If an individual is using drugs and he or she decides to stop using, they can... right? Not really. Why, you ask. Quite simple. It can be summed up all in one word: withdrawal. Drug use is more than just a bad habit. Drug use is addictive not only because psychologically an individual feels compelled to use, but also because his or her body develops a physical dependence. When this dependence develops and drug use is abruptly discontinued, symptoms of withdrawal can and usually do arise. Basically, the body goes into shock. The exact symptoms of withdrawal will change depending on the drug the individual is dependent upon. Here we will discuss some of the different withdrawal states that can occur.
What are examples of withdrawal?
* Benzodiazepines
* SSRI discontinuation syndrome
* Methadone withdrawal symptoms
* Alcohol withdrawal syndrome
* Delirium tremens
* Neonatal abstinence syndrome
Why Does Physical Dependence Occur?
As one uses more and more of a drug, or any kind of substance, the body develops a drug tolerance. This does not just refer to illegal substances, it can also happen when one drinks coffee on a daily basis. After a while, just one cup may not be enough to get that kick which is neccesary to get going in the morning, or to stay up all night. Thus, a second or third cup may be needed. In the case of drug users, one pill or one puff on x substance may not be enough. The body adapts to the substance that has been introduced. When the drug is no longer available withdrawal symptoms that are the opposite of the direct effects of the drug appear- and this is when the withdrawal occurs. Depending on the elimination half life of the drug, symptoms can arise a few hours afer the drug is stopped or may even begin several days after discontinuation of the substance.
So, Withdrawal just Applies to Heavy Drugs Users...Right?
There are many legal drugs used all over the world which are generally not associated with having a withdrawal effect. These are medications which are not generally used to generate a feeling of pleasure, however, the body can still develop a dependence. Some of these substances include:
* Beta blockers (used for management of cardiac arrythmias)
* Corticosteroids – cortisone (an anti-inflammatory)
* Antidepressants/Antianxiety
* Anticonvulsants (used to prevent seizures)
For this reason, one must not abruptly discontinue any medication without consulting with his or her medical provider.
Its all about the dopamine
The euphoria that drugs produce is usually what causes addiction. This is produced by the nucleus accumbens which is considered the pleasure center of the brain. Dopamine is used by this center to cause the euphoria drug users enjoy. The particulars of dopamine use by the body, varies depending on the drug utilized. Constant use of the drug means that the body requires, more and more stimulation, this leads to dependence. In order to produce feelings of euphoria, one needs more and more of the drug. Withdrawal syndrome is characterized by dysphoria which is the opposite of euphoria- sadness. Symptoms of withdrawal include: Depression, anxiety, and craving.
Why Can Some People Just Stop and Others Cant?
Ever heard someone say: “I stopped smoking cold turkey.” This type of easy withdrawal doesn’t happen for everyone. How someone withdraws from a drug depends on many factors. For instance, how long have they been using? What kind of medication/drug is it? At what rate have they been using? All of these questions need to be answered in order to properly assess how someone is going to withdraw. Depending on the medication, an individual may need supervision while withdrawing from a substance. This applies to both benzodiazepines and alcohol withdrawal, which if not carefully handled can lead to seizures. If alcohol is stopped abruptly, delirium tremens can occur, and this can be deadly.
Rebound Withdrawal
This often occurs with depression medications. When a medication is stopped, withdrawal from the drug results in a return to the original symptom, often in a much worse state. Meaning, a depressed person may become more depressed than they originally were. Depression also occurs for individuals using amphetamines, stimulants and ecstasy. After being in a state of euphoria, the individual may crash and become depressed. Other medications that may result in rebound include:
* Analgesics include: Advil, Ibuprofen, Aspirin, Tylenol and some prescription medications can cause headaches for long periods of time.
* Nasal decongestants: including Afrin and Otrivin, can cause rebound congestion if used for more than a few days.
* Sedatives and benzodiazepines can cause rebound insomnia when used regularly to aid sleep.
The only way to combat rebound of these symptoms is to deal with the symptoms for a few days and allow the body to go back to its normal state.
What if Someone Wants to Stop Using?
The best thing to do when attempting to withdraw from drugs is to consult the medical professionals who can properly outline a course of action which will be effective. Never attempt to withdraw from any medication, legal or otherwise, on one’s own as the effects of such a venture could be potentially deadly.
Drug dependence is a universal public health problem of which opioid dependence, notably involving heroin and morphine are a major component. In Europe alone, there are an estimated 1.1 million intravenous drug users and the number is estimated to be at least 3 times that many in North America. The majority of these individuals remain untreated. Opioid dependence is a chronic relapsing medical condition that requires long-term treatment and patient support. In addition, many of these intravenous drug users share syringes and needles, a practice that can lead to the transmission of serious blood-borne infections including human immunodeficiency virus (HIV), hepatitis B and hepatitis C.
Currently opiate dependence treatments like methadone can be dispensed only in a few centers that focus in addiction treatment. There are not enough addiction treatment clinics to assist all patients seeking treatment. Suboxone is the first narcotic drug available under the Drug Abuse Treatment Act (DATA) of 2000 for the treatment of opiate dependence that can be prescribed by a physician. Hopefully, this advance in therapeutics will provide more patients the opportunity to access treatment.
Suboxone (buprenorphine with naloxone) is currently available for the maintenance treatment of opioid addiction. The intention of adding naloxone to the formulation is to deter intravenous misuse and reduce the symptoms of opiate dependence. Suboxone treatment is intended for use in adults and adolescents more than 16 years of age who have agreed to be treated for addiction.
Once detoxification of the individual is completed, Suboxone is used during the maintenance phase of treatment. Suboxone has recently become the drug of choice instead of methadone in the treatment of opiate addiction. Suboxone use is less rigidly controlled than methadone because it has a lower potential for abuse and is less dangerous in an overdose. As patients progress on therapy, the physician may write a prescription for a take-home supply of the medication.
Suboxone Prescription
Only those physicians who have approval from the Drug Enforcement Agency (DEA) are able to start in-office treatment and provide prescriptions for ongoing medication. The Center for Substance Abuse Treatment (CSAT) maintains an active database to help patients locate qualified doctors.
Route of Administration
Suboxone is available as a tablet which is always administered sublingually. The pill is placed underneath the tongue until it is fully dissolved. Swallowing or sucking on the pill does not offer any therapeutic benefit. When placed underneath the tongue, the pill dissolves and is absorbed in 10 -20 minutes.
Suboxone treatment is generally done under medical supervision. During the induction phase, one is taught how to properly take the medications and dose adjustments are done during the phase. One is usually started on the smallest dose until the best therapeutic effect is obtained. Once the ideal dose is obtained, the individual is seen once in a while and prescriptions can generally be available from the same physician.
Suboxone is available as 2 and 8 mg tablets. Most anecdotal reports indicate that the response to the 2 mg dose is suboptimal. The majority of individuals report benefit at higher doses of 8-16 mg. The aim of the maintenance treatment is to rid the drug craving and decrease the anxiety. The dose is usually adjusted until the drug craving features are diminished.
Since Buprenorphine is a Schedule III drug, the physician is only allowed to prescribe 5 refills in 6 months.
Maintenance therapy
Although Suboxone can be used for detoxification, its intended use is for maintenance. The ideal candidate for maintenance therapy with Suboxone is an older individual who has previously been on drugs but now has a job and wants a stable lifestyle. The individual previously has failed detoxification and wants to live a simple life without the daily cravings of his previous addiction. The majority of past drug users immediately adjust to Suboxone as the cravings disappear immediately and a smoother life style are accessible.
Suboxone Control
Because of the great potential for abuse, FDA works closely with the drug manufacturer, Reckitt-Benckiser, and other agencies to develop an in-depth risk-management plan. The FDA receives quarterly reports from the manufacturer and pharmacies and maintains a comprehensive surveillance program. This monitoring allows for early detection of abuse of the drug. The major components of the risk-management program are preventive measures and surveillance. Preventive measures instituted include drug education, tailored distribution, Schedule III control under the Controlled Substances Act (CSA), child resistant packaging and supervised dose induction. The program regularly monitors local pharmacies and web sites. Numerous other agencies also monitor the abuse of Suboxone and these include:
-Drug Abuse Warning Network (DAWN). This agency run by the Substance Abuse and Mental Health Services Administration (SAMHSA) gathers data from emergency rooms related to the illicit use of drugs or non-medical use of a legal drug.
-Community Epidemiology Working Group (CEWG). This agency monitors the use of buprenorphine.
-National Institute of Drug Abuse (NIDA). NIDA frequently sends newsletters to physicians about the addictive drugs and to report it if necessary.
Side Effects
The most common reported side effect of Suboxone includes:
- Cold or flu-like symptoms
- Headaches
- sweating
- insomnia
- Nausea
- Mood swings
- Pain
- restlessness
Like other opioids, Suboxone have been associated with respiratory depression (difficulty breathing) especially when combined with other depressants.
Cautions
Intravenous use of Suboxone usually in combination with benzodiazepines or other CNS depressants has been associated with significant respiratory depression and death. Suboxone has the potential for abuse and produces dependence of the opioid type with a milder withdrawal syndrome than full agonists. There are no adequate and well-controlled studies of Suboxone use in pregnancy. Due caution should be exercised when driving cars or operating machinery.
One of the defining characteristics of an addictive personality is the inability to practice delayed gratification. Whatever the individual wants, he or she wants now, not later, not in five minutes. Having said this, one of the main components present in substance abuse treatment is a behavioral change in order to procure long lasting abstinence from drug use. Enter rapid drug detox- is it an option from hard core drug users? The ads offer quick, efficient and painless detoxification from opiod drug use. In a few hours, the drug user has totally bypassed the often, long and torturous road to recovery.
But the question comes….is it effective? An even more pressing question- is it safe? The physicians that run these operations will say, yes, absolutely, there is no danger in rapid detox. However, seven patients from 1999-2003 died under the care of Dr. Lance Gooberman at the U.S. Detox Intensive Treatment Center which is based in New Jersey. This physician had his license taken away from him. Why did these patients die? Well, the procedure puts a lot of stress on the drug user’s body, which is already not in full working order. Over the course of the last few years however, there has been much advancement in the rapid detoxification process.
How Does Rapid Opiod Detoxification Work?
In order to speak about the rapid detoxification process, one must speak of Andre Waismann. Dr. Waismann is an Israeli physician, specifically an anesthesiologist, who started practicing the rapid detoxification method in 1994. Dr. Waismann and his team screen patients for their levels of dependence to their drug of choice, in most cases, opiates. Opiates are artificial endorphins. Meaning, one naturally produces endorphins which make one feel happy, and are the physiological components behind someone experiencing a natural high. Continued use of opiates causes the body to stop producing endorphins and the opiate receptors present need more and more stimulation in order to procure a reaction. The brain may also develop more receptors to take in the opiates that are being introduced to the system.
The Waismann team administers drugs that anesthesiologists use to block the opiod receptors and then a drug is introduced that blocks opiods. The entire process takes about 36 hours and according to Dr. Waismann, the patients don’t feel any of the symptoms associated with withdrawal:
• Abdominal pain
• Agitation
• Diarrhea
• Dilated pupils
• Goose bumps
• Nausea
• Runny nose
• Sweating
• Vomiting
Patients are screened prior to treatment to find out what level of dependence they are displaying. The physician sedates the patient and medications are introduced to block the opiod receptors from further reaction to opiod. The patient’s are monitored as the medications are being administered. According to Dr. Waismann the patient is unaware this process is taking place. For a year after treatment, the patients take Naltrexone, which is a tablet taken once a day by mouth. The purpose of naltrexone is to block opiod receptors which should stop the patient from getting a high should they attempt to use.
Can This Really Work?
According to the organizations that perform rapid opiod detoxification, there are no issues with the treatment. For instance, according to a study from Mount Sinai Medical Center, University of Miami School of Medicine, the process is one hundred percent successful. According to this institution, relapse is only reported fifty five percent of the time, during the six month follow up period. These numbers do not include use of alcohol and other drugs however. Furthermore, there are physiological risks for the addict going through a rapid detoxification program as demonstrated by Dr. Gooberman’s practice.
Is It a Magic Cure?
The answer to this is no. Though these practices will have one believe that the detoxification process will result in unsolicited recovery from substance abuse, what this does not take into account is the fact that one is dealing with an addict. It is not just the fact that the individual is using substances; it is the behaviors and lifestyle that accompanies drug use which need to be remedied. This includes unlearning behaviors that have been with the individual for most of his or her life. Unlearning them takes time and a lot of work on the part of the addict. Rapid detoxification is just the first step in a lifetime of work the addict has to commit to.
Dr. Waismann’s method is a helpful push in the direction of recovery from opiod use, however, unless there is a bridge to behavioral changes, it is likely that the addict will relapse. The use of naltrexone, as Dr. Waismann suggests can help to fight cravings while the patient continues to work on the reasons why he or she is looking for a chemical high. It is the nature of the addict to look for the easier way to do things. In terms of detoxification, there is nothing wrong with that, but for lasting abstinence one must change his or her behaviors in addition to physically ridding the body of these substances. So, final verdict, Waismann’s method can work but its not the end of the treatment- its only the beginning.
There have been substantial advances when it comes to understanding the biochemical and genetic basis for substance abuse and addiction over the past ten years. In spite of this knowledge very little information is disseminated in regards to alternative forms of detox treatment. One form of alternative treatment is rapid detox and is a viable alternative for certain patients.1 Rapid detoxification and rapid opiate detox can be beneficial if you are suffering from an addiction to heroin, prescription painkillers, Oxycontin, Methadone, Suboxone, Vicodin, Darvocet, Percocet, Hydrocodone or any other opioid. 2
Traditional treatment entails a detoxification period that is often debilitating and has horrendous withdrawal symptoms that are both painful and often dangerous for the patient. Not only is there intense physical pain there is often psychological cravings for months beyond treatment. 3 Statistics show that with regular detox methods within a year 85 to 90 percent of all patients have suffered a relapse and are using again. 4
The most visible and widely talked about rapid detox method is the Waismann Method. 5 The Waismann Method also known as Neuro-Regulation is performed in a hospital intensive care unit. It involves cleansing the opiate receptors in the patient’s brain of the narcotics while the patient is under anesthesia. During the procedure, the patient will experience no conscious withdrawal, and will be able to return home within days. Over 65 percent of the patients who are treated with the Waismann Method remain drug free after one year.
In April 2000, the American Society of Addiction Medicine (ASAM) released a public policy statement on rapid and ultra rapid opioid detoxification.6 Based on their policy and further studies, ASAM updated April 2005, to include their policy recommendations which are listed below and should be considered when considering detox.
Policy Recommendations
1. Opioid detoxification alone is not a treatment of opioid addiction. ASAM does not support the initiation of acute opioid detoxification interventions unless they are part of an integrated continuum of services that promote ongoing recovery from addiction.
2. Ultra-Rapid Opioid Detoxification (UROD) is a procedure with uncertain risks and benefits, and its use in clinical settings is not supportable until a clearly positive risk-benefit relationship can be demonstrated. Further research on UROD should be conducted.
3. Although there is medical literature describing various techniques of Rapid Opioid Detoxification (ROD), further research into the physiology and consequences of ROD should be supported so that patients may be directed to the most effective treatment methods and practices.
4. Prior to participation in any particular modality of opioid detoxification, a patient should be provided with sufficient information by which to provide informed consent, including information about the risks of termination of a treatment plan of prescribed agonist medications such as methadone or Buprenorphine, as well as the need to comply with medical monitoring of their clinical status for a defined period of time following the procedure to ensure a safe outcome. Patients should also be informed of the risks, benefits and costs of alternative methods of treatment available.
In rebuttal to ASAM’s policy Clifford Bernstein, M.D., medical director of AAMOD, the leading practitioners of the Waismann Method treatment for opiate dependency, stated that the study offered misleading results and failed to recognize those who have had success with rapid detox.7 He states that anesthesia-based detox is a humane and effective medical treatment that allows patients to avoid most of the unnecessary withdrawal symptoms. Furthermore, he points out that the study misleads the reader into believing that anesthesia-based detox is not a successful method for opiate treatment by stating that 80% of participants dropped out of follow-up treatment. This statistic does not say anything about the success of the detox treatment or whether or not patients were able to stay off of the drugs. Since the opiates have been blocked from their brains and they no longer feel cravings following the anesthesia-based detox, many of these patients do not need an aftercare program. He stated that the study did not accurately represent the procedure, the merits of the doctors performing it nor the benefits of this treatment. He states that the procedure is safe, however one should use the same precautions as any other procedure under anesthesia as well as verify the qualifications of the doctor performing and to be sure to do it at an hospital with appropriate emergency resources if they are necessary.
Rapid detox is a relatively painless way for people suffering from addiction to opiates. While rapid detoxification can be effective, it is should be undertaken only after discussing the pro’s and con’s as well as follow- up treatment.
Opiate addiction is recognized as a central nervous system disorder, caused by continuous opiate intake.1 Extended opiate use leads to the nerve cells in the brain to stop functioning as they normally would and stop producing natural endorphins. Because the body is getting opiates and no longer is producing endorphins the nerve cells start to degenerate and cause a physical dependency on opiates. Sudden withdrawal (quitting cold turkey) leads to a syndrome called withdrawal syndrome. Withdrawal syndrome is a long and painful process and can result in permanent damage to the cardiopulmonary system and the central nervous system. Untreated and unmonitored, it can result in death for unhealthy patients. For these reasons, opiate dependency treatment requires appropriate and responsible medical care.2 These symptoms have led to the growth of ultra-rapid, anesthesia-assisted opioid withdrawal procedures. Proponents state that rapid detox as a painless way to withdraw from opioid. However, studies show that the procedure can lead to risk of death, psychosis, increased stress, delirium, attempted suicide, abnormal heart rhythm and acute renal failure and are very expensive.3
There other tradional forms of opate detoxification including opioid agonist drugs. These include drugs like methadone, levo-alpha-acetylmethadol (LAAM), or Buprenorphine; Clonidine, which blocks some withdrawal symptoms; ultra-rapid opioid detox under anesthesia; and an experimental method using the drug lofexidine. Opioid agonist drugs act like opiates but do not produce the same high and are administered in doses that are gradually reduced. Since these medications act like opiates there appear to be no noticeable or significantly reduced withdrawal symptoms.4
Clonidine can be administered by a transdermal patch, which dispenses the drug gradually and consistently over a seven- day period. Patients who choose to use the patch should also take Clonidine orally for the first two days since medications taken through the skin takes two days to reach a steady effectiveness. Monitoring of blood pressure is essential since Clonidine causes hypotension and sedation.
Rapid detox is done under general anesthesia with intubations for six to eight hours. During this time a combination of drugs, usually naltrexone and Clonidine are administered to the patient.4 Lofexidine, a non-addictive drug brought to the market in 1992, is a centrally acting alpha-2 adrenergic agonist targeted for relief of opiate withdrawal symptoms.
Withdrawal symptoms continue to be the greatest obstacle in heroin detoxification treatment. Studies concur that there is no proof that one detoxification treatment is better than another. Relapses continue to occur in numerous cases around the world therefore making opiate addiction very difficult to treat successfully long term. Studies show that on average addicts will stop and start detox 10-25 times in their lifetime relapsing back to opiate use each and every time5
Opiate detoxification involves admitting there is a problem, seeking medical help, staying focused on the goal and rehabilitation and treatment through a continuing program. Statistics and studies how that there is no easy cure all nor is there a guarantee that a relapse will not happen. Support from family, friends and physicians along with the will to succeed are all necessary factors in successful detox regardless of the method chosen. While there are many methods to use for opiate detox, one must choose the method that looks at their general health condition, psychological state, external support and length of time addicted and making an informed decision that best meets the needs of the individual.
Addiction to drugs and alcohol encompasses more than a behavioral intervention. The reason for this is drug addiction is a complex disease, however, it is treatable. Like chronic illnesses such as hypertension and asthma, relapse can occur with drug addiction even after extended periods of continued abstinence. For this reason, repeated treatments may be necessary. Treatments should be tailored to the individual in order to be more effective and long lasting, therefore allowing people to live long and productive lives.
In a study conducted in 2004, 22.5 million American needed treatment for substance abuse. Out of this large number, only 3.8 million received help (NSDUH2004).Leaving substance abuse and addiction cases untreated, though in the short-term can save money, in the long-term can lead to many extraneous costs to society. Some of these things include: court and criminal costs, emergency room visits, prison costs, child abuse and neglect, foster care, welfare costs, healthcare utilization, reduced productivity and unemployment.
For every dollar spent on addiction treatment, there is a four to seven dollar reduction in the cost of crimes related to drugs. In 2002, it was estimated that $181 billion dollars was the cost to society for drug use. Over $500 billion was spent when including tobacco and alcohol costs. This includes lost productivity, healthcare and criminal justice costs. Substance abuse programs that are run successfully and efficiently can help society in more than one way. Not only can they assist the person in need, they can also help reduce the amount of sexually transmitted disease that are spread such as HIV/AIDS and Hepatitis. In addition, crime and costs to society can also be reduced. So, the question comes, how can one develop an effective treatment program?
Effective Treatment Guidelines
Research has been conducted since the 1970s shows that treatment can help people avoid relapse, change destructive behaviors, and take them out of a life of substance abuse and addiction. Treatment tends to be a long term process and can require several episodes of treatment. This research has helped lay down the structure on which effective treatment programs should be based.
• Treatment does not need to be voluntary to be effective.
• For certain types of disorders, medications are an important element of treatment, especially when combined with counseling and other behavioral therapies.
• No single treatment is appropriate for all individuals.
• Treatment needs to be readily available.
• Effective treatment attends to multiple needs of the individual, not just his or her drug addiction.
• Remaining in treatment for an adequate period of time is critical for treatment effectiveness.
• Addicted or drug-abusing individuals with coexisting mental disorders should have both disorders treated in an integrated way.
• An individual’s treatment and services plan must be assessed often and modified to meet the person’s changing needs.
• Medical management of withdrawal syndrome is only the first stage of addiction treatment and by itself does little to change long-term drug use.
• Possible drug use during treatment must be monitored continuously.
• Counseling and other behavioral therapies are critical components of virtually all effective treatments for addiction.
• Treatment programs should provide assessment for HIV/AIDS, hepatitis B and C, tuberculosis, and other infectious diseases, and should provide counseling to help patients modify or change behaviors that place themselves or others at risk of infection.
• As is the case with other chronic, relapsing diseases, recovery from drug addiction can be a long-term process and typically requires multiple episodes of treatment, including "booster" sessions and other forms of continuing care.
An All Encompassing Treatment
When treating an individual for addiction treatment, it is important for the individual as a whole to be looked at. Usually, treatment begins with detoxification which is followed by treatment and relapse prevention. Initially, in order to ease the individual into treatment, medications may be needed in order to control symptoms of withdrawal. All encompassing care includes mental health services, medical care and of course aftercare. In order to make sure that someone in recovery continues to stay there is to make sure all bases have been covered. Follow up options such as community or family based recovery support systems can be essential to acquiring and maintaining a life that is free of drug use and abuse.
Medications
Medications can help in various different fashions. In some cases, coming off of a substance can be life threatening and medication is necessary. Often times, the symptoms of withdrawal can be so severe that medication is necessary. This is not considered treatment; it is however, the first step in the process of recovery. Going through withdrawal treatment is not sufficient. If one does not receive further treatment, it is like not receiving treatment at all.
Using chemical substances can help to establish brain functioning that may have gone awry. At present medications are available to help reestablish pathways for addiction related to heroin, morphine (opioid) and nicotine (tobacco). Other medications are currently being developed for treatment of cocaine and methampetamines (stimulants) and marijuana (cannabis) addictions.
Methadone and buprenorphine act as antagonists on brain receptors which means that they block the pathways which opiates like heroin take. This helps to block the drugs effects, suppresses symptoms of withdrawal and can even reduce the incidence of cravings. Ideally, this helps patients to stop drug seeking behaviors and activities that may be criminally related. Thereby, patients should be more focused on treatment having reduced many outside stimuli.
Behavioral Treatments
This is a very important part of effective therapeutic treatment. Stopping substance abuse habits is only effective if behaviors change, therefore, attitudes have to be changed so that a healthy lifestyle is maintained. Life skills need to be altered, unhealthy patterns need to be changed. In addition, medication effectiveness is usually better, and this can help people stay in treatment longer which will hopefully improve the likelihood of the individual staying clean.
Outpatient behavioral treatment can include a wide variety of programs. Most include group or individual counseling. Some of the more popular forms of treatment include the following behavioral treatment programs:
• Motivational Incentives (contingency management), which uses positive reinforcement to encourage abstinence from drugs.
• Cognitive Behavioral Therapy, which seeks to help patients recognize, avoid, and cope with the situations in which they are most likely to abuse drugs.
• Motivational Interviewing, which capitalizes on the readiness of individuals to change their behavior and enter treatment.
• Multidimensional Family Therapy, which addresses a range of influences on the drug abuse patterns of adolescents and is designed for them and their families.
Residential treatment can be very helpful, even more so for individuals with severe problems. Therapeutic communities are structured programs in which patients remain for half a year to twelve months. Those in treatment usually have long histories of drug addiction, have often been involved in criminal activity and may have reduced social functioning. Treatment communities have become so evolved that they may also be structured to accommodate women who are pregnant or have children. The purpose of treatment communities is to help the individual learn how to behave in society without drugs.
In conclusion, with the proper mix of effort on the part of the individual, the proper care by practitioners, medications and community, a formula for success on the part of the substance user can be acquired. With that formula put in motion, an addict can become a former one and go on to live a happy and fulfilling life.
Since the 1960s, many addicts have reported that even a single dose of ibogaine, a hallucinogenic alkaloid extracted from the root of an African shrub, helps them kick their habit by reducing their cravings for drugs. And there is hard evidence to back these claims, as well.1 Ibogaine was first introduced as a potential treatment for opiate addiction by Howard Lotsof, who took the drug in 1962 looking for a psychedelic experience, and awoke 30 hours later with no cravings and no withdrawal symptoms, despite being a heavy heroin user at the time.2 Lotsof was able to develop and follow an ibogaine maintenance program, which he then followed for three years while remaining opiate free. In 1986, Lotsof opened a company by the name of NDA International to advocate for the use and research of ibogaine and its active constituents as anti-addictive compounds.
Since ibogaine aides in the cessation of addiction, it started to be used to deal with opiates and other substance addictions. Ibogaine has only been introduced to Western scientific medicine but has documented use by the Bwiti tribe in Central Africa for centuries. At lower doses ibogaine has the ability to increase energy and mental alertness and appears to decrease the desire for food and drink. Higher doses (20+ mg/kg) of ibogaine have a larger psychoactive property, and is used ritualistically in initiation rites for its potent hallucinogenic properties. 3
Barbara E. Judd, CSW did a study on ibogaine and stated that the most difficult aspects of treatment are getting the patient to enter treatment. 4 She notes that the three major obstacles are the fear of detoxification lack of insight, and the inability of patients to control their urges to use drugs. It was in these three areas where she felt the benefits of ibogaine treatment far outweighed those of traditional methods. Judd further states that psychological fear of pain and withdrawal prevents many addicts from even attempting detox. Addicts feared having to deal with the emotions that lead them to use in the first place. Judd adds that when patients learn the benefits of ibogaine they are more willing to try it.
Like all forms of detox, ibogaine is not without risks and side effects. At therapeutic doses, ibogaine has an active window of 24 to 48 hours, is often physically and mentally exhausting and produces ataxia for as long as twelve hours.5 Nausea that may lead to vomiting is not uncommon throughout the experience. These side effects reduce the attractiveness of ibogaine as a recreational drug at therapeutic doses, however, at lower doses ibogaine is known to have stimulant effects. It is still a controversial and experimental drug and there are some cases of fatal cardiac arrhythmias.
There are two types of ibogaine treatment. The first type of treatment is oriented toward addiction, most commonly heroin dependence, and typically involves dosages in the range of 15 to 25 mg/ kg .5-8 The second type of treatment, also know as “initiatory," involves a dosage on the order of 8 to 12 mg/kg, or about half of the dose used for addiction and is used for spiritual insight and facilitating psychotherapy. 9-11. In addition to reducing craving, ibogaine often promotes a sense of wellbeing that can last from weeks to months. As the studies into the nature of ibogaine progress, scientists have discovered that ibogaine's anti-additive properties are actually two-fold. First, when the substance is consumed, the body produces a chemical called noribogaine. Noribogaine blocks the brain's receptors that control cravings. Noribogaine also increases dopamine and serotonin levels, which elevate feelings of wellbeing.
So while ibogaine is not a substitute for drugs, and is not addictive, ibogaine is a chemical dependence disruption and a chance for patients to get a head start on recovery. Ibogaine enables the patient to focus on the underlying causes of addiction without going through the intense withdrawal symptoms that accompany most types of detoxification. And, even if there are some remaining symptoms after ibogaine detox they are more tolerable than other detox approaches.13 Studies show that ibogaine has the ability to drastically attenuate drug withdrawal in all patients and, in 90 percent of treated patients during one case study, to interrupt the patient's craving to continue drug use for periods of time ranging from as short as two days to as long as two and a half years from a single treatment.14
