Detoxification without medication
Medication has traditionally been used to alleviate the withdrawal symptoms associated with detoxification. Medication focuses especially on the physical problems related to detoxification. Detoxification without medication literally means that detoxification is undergone without medication or other substances affecting the central nervous system.
Substance addiction has many different levels. People tend to abuse substances in order to manage unbearable or difficult emotions that they do not believe they have the abilities or resources to manage otherwise. When substance abuse becomes long-term, also the levels of addiction change. People connect the substance they abuse to their ability to function in everyday life by becoming attached to the substance physically, socially, psychologically, and mentally. Often substance abusers have become accustomed to manipulating their emotional states with the substance, thus weakening their tolerance to deal with setbacks without the sense of relief given by the substance.
The physical attachment to intoxicants entails getting used to the substance, increasing tolerance while maintaining the ability to function, and preventing the onset of withdrawal symptoms. The social attachment is formed when the substance user relates to other users, embraces the life style of drug use, and adopts the identity of a user. The psychological attachment is formed through emotional reasons, personal characteristics, and rationalization. The mental attachment encompasses beliefs about drugs, a sense of fate, and the life content they bring.
All these dimensions of addiction need to be considered during rehabilitation, and a possibility for change needs to be provided through clear and concrete means. A superior form of treatment within the holistic approach to addiction treatment is communality. Interaction, peer group support, and the forums built into the structure of the treatment, such as discussion groups and joint gatherings, are designed to maintain the process of change, making it possible to deal with the physical, psychological, social, and mental dimensions of addiction.
The physical withdrawal symptoms can be alleviated by acupuncture, different massage therapies, aroma therapy, and reflexology. In addition, good hygiene and diet play an important role in physical detoxification. For the psychological withdrawal process, it is important that clients learn to know their own feelings, find and begin to use their inner resources, and start to sort out priorities. Encouragement, support, and discussions are crucial – and so is humor.
In addition to addressing the psychological and physical aspects of addiction, the rehabilitation should also address the social and mental aspects, so that the treatment challenges clients to greater honesty toward themselves and encourages them to practice whatever skills they lack that sustains the cycle of substance abuse. Social withdrawal aims at changing the clients’ ‘user’ identity through open interaction, by guiding them to take responsibility, by acknowledging their success, and through various other activities, making sure that clients do not retreat to an inner, self-absorbed world. The mental withdrawal process provides ‘peace to the soul’. This can be achieved in several ways, such as through redefining issues, dealing with clients’ own beliefs, finding new perspectives, and giving them responsibility. It is important that clients receive genuine experiences of success in their progress, since they have put a great deal of effort into it. This way, clients can learn that in a substance-free life you first do something and afterwards you feel good, whereas when they were using, the substance would make them feel good so that they were capable of performing in everyday life.
Detoxification without medication aims at breaking the chemical dependence, starting the process of change for the client as soon as possible, while finding and using the client’s own resources and coping skills. People coming to rehabilitation often consider themselves ‘losers’ and their need for help is desperate, even if they only have a vague hope for something better. Often they also feel that their only solution is to find help from the outside, in the form of some miraculous medicine. Detoxification without medication aims at supporting clients’ own will to break away from the addiction and from seeking pleasure chemically, so that they learn to face difficult emotions instead of fleeing from them.
Communal treatment, based on peer support, provides a safe place to experience and practice the skills needed in life. Communal treatment gives clients the opportunity to learn to look at things in a new way and provides them with support, encouragement, constructive feedback, and genuine care from people who share their situation. Camaraderie makes it easy to try new things and to share your story, which some clients may never have told honestly to anyone. Thus, they can be accepted for who they really are and not for a role they play.
The opportunity to learn to take responsibility for your own affairs – including decisions about the treatment – is invaluable. While still using, people have often tried to not take responsibility for anything and they may even have blamed others for their own choices and emotions. The ability to comprehend cause and effect helps them to understand the effects of their own choices and the fact that you can affect your life, which for many has felt impossible; as if life would inevitably be out of your grasp. In communal treatment, former clients and clients who have participated in the treatment for a longer time have a very important role, because they represent living proof of recovery and progress, which encourages newly arrived clients to invest in their own treatment.
The media often gives the impression that detoxification from opiates (as well as from other, so-called hard drugs) is impossible without medication or replacement treatment. This image is also strengthened by the fact that many opiate addicts, who in fact wish to continue their drug use, demand access to replacement treatment claiming that they cannot handle the withdrawal symptoms. For the treating health care personnel there is a real challenge deciding whether to support this image in the choice of treatment or whether to find other options. Especially for young clients, it is important to offer detoxification without medication as the first option.
Withdrawal symptoms are very individual, depending on the substance and the total time of drug use. The rule of thumb is that the worst is over in a week, as far as physical symptoms are concerned. The rest will take considerably longer. For some (especially those having used opiate-based drugs), the symptoms of physical pain may be difficult to endure. Others may have a dual diagnosis, with a mental illness in addition to the substance addiction, which demands medication even during detoxification from the abused substance. Therefore, it is important that in severe cases of addition, a doctor evaluates whether the person with dual diagnosis is capable of undergoing detoxification without medication right away, or whether they should first begin with medicated detoxification, or whether an entirely different form of treatment would be best.
Detoxification and rehabilitation without medication enable recovery into normal life, as clients learn to treat their addiction and change their identity from a chronic user into a recovering and active agent in their lives. This form of treatment requires that the treating personnel refrain from doing things for the clients, and instead guide them to do things themselves with the support of the community. The treatment takes the clients forward; the peer group is encouraged to function as one element in the treatment and to find solutions from among the group itself. That becomes an experience that carries them through – that it is possible to face every situation in life and survive, even without substances.
Many of those who have undergone detoxification without medication have said that once you’ve gone through the withdrawal symptoms, you really feel like you’ve done something real in order to break free from drugs and the threshold for starting again has definitely risen. Through experiences of success the clients’ image of themselves as losers changes and what was once considered impossible becomes possible.
Instructor, the Hietalinna Therapeutic Community