Medical Detox

At Strong Hope detoxification is carried out under the medical supervision of Clinical Director Dr. Kristi-Anne Evelyn and a highly trained nursing team in a fully equipped, bespoke detox suite with 24-hour medical monitoring.

While the client needs to be monitored very closely and continuously during this process, Strong Hope strives to make this process as comfortable as possible by ensuring that our detox suite is luxurious with the highest level of comfort without the feel or obvious appearance of a medical facility. The suite includes a beautifully furnished private bedroom and bathroom with wheelchair access if necessary, private lounge and outdoor deck overlooking the rolling hills and landscaped gardens of the property.

What is a Medical Detox?

Physical addiction is a medical issue that requires medical treatment and medical detox is the procedure used to deal with the issue of physical addiction.

Medical detoxification refers to treatment that prevents or lessens withdrawal symptoms when a client stops using any form of addictive drugs or alcohol and usually entails the administration of medications that stop or lessen cravings and physical dependence upon the one or more substances that the client has been misusing.

When a person becomes addicted to alcohol or to one or more mind-altering substances, both psychological and physical dependence can result. Psychological dependence is a feeling of inability to deal with daily life or issues without resorting to addictive substances. Clients may realise the need to stop relying upon mind-altering substances but find that they have become physically dependent on the substances that they have been using.

The main goal of medical detox is to break the client’s physical dependence upon addictive substances and one of the first steps in restoring the client’s physical health. This way, they can then concentrate on the therapeutic aspect of treatment, both behavioural and cognitive. This is imperative in overcoming addiction in any form.

Medical Detox At Strong Hope

Medical detox at Strong Hope encompasses both pharmacological and psychological treatment while under close supervision of both medical and mental health specialists in a safe, luxurious, comforting and supportive environment.

On admission to Strong Hope, a complete physical exam is carried out with comprehensive blood testing done to ensure that every aspect of the client’s physical health is investigated and monitored. With these results we then embark on a programme to ensure that during every client’s stay with us, we are improving their physical health.

Medical detox is relatively short and provides the stepping stones for a more stable and successful recovery.

Alcohol Detox

An estimated 17.6 million Americans currently have alcohol use disorder (AUD), but only a fraction of the people with alcohol problems seek professional help. It is normal for a person ready to embark on the difficult path of sobriety to feel anxious about what to expect and how long it will take to complete alcohol detox.

Again, it is important to keep in mind that detox is just the initial step on the long road of recovery. Detox marks the abrupt ending of alcohol intake and is necessary for the body to cleanse itself of all traces of alcohol. The physical detox process usually takes seven to ten days, but this is only the beginning of the treatment process. Length of stay for recovery from alcohol misuse varies according to:

• Addiction history
• Addiction severity
• The presence of other medical, mental or behavioural health conditions (co-occurring diagnosis)
• The client’s physical, mental, emotional, social and spiritual needs

Symptoms experienced during detox from alcohol may be as mild as a headache or nausea, or as serious as delirium tremens (DTs) marked by seizures and/or hallucinations.

If there are no co-occurring conditions or other drug use or treatment, alcohol withdrawal follows a characteristic course consisting of three relatively distinct phases. The phases are as follows:

Acute withdrawal: This period is dominated by tremors, autonomic nervous system hyperactivity and the risk for DTs and seizures. Physiological symptoms commonly experienced during acute alcohol withdrawal include tachycardia (increased heart rate), increased blood pressure, diaphoresis (profuse sweating), body temperature dysregulation and gastrointestinal problems (nausea, vomiting).

Early abstinence: During this second phase, anxiety, low mood and disturbed sleep patterns continue. However, physical symptoms are substantially lessened.

Protracted abstinence: During this final phase, elevated anxiety and dysphoria (profound state of unease or dissatisfaction) may not be obvious, although normally insignificant challenges can provoke negativity, craving of alcohol and relapse.

The psychological discomfort associated with anxiety during abstinence can be overwhelming, even after most acute physical symptoms have subsided.

At Strong Hope we employ a variety of modalities to assist in physical alcohol withdrawal and detox, including implementation of the necessary medications for treatment of symptoms as they occur. We also administer vitamin and mineral supplementation in the form of intravenous vitamin infusions, and if necessary prescription medications to assist cravings and maintain abstinence even after discharge from our facility.

Cocaine Detox

Discontinuing cocaine use often results in withdrawal symptoms like fatigue, sleep disturbances and agitation. This is one of the major reasons people keep using cocaine. Many people who use cocaine fail to get clean when going at it alone, as the side effects of withdrawal and the temptation to seek out more drugs can be overpowering. With medically assisted detox and close supervision, clients can safely detoxify their system and prepare their body and mind for the recovery process.

One of the most common withdrawal-related symptoms of cocaine abuse is a heavy “crash” when stopping.

Symptoms include:

• A general feeling of depletion
• Dysphoria or depression
• Anxiety
• Irritability
• Exhaustion
• Increased appetite
• Strong desire for sleep

After the crash is when the withdrawal syndrome/symptoms begin.

Common symptoms of cocaine withdrawal include:

• Strong cravings to use
• Irritability or anger
• Lethargy and extreme fatigue
• Depression
• Hyperactivity
• Insomnia and erratic sleep
• Poor concentration
• Tremors
• Psychomotor agitation or retardation
• Vivid, unpleasant dreams

Phases of the cocaine withdrawal timeline are:

The Crash: A cocaine crash period can last anywhere from one to 40 hours following the final dose, during which time sleep may be difficult, if possible at all. Even with a successful period of sleep, general sleepiness and fatigue may last more than two days. Cravings for more of the drug decrease over the course of the crash, as the need for sleep builds and builds. However, the cravings return in the next phase of withdrawal.

Withdrawal: Those who use cocaine may experience one to five “near-normal” days on the other side of a crash, returning to regular sleep routines and minimal cravings. Lethargy, anxiety and cravings begin. Symptoms can occur intermittently for up to 10 weeks, while the desire to use again grows and grows.

In medically assisted cocaine detox, the medical team at Strong Hope oversees the process and works with the client to manage and alleviate discomfort whether physical or psychological. Each client’s situation is unique, so we work together with the client to create a bespoke treatment plan that they are comfortable with but that is still effective and safe.

Heroin & Opioid Detox

Opioids come in many different formulations including but not limited to:

• Heroin
• Codeine
• Hydrocodone (Vicodin)
• Hydromorphone (Dilaudid)
• Methadone
• Meperidine (Demerol)
• Morphine
• Oxycodone (Percocet or Oxycontin)

Opiate withdrawal symptoms can be very uncomfortable, and medical detox provides the safest and smoothest way to detox. Vital signs such as blood pressure, pulse and respiration rates, body temperature and heart rate are closely monitored in our state of the art, fully equipped medical detox suite where we utilise medications as needed to regulate brain and body functions to lessen the discomfort of withdrawal.

Mental health professionals will evaluate and stabilise clients during medical detox. While there is no specific timeline for detox, (as each client will likely experience withdrawal from opiates differently), medical detox usually lasts 5-7 days.

Opiate withdrawal symptoms may range from mild to severe, depending on how dependent the individual is on an opioid drug. This depends significantly on the

• length of time using a drug,
• dosage amount,
• which drug,
• route of administration,
• underlying medical conditions,
• the co-occurring presence of a mental health issue,
• biological and environmental factors,
• family history of addiction,
• previous trauma,
• degree to which surroundings  are stressful and unsupportive.

Withdrawal from an opioid drug varies from person to person depending on the above factors, but generally follows the timelines below.

Early Withdrawal: These symptoms usually start within 6-12 hours for short-acting opiates, and within 30 hours for longer-acting ones.

• Runny eyes and nose.
• Muscle aches
• Agitation
• Trouble falling and staying asleep
• Excessive yawning
• Anxiety
• Sweats
• Increased heart rate
• Increased blood pressure
• Fever

Late Withdrawal: These symptoms peak within 72 hours and usually last a week or more.

• Nausea and vomiting
• Diarrhoea
• Goosebumps
• Stomach cramps
• Depression
• Drug craving

Medications that can be used in Opioid Medical Detox

Methadone: relieves withdrawal symptoms and helps with detox. It is also used as a long-term maintenance medicine for opioid dependence. After a period of maintenance, the dosage may be decreased slowly over a long period of time. This helps reduce the intensity of withdrawal symptoms.

Buprenorphine (Subutex): treats withdrawal from opiates and it can shorten the length of detox. It may also be used for long-term maintenance, like methadone. Buprenorphine may be combined with Naloxone (Suboxone), which helps prevent dependence and misuse.

Naltrexone: can help prevent relapse. It is available in pill form or as an injection.

Prescription Drug Detox

Prescription drugs with the potential for misuse fall into three main classes: opioid pain relievers, stimulants and central nervous system depressants.

The class of drugs responsible for slowing brain activity, often considered sedatives or tranquilizers, is central nervous system (CNS) depressants. Examples of CNS depressants include benzodiazepines like Valium and Xanax, sleep medications like Ambien or Imovane (Z-drugs), and barbiturates including Nembutal and Mebaral. CNS depressants are often prescribed for anxiety and sleep disorders due to their calming and drowsy effect promoted by the increase of the neurotransmitter gamma-aminobutyric acid, GABA.

Detoxing from CNS depressant drugs at Strong Hope is done under direct 24- hour medical supervision as the withdrawal symptoms can be extremely serious and even life-threatening. Since these drugs work to depress brain activity, sudden removal of them can cause the brain to rebound, which can lead to seizures, coma, or even death.

Symptoms of CNS depressant withdrawal include:

• Sleep problems
• Irritability
• Severe stress and anxiety
• Short burst of extreme anxiety called anxiety or panic attacks
• Shaking
• Excessive sweating
• Difficulty focusing
• Nausea
• Weight loss
• Racing and palpable heartbeat
• Headache
• Pain in the muscles
• Changes in perception and thinking
• Seeing or hearing things that are not there or hallucinations.
• Convulsions

The length of withdrawal syndrome, length of the detox protocol and severity of the symptoms all depend on:

• The amount of the drug taken: The higher the doses the more severe will be the symptoms.
• Duration of the Benzodiazepine use: The severity is proportional to the length of use.
• Type of the Benzodiazepine taken: Normally, short-acting Benzodiazepines cause more severe withdrawal symptoms.

CNS depressant use should NEVER be stopped immediately and should always be tapered slowly in order to avoid serious withdrawal symptoms and complications such as seizures, hallucinations, dangerous increases in blood pressure and heart rate.

At Strong Hope, every client’s case is approached uniquely with special attention to the type of medication, dosage, length of use etc. After obtaining this information as well as other details from the physical examination and blood investigations, a bespoke detox programme is created and started. The client is continuously monitored by our medical team of doctors and nurses to ensure that the medical detox process is going smoothly without complications and excess levels of discomfort for the client. To ensure this we may use medications to relieve withdrawal symptoms where necessary.