‘Detoxification: the ‘nuts and the bolts’ by Peapod

“Expect the first few weeks to be rocky emotionally. Life can feel a bit ‘greyed out’ for a while and youʼll need to adopt a longer-term view. Getting to as many recovery meetings as you can manage during this period will help.”

“Expect the first few weeks to be rocky emotionally. Life can feel a bit ‘greyed out’ for a while and youʼll need to adopt a longer-term view. Getting to as many recovery meetings as you can manage during this period will help.”

Okay, youʼve got to the point where you are looking to detox but youʼre not sure what the nuts and bolts of it are. How do you go about it and how do you know you are ready? What can you do to boost success?

Here are my suggestions, which are based on guidance and my own experience of working with hundreds of people going through detox.

First things first: “detox plus”
The first thing to say is that any detox which is not connected to other things will almost certainly fail. You might get through the detox (or “stopped”) but remaining drug free (“staying stopped”) is very, very unlikely without other things added in. Not to mention that itʼs potentially dangerous too. Donʼt set yourself up to fail.

Itʼs best to see detox as a tiny part of the recovery process. Important, no doubt about it, but in the grand scheme of things not a giant cog in the machinery. Recovery is a longer-term process.

What is the “plus” part of “detox plus”: what needs to be added in?
1. Ask: am I ready? You will probably have a feel for this because youʼve been working towards this goal for a while and others have been supporting you. If youʼre using regularly on top of your script or have major stressful life events going on, you may want to wait a bit, or get referred for consideration of residential options where the support is highest.

2. Weigh up the pros and the cons. Everything involves some sort of risk. Talk to others whoʼve done it successfully. Make an informed choice.

3. My next suggestion is to get referred to an intensive community or residential rehabilitation programme. Some will offer detox as part of treatment. Your prescriber or support worker will be able to advise. Try to get onto a programme that is at least three months long and that prioritises connecting up their clients to peer-led recovery communities.

4. Get involved with local recovery community activities in any case. The most important of these is mutual aid. Groups like Narcotics Anonymous, Cocaine Anonymous (you donʼt need to have a problem with coke) and SMART recovery offer peer-based support.

The evidence suggests that engaging with these groups reduces relapse rates and adds much to quality of life too. You donʼt need to be drug-free to attend.

5. If youʼre not going to sign up to intensive treatment, then get started with meaningful activities daily. Find an educational course or volunteering opportunity and get stuck in. Structure your days and donʼt spend time in bed or stuck to the TV or computer screen.

6. Stay away from using friends and places you associate with scoring and using. These are powerful triggers to use when you are feeling vulnerable.

Detox basics

1. Donʼt do your own detox. Shutting yourself in a room with DFs and Valium might seem like a sensible idea, but it is not known for its success rates. Achieving your goals is much more likely if you have an expert in detoxification supporting you as you do it. Cold turkey is being unkind to yourself and has low success rates.

At the same time, this is your detox, so youʼll want to know you have some say in how it looks. It shouldnʼt be something that is done to you, but something you do with the support of the prescriber. Alcohol, GHB/GBL and Benzodiazepine detoxes are particularly dangerous if not medically supervised.

2. If you are coming off opiates, discuss whether you want to use methadone or Suboxone to detox. In some areas you might also have the option of lofexidine (Britlofex) too. Occasionally some doctors offer a dihydrocodeine (DF118) detox. Iʼm going to write a separate article on choosing between a methadone detox and a Suboxone detox.

3. Get as much support around you as you can. If you are in a structured day programme, residential treatment or a therapeutic community, the support ought to be built in.

If youʼve chosen to try this without that sort of intensive input, then tell your mutual aid group members what youʼre planning, get your prescriberʼs support and that of family members (non-drug using). Do some relapse prevention work and donʼt rely only on yourself. I canʼt stress this enough; most of us need help to do this.

4. If you are struggling, admit it. There are various medications that can be added in to help with any unpleasant symptoms like pain, insomnia, nausea, diarrhoea, cramps etc. Emotional support from positive people will boost your chances of success. If you know people whoʼve been through detox successfully, find out how they did it and get their help.

5. Expect the first few weeks to be rocky emotionally. Life can feel a bit “greyed out” for a while and youʼll need to adopt a longer-term view. Getting to as many recovery meetings as you can manage during this period will help.

6. Guard against relapse and if you do go back to using, remember loss of tolerance and the increased risk of overdose. Donʼt use as much, donʼt use alone, donʼt inject and donʼt mix heroin with other drugs (particularly alcohol or valium).

7. Remember a lapse is not the end of recovery. Itʼs common and not a cause for shame or giving up. Most of us need more than one go. Going back onto maintenance for a while is a viable option, as is getting referred to a more intensive treatment setting.

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