Forty years ago, people who were drunk in public were arrested, put in “drunk tanks” of local jails, and ultimately charged with a crime. While in the drunk tank, the majority of these people experienced full-blown alcohol withdrawal without the benefit of pain relievers or medical supervision. Some died. Hardly any stayed sober.
Today, addiction professionals understand the need for controlled withdrawal. More importantly, mainstream society is slowly learning that addicts are sick individuals who deserve consideration and care rather than scorn. So, what changed?
In the late 1950’s, the American Medical Association (AMA) determined that alcoholism was a disease. The organization disseminated this new revelation far and wide, arguing that alcoholism was a medical illness that required intervention by trained medical professionals. Then, in the early 1970’s, the Uniform Alcoholism and Intoxication Treatment Act was drafted and adopted by the National Conference of Commissioners on Uniform State Laws. The scheme proposed that alcoholics not be criminally prosecuted solely because they drank alcohol. Instead, it was argued that these patients should receive medical treatment with an eye toward living normal and productive lives. Although not technically a law, it was the first effort toward decriminalizing alcoholism and, as the Act became acknowledged by state legislatures, paved the wave for a more humane approach to the treatment of alcoholism.
Over the ensuing decades the science of detoxification has developed, with humanity as a guiding principle. Now, the medical model of detox puts doctors and nurses at the forefront of the process, allowing for medication to help ease the negative effects of withdrawal from alcohol. Contrast this approach with the social model of detox, which rejects medication and medical supervision and substitutes a non-clinical, but supportive, environment. Other models use a combination of both approaches, such as the administration of anti-withdrawal meds at home. In all cases, detox and withdrawal are now acknowledged as a difficult process that deserves support and care.
Where once alcohol was the primary substance in the field of detox and withdrawal, other addictive substances such as heroin and cocaine have reinforced the need for a systematic approach to withdrawal; the more potent the substance the more likely the chance that withdrawal will lead to permanent injury or death.
Although detoxification tends to be defined differently by the judicial system and medical personnel alike, addiction professionals have made an effort to formalize their own definition. In sum, detox means an intervention intended to manage acute intoxication and subsequent withdrawal. The term “detox” refers to the clearing of toxins from somebody who is actively intoxicated or under the influence of drugs or alcohol. During an alcohol detox or a drug detox program, the goal is to minimize the severity of physical harm (including death) that could result from the process. It is important to note, however, that typical detox programs do not aim to resolve the psychological, behavioral or social problems that may accompany the alcoholism or drug addiction. Therefore, detox should not be confused with drug rehab or alcohol rehab, which are intended to promote the sobriety achieved in detox.
In most cases, the detox process consists of three steps — evaluation, stabilization and facilitation into long-term treatment. A hallmark of all three steps is ensuring that the patient is treated with the utmost care and that he or she knows that people understand. During the evaluation phase, the patient is tested to determine the level of toxic substances in their system and whether or not there are any accompanying mental disorders or physical ailments. The patient is also evaluated to determine the best type of long-term treatment to offer after detox is complete. After a successful withdrawal, this evaluation can serve as a rudimentary long-term rehab treatment plan.
During stabilization, the intoxicated patient will experience a complete withdrawal of the alcohol or drugs from their system and will become medically stable. In most cases, medication will be administered to ease the patient through the stages of withdrawal. Once the individual is free of the substances to which he was addicted, he will be instructed on the next stage of addiction treatment. In this final stage of drug and alcohol detox, the patient will learn the importance of completing the entire treatment protocol. Many facilities will require patients to sign a contact of sorts, which solemnizes the recovery process and encourages treatment follow through.
Originally, for many health insurance companies, detox is largely seen as the only relevant treatment for addiction to drugs or alcohol. Once a patient was declared clinically free of the substances, there was a resistance on the part of the insurer to support the patient’s transition to residential or outpatient rehab. Over time, however, the costly cycle of repeated alcohol and drug detox has alerted insurers that long-term sobriety, and reduced financial expenditures, is best achieved by safe medical detox followed by a period of formalized substance abuse treatment in an alcohol or drug rehab.