The initial phase of detox is often the first critical step for most addicts coming into recovery. I am therefore often one of the first members of the medical team to meet the patient. As a result of my experience of working in this area I have come to learn that although there are a lot of similarities every patient is different with a unique set of symptoms and needs. Working as part of a team I am involved in performing the initial assessment. This assessment is absolutely critical as it will inform the nature of the detox plan, and how this is tailored to meet individual needs.
Addictions come in every form, from eating disorders to opiate dependency and although there may be a primary addiction there are often also cross-addictions such as cocaine, sugar, marijuana, nicotine and alcohol. An addict may ‘use’ various substances in order to self-medicate, and so the more information available or gained during the initial assessment the better.
There are often also additional complications from prescription medicines. Addicts are naturally often not totally honest with their GP about their ‘using’ and are good at claiming, for example, that they feel depressed or in pain. It is important that we start to learn the full extent of drug abuse, whether it be illegal or prescribed.
However, the patient may also have other pathologies, possibly aggravated or even caused by the addiction and so it is also important that we get a thorough initial medical assessment. It is not uncommon for there to be liver or urological damage. Addictions can also be complicated by infections such as hepatitis or other conditions such as diabetes.
Often, despite long term ill-health including visits to A&E addicts will still be in denial. It is a nature of the disease that they wish to protect the illness. Experienced staff in detox units are fully aware of this, but it takes a particular skill set to help the patient to confront the seriousness of the situation and to start being honest. However, the disease is cunning and lethal. For this reason we will back up our questions with a range of relevant pathology and toxicology testing.
On the other hand, some patients with severe addictions seem to be remarkably physically robust despite the often staggering extent of their substance abuse. In these patients, sadly relatively good physical health is often counter-balanced by the extent of emotional and mental damage.
Effective Management of Withdrawal
For patients who have been abusing substances it is necessary to first clear the main levels of residual toxins from the system. Every addict is aware of what this involves; part of the progressive addiction process is caused by the fear of withdrawal. We therefore utilise every tool available to ensure that the withdrawal period is as comfortable and manageable for the patient as possible.
If patients could do the detox for themselves and go ‘cold turkey’ they probably would, but it is often too much and without professional help can also be dangerous. Even following the discontinued use of drugs and chemical withdrawal there will be other physical, emotional, mental and behavioural withdrawal symptoms and these need to be managed too.
Withdrawal symptoms will vary vastly depending in part on the particular self-medication (drug mix) regimen of choice. It is also worth noting that no two patients will react to withdrawal in the same way. Experienced detox staff understand this and know how to respond at all times for the benefit of the individual.
Integrating Detox with Long Term Recovery
Following a successful detox and with appropriate psychological support it is then possible for the patient, with the best help, to start putting the right effort into their recovery. However, until the chemical induced mist has entirely cleared the more advanced psychological therapies will not be appropriate. Good recovery therefore not only requires thorough and effective detox, but also to link with a longer term plan and range of therapies.
Despite the bluster, most addicts have an incredibly low opinion of themselves. They think that they are weak-willed and that their bad behaviour around drink or drugs is a true reflection of their real character. However, many addicts with long term recovery have long realised that addiction is not about being weak-willed, and paradoxically addicts (when clean) are usually highly intelligent and sensitive people. Indeed, it is that sensitivity and innate goodness that is so often linked with addictive tendencies.
That is why those struggling with addiction deserve the best possible detox care and why I work in this professional field with a team of similarly minded experts.
Lucy Botes, RGN, Addiction Therapist