take into account when considering a program. The top consideration was the center's monetary policies, like insurance, financial support, and payment options. People entering treatment may want to examine a program's financial practices as well as the clinic's offerings to inform their final treatment decision. If you’re considering treatment, you may want to examine a program's financial practices as well as the clinic's offerings to inform your final treatment decision. What Is the Cost? Whatever you do, do not let the cost of substance detox scare you away from the care you need. The most intense addiction treatments are usually the most expensive, and medically managed detox will usually be among the priciest of treatment programs.1 However, the treatment intensity is only one variable affecting cost. Addiction treatments may also vary greatly based on:6 The location of treatment. Options with picturesque scenery, privacy, or convenient access will generally be more expensive than others. The duration of treatment. Shorter programs may cost less than longer forms of treatment regardless of intensity. Range of services offered. A program with an array of complementary treatments like yoga, art/music therapy, and equine therapy will be more expensive than ones with standard treatments. Types of conditions treated. If a program is highly specialized in treating a certain population such as individuals with dual diagnoses, the fees could increase. Whatever you do, do not let the cost of substance detox scare you away from the care you need. Programs may seem expensive, but there are many options to make the treatment that may save your life more affordable. If you have insurance, start by calling the number on the back of your card for information about covered programs. Depending on your plan, your detox treatment may be fully or partially covered by your insurance. Your insurance provider will link you to in-network facilities to discuss their fees and your coverage. [callout] If you don’t have insurance, consider acquiring coverage by: Exploring insurance provided by the county or state in which you live. Options usually exist for people with low incomes or certain mental/ physical health conditions. Search the online health insurance marketplace for plans that fit your financial situation and medical needs. If you’re uninsured, don’t assume that treatment isn’t an option for you. Many people utilize alternative methods to afford their care, including: Loans. By securing a loan from a bank or even a personal connection, you can attend treatment now and payback to the money over time in digestible payments. Crowdfunding. Many websites can make setting up a page, collecting money from your social network, and transferring it to your detox center simple and streamlined. Financing and sliding scales. Some detox facilities may offer flexible payment schedules that begin after treatment concludes. Others may offer free or deeply discounted care based on need, income, and level of commitment. Be sure to inquire with the center how they work with clients on payment. [/callout] [accordion title="Rehab at American Addiction Centers"] Laguna Treatment Hospital Adcare - Boston Sunrise House Desert Hope Greenhouse Oxford Treatment Center Recovery First River Oaks [/accordion][accordion title="Rehab insurance coverage"] Ambetter American Family Beacon BHO Blue Cross Blue Shield Cigna Connecticare Geisinger HCSC Harvard Pilgrim Highmark Kaiser Permanente Magellan Magnacare Meritain Health Medicare and Medicaid Optum Oxford Health Providence Qualcare Sierra Health Tricare Triwest Tufts United Healthcare UPMC Zelis [/accordion][accordion title="Rehab near me"] Alabama Alaska Arizona Arkansas California Colorado Connecticut Delaware Florida Georgia Hawaii Idaho Illinois Indiana Iowa Kansas Kentucky Louisiana Maine Maryland Massachusetts Michigan Minnesota Mississippi Missouri Montana Nebraska Nevada New Hampshire New Jersey New Mexico New York North Carolina North Dakota Ohio Oklahoma Oregon Pennsylvania Rhode Island South Carolina South Dakota Tennessee Texas Utah Vermont Virginia Washington West Virginia Wisconsin Wyoming [/accordion][accordion title="Rehab"] Rehab Choosing a rehab center Couples rehab Court ordered rehab COVID-19 and rehab Dual-diagnosis rehab Deciding you need rehab Helping a loved one go to rehab Inpatient rehab Medication asssisted rehab Outpatient rehab Preparing for rehab Relapse prevention State-funded rehab Teen rehab Veterans rehab [/accordion][accordion title="Detox"] Detox 24/7 detox hotlines Inpatient detox Outpatient detox Medical detox Dangers of detoxing at home The cost of detox [/accordion] References: Substance Abuse and Mental Health Services Administration. (2015). Detoxification and Substance Abuse Treatment. National Institute on Drug Abuse. (2018). Principles of Drug Addiction Treatment: A Research-Based Guide. Medscape. (2016). Withdrawal Syndromes. National Institute on Drug Abuse. (2018). DrugFacts: Treatment Approaches for Drug Addiction. American Psychiatric Association. (2013). Diagnostic and statistical manual of mental disorders (5th ed.). Arlington, VA: American Psychiatric Publishing. French, M. T., Popovici, I., & Tapsell, L. (2008). The Economic Costs of Substance Abuse Treatment: Updated Estimates and Cost Bands for Program Assessment and Reimbursement. Journal of Substance Abuse Treatment, 35(4), 462–469. ...Read more