hey there everybody and welcome to today's presentation on the problem
with detox I'm your host Dr Donnelly Snipes
it's important that people understand what detox is and what it isn't according
to samsa in 2015 detoxification is a set of interventions aimed at managing acute
intoxication and withdrawal the focus here is on acute what the person's going through right then
it denotes a clearing of toxins from the body of the patient who's acutely intoxicated and or
dependent on substances of abuse it's important to recognize that acute detoxification helps get the
for example alcohol the alcohol itself out of the system it does not repair the damage it does not
repair the alterations that the person's body the person's body is undergone when they were using
over a long period of time rapid and traditional detox get the person to the point that they are
physiologically stable they're not likely to experience life-threatening consequences and
their past those acute withdrawal syndromes acute withdrawal syndromes are the ones that make you
feel really really awful with some substances this is the period where the withdrawal symptoms can
be life-threatening like with alcohol when blood pressure can Spike and people can have a stroke
with other substances like opioids that tend to not be life-threatening in and of themselves the
acute detox period is when those symptoms are the worst when they feel like they have got the worst
flu that they have ever had in their entire life and they are at high risk of relapse they're at
high risk of reaching out and using again in order to stop that discomfort unfortunately
using at this point especially if the person is feeling exceptionally desperate may lead
them to overdose so supervised detox is definitely extremely helpful even for
substances that again by themselves are typically not going to induce some sort
of life-threatening crisis because of the detox itself
when people get out of detox they are not recovered their brain has undergone all
kinds of changes substance abuse causes systemic inflammation and alterations in
neurocircuitry which are almost never resolved during detoxification what your body has adapted
to over the course of three months three years 30 years it's not going to reverse
in three days or three weeks it's important to recognize that the body became used to having this
um influx of this substance and is adapted to it so without it the person may feel flat for
example with opioids a lot of people in the post-acute withdrawal time frame experience
more aches and pains because the body takes time to ramp up its production of internal
painkillers again their endogenous opioids take a while to get back online if you will
dopamine for example when people abuse just about any substance dopamine surges so the
body gets used to having these high levels of dopamine and when the body
is not experiencing that the person may feel flat and exhausted and apathetic and
that will eventually turn the corner as the body recognizes hey there's not going to be
a tsunami of dopamine again so we can be more receptive to any dopamine that comes our way we
don't have to guard against it we can actually embrace it when it comes the body must heal
from the toxins that have been ingested the oxidative stress and that can come not only
from the toxins and the inflammation but from a disrupted circadian rhythms from mental stress
itself from a lot of different things any kind of stress on the body produces oxidative stress
the microbiome has to rebalance we know that when we're under stress physical or psychological the
gut microbiome is altered in order to support fight or flea in order to support that HPA
axis and as the body heals the microbiome needs to rebalance to be able to be more
um relaxed if you will where it's not constantly fighting off threats and fighting off toxins
the brain must heal there's a part of the brain and sometimes multiple parts of the brain that
actually are killed off we see shrinkage in the density of the brain in people who have
addictions as they recover we see something called neurogenesis where some of these places
like the hippocampus start to heal and start to regenerate those neurons but it takes time
the neurotransmitters have to rebalance the body has gotten used to having you know oodles
and oodles of dopamine which also means a lot of Serotonin and norepinephrine and now that that is
not being artificially inflated the body must adjust the neurotransmitters must rebalance in
order to support a more moderate lifestyle and the nervous system including the vagus nerve has to
recalibrate a lot of substances basically hijack the vagus nerve the vagus nerve is our traffic cop
if you want to think about it that way it has its grimy little mitts in just about everything and
it controls or helps to control it relays signals to the brain to let us know when there's time
to be stressed and when it's time to relax well substances if you take stimuli stimulant
substances that's going to hijack the vagus nerve and say hey we need to stay in stress mode if it
if you're taking um depressant type substances that's going to Hydra Jack this vagus nerve and
say hey just don't worry about it don't worry about anything so the vagus nerve loses its uh
attention to what's going on because it's kind of a lot more responsive to the substances themselves
in terms of acute withdrawal the time frame for most people is for alcohol five to seven days
for benzos like Valium and Xanax between one to four weeks or three to five weeks with tapering
for cannabis five days nicotine two to four weeks
opioids four to ten days or longer if you're using something like methadone or Suboxone
and stimulants generally one to two weeks anybody who's been addicted to these substances
knows that after that period of time they're still not feeling great which means they're
still at high risk of relapse because at a certain point you want to feel better
post-acute withdrawal the signs and symptoms of post-acute withdrawal from alcohol for example
May last two years or longer after the last use of alcohol alcohol is really hard on the body
sleep studies using polysomnograph recordings found that sleep abnormalities including
difficulty falling or staying asleep and sleep apnea can persist for one to three
years after stopping alcohol consumption and if you've watched any of my other videos on the
YouTube channel you're aware of how integral the good quality sleep is in mental health
as well as regulated circadian rhythms if either one or both of these is out of
whack it is going to make it a lot harder to feel happy to feel healthy to feel energetic
opioid withdrawal symptoms can last for months after acute detoxification and this is one of my
pet peeves if you will of Rapid detox because a lot of Rapid detox places tell people when
you wake up the the opioids will be out of your system and you'll feel great you just need to go
to counseling to learn some tools to cope with stress that ain't it that ain't it when people
finish acute detox yes they need to learn tools to deal with stress but
they need to recognize they are not going to be back to their old selves for a long time
they need to know this they need to be prepared to deal with post-acute withdrawal symptoms during
this post-acute phase people who are withdrawing from opioids may experience anxiety depression
anhedonia that is a loss of pleasure and just not having feelings about much of anything low energy
lack of motivation and sleep disturbances now again lots of videos on the YouTube channel that
can trace this back to certain neurotransmitters and the effects of addiction but what's important
in the takeaway here is for people who've abused opioids for a significant period of time
the these symptoms may occur sporadically for the next up to two maybe even three years
and that is really hard to wrap your head around now with post-acute withdrawal
one of the things that I think is important in order to maintain hope and motivation is
the fact that it gets easier with time just like grief initially after you experience a loss that
grief is palpable that grief is hard to deal with but as you get further away from that loss you
may have occasional grief bursts where something hits you and you suddenly become Melancholy but
the intensity the duration and the frequency of those symptoms goes down significantly and the
same thing is true for post-acute withdrawal and it's important that we let people know
that it will get better and it's important to for a lot of people to keep a log so they
can see those incremental improvements in their energy levels in their mood and their motivation
with benzodiazepines these are your Valium your Xanax your anti-anxiety medications clients may
have no symptoms for a time after initial detox and then suddenly become extremely anxious
these fluctuating symptoms May last for months but gradually subside with prolonged abstinence
one of the things that is interesting is that there are a lot of substances including
cannabis and opioids that are lipophilic they are stored in fat tissue so think about that if you
lose weight and that fat gets metabolized it's possible that it may release Trace Amounts now
sometimes this is not enough to really even notice just like when you use a substance
like caffeine for example and when you first use it you can feel the effects but then after it's
gotten been in your system for a while you don't hardly notice it anymore and a lot of times we
talk about Half-Life so when the substance is fully in your system you may feel the effect
but once you get past that Half-Life a lot of times these symptoms and the effects of it are
not super noticeable and so it's important to recognize that people can still have cannabis
benzos alcohol well not so much alcohol in their Sim in their system but not have the intense acute
effects it's not like they suddenly wake up and they're like oh I feel like I just had a dose
in general and and this depends on the person's physiological makeup their co-occurring mental
health issues as well as the substance they were using but possible symptoms of protracted
withdrawal or post-acute withdrawal syndrome include anxiety sleep difficulties problems
with short-term memory persistent fatigue difficulty concentrating and making decisions
alcohol or drug cravings impaired executive control executive control is attention
concentration problem solving so people who are experiencing pause or post-acute withdrawal may
have more difficulty they may seem a little bit more adult than they used to until their brain
heals anhedonia that lack of feeling about much of anything definitely difficulty experiencing
pleasure difficulty focusing dysphoria or depression irritability unexplained
physical complaints and reduced interest in sex well where does that sex one come from
when the body is going through post-acute withdrawal it is under stress when the body
is under stress a lot of times the Well when the body's under stress anytime the gonadal
hormones that HP g-axis the hypothalamic pituitary gonadal axis is involved but to kind of shortcut
this explanation when the body's under stress a lot of times the brain says you know what
we don't have the energy reserves to focus on sex on procreation right now and you know what
if there's a threat out there it may not be the right time to bring another life into the world
for more information you can watch my long
video on post-acute withdrawal syndrome at All ceus.com Pause
all symptoms is important but it's also insufficient discharging clients without
further biopsychosocial treatment sets them up for failure and hopelessness detox is not it
some people when they get out of detox they think they're feeling better
and they may not be motivated for treatment so that's one of the things that we need to do in
detox is make sure to increase motivation using those motivational enhancement tools
treatment must involve helping the person improve their sleep hygiene circadian
rhythms maintain a diet supportive of recovery address underlying medical issues reduce stress
address grief and guilt and Trauma issues that preceded or relate to the addiction
there are no shortcuts in the recovery process even once the person gets passed post-acute
withdrawal and their body has theoretically healed as much as it can from The Addictive substance if
they have not addressed the anger grief guilt trauma that either precipitated the addiction
or occurred as a result of the addiction then their HPA axis is still going to be
um dysregulated they're probably still going to have difficulty maintaining sobriety
because they're still feeling so much pain in recovery there are no shortcuts sorry to say