“Detoxification” or “detox” is a word that is put to many (related) uses. When used in a psychiatric sense its use refers to “the process of withdrawing a person from an addictive substance in a safe and effective manner” (Cambell’s Psychiatric Dictionary). Detoxification can also refer to the treatment of poisoning.
When referring to the treatment of addictive substances detox is used variously to mean the treatment of a withdrawal syndrome, the experiencing of a withdrawal syndrome or the treatment of an acute drug overdose.
Talk of “detoxing” is also beloved of alternative practitioners, the idea being that because of modern lifestyles or diets the body accumulates various toxins. With the aim of attaining health and equanimity these require periodic purging by (say) yoga, cold showers, or holding crystals etc. As the liver and kidneys work full time removing toxins from the human body, neither the mechanisms by which these interventions work nor their efficacy is established. (This is not to say that eating healthily and exercise are not noble pursuits).
Detoxification of addictive substances involves cessation of drug intake cross tapered with medication to address withdrawal effects. In this sense “detoxification” is a misleading term as – beyond stopping taking a toxic substance – the process does not include the removal of body toxins. Depending on factors like the drug of misuse, habitual daily intake and the severity of the withdrawal syndrome, medical detoxification can take place either in the community, or in a rehabilitation clinic.
Withdrawal from alcohol is probably the most common detoxification requiring medical intervention. Prolonged periods of heavy alcohol use can lead to physiological dependence and abrupt withdrawal from alcohol can be fatal. Alcohol acts as a central nervous system depressant. Because of this, chronic heavy use leads to GABAA receptor desensitization and a reduction in receptor numbers. If alcohol is abruptly stopped then the nervous system suffers from uncontrolled synapse firing, which can result in anxiety, life threatening seizures, and delirium tremens. Benzodiazapines are the most commonly used drugs to reduce alcohol withdrawal symptoms. Severe withdrawal is also seen with GHB and sedative-hypnotics also produce a withdrawal syndrome similar to that of alcohol.
Other withdrawal syndromes can be less severe, but nevertheless act as a barrier to cessation. Opiates withdrawals resemble a flu-like illness, and directly life-threatening symptoms are not caused. Methadone acts on the same receptors as heroin and is used to reduce withdrawals. Stimulant (cocaine, amphetamine) withdrawal following heavy use can resemble a severe depressive illness and a number of medications such as dopamine agonists can be administered.