Addiction is one of the most common and serious chronic medical conditions in the United States. Over 46 million people nationwide Meets criteria for substance abuse disorder Latest data available as of 2021.

Decades of evidence shows that addiction is chronically relapsing brain disease. Nevertheless, it is still widely known Misconceptions about what “treatment” is for addictionNeedless to say heavy stigma associated with it.

Many patients, families, and even the health care system believe that detoxification treatment or admission to a medically supervised withdrawal ward is a key step toward recovery. In some cases, this first step may be considered all that is required. as Doctor and addiction medicine researcherI know firsthand that this common perception is wrong and that it perpetuates misinformation about evidence-based treatments.

Centers that provide medically supervised withdrawal are designed to stabilize patients in crisis, safely manage acute withdrawal, and interrupt unsafe patterns of use. However, the idea of ​​“detoxing” equivalent to recovery It has become established over the past few years. This belief is based on outdated models of addiction, public misconceptions, and media portrayal They view addiction simply as a problem of physical dependence.

Detox is a starting point, not a treatment plan

It is not uncommon for patients to present for medically managed withdrawal (commonly known as “detox”) without a post-discharge plan in place. “I haven’t really thought about it that much.” “I just want to get over it.” “I’m currently undergoing treatment.” Reactions such as these are often heard.

However, this first step is only the beginning of recovery. Detoxification with alcohol, benzodiazpine – Drugs commonly known as “benzos” such as Xanax, Ativan, and Valium – dangerous or even deadly If not managed in a medical setting. Detox is often necessary to safely overcome withdrawal symptoms, but it only addresses short-term physical symptoms and does not address the underlying addiction. Nor does it address the factors that drive people to problematic alcohol and drug use.

For addiction neurobiological causespsychological and structural. Treating these causes is just as important as managing the initial withdrawal symptoms. Medically managed withdrawal does not restore neurochemical imbalances, provide a long-term relapse prevention strategy, or help patients manage ongoing life stressors and triggers as they occur.

A 2023 study of adults with opioid use disorder had the highest relapse rate six months after treatment Those who received only short-term inpatient treatment77% of these patients resumed use. Relapse rates were significantly lower for patients who continued inpatient treatment for a longer period of time or who transitioned to outpatient treatment after a short period of inpatient treatment.

When patients were also treated with a long-acting opioid blocker called naltrexone, relapse rates decreased in all settings: 59% after short-term inpatient treatment, 46% after long-term inpatient treatment, and 38% for patients treated in an outpatient setting. These results highlight that short-term detoxification without ongoing care is often insufficient to support sustained recovery.

However, many centers offering medically supervised withdrawal face clinical, regulatory, and financial constraints. As a result, resources are often limited and patients can be admitted for only 3 to 5 days. In these situations, centers work primarily on stabilizing acute withdrawal symptoms rather than identifying underlying factors that may lead to drug use and possible relapse.

Why does addiction not end even after withdrawal?

Addiction is a chronic condition and sometimes relapses. that Disrupts three interconnected systems in the brain:

– Reward pathway. dopamine, neurotransmitteracts on the pleasure center of the brain.

– Stress Center amygdalathe part of the brain that processes emotions such as fear, aggression, and anxiety. and

– Motivation and control system prefrontal cortexwhich manages higher-level executive functions such as planning and problem solving.

When a person repeatedly uses substances such as alcohol or drugs, they may find that the things they once found rewarding and pleasurable no longer match up on the same scale. This often leads to increased stress and decreased self-control. their bodies reduce their numbers dopamine receptor – The part of the brain that binds to dopamine – As a result, previously motivating and pleasurable activities begin to seem gloomy.

This is what happened to one patient who said, “After the stimulants, everything went haywire and nothing brought me joy.” Methamphetamine use initially produces a “high,” or euphoria. However, over time, some people use it simply to avoid illness. The once intoxicating substance becomes the proverbial ball and chain.

These neurobiological changes do not occur overnight and are not reversible. It is unrealistic to expect a patient’s damaged circuitry to heal with a typical hospitalization for medically managed withdrawal (of just 3 to 5 days).

Additionally, some symptoms may last for a long time, such as anxiety, mood changes, sleep disturbances, and general dissatisfaction with life. 3 months to more than 6 months After the initial withdrawal period. Cravings, which are strong psychological urges, often occur without warning. When this happens, it can be important to have recovery support systems in place, including a sponsor, a mental health professional, and a relapse prevention plan.

Addiction is often rooted in aggravating factors such as anxiety, depression, trauma, chronic stress, and pain. For example, chronic pain from a past injury often leads to misuse of prescription opioids, which can then lead to opioid use. Other substances such as heroin or fentanyl.

Patients with substance use disorders often rely on substances as a means of escaping these serious problems, rather than developing healthier coping mechanisms. In times of suffering, all they know is their medicine of choice.

it often require months or years Developing new ways of thinking, emotional regulation, habits, and trauma responses after leaving behind a history of drug use. Learning to live without substances and without changing anything can be a new and scary concept.

Treatment after detox

If medically managed withdrawal is just the first step, what should you do next? Patients can choose to start drug therapy in consultation with their doctor. This can help prevent cravings and withdrawal symptoms when addressing deeper issues through mental health treatment, such as medication. cognitive behavioral therapy. opioid use disorder It is treated with drugs such as buprenorphine and methadone, but alcohol use disorder Medications include naltrexone, acamprosate, and disulfiram.

These drugs are at least as effective as many standard treatments in medicine, and I believe they should be considered if appropriate. Medications for treating alcohol use disorder include proven to be effective Although the risk of death and hospitalization is reduced, Medicines are often underutilized.

Treating a substance use disorder is similar to managing diabetes, high blood pressure, or other chronic health conditions. Efforts continue even after patients are out of immediate danger.