Hi

I mentioned a week or so ago that I had posed our "to home detox or not to home detox" question to Wired In - the online recovery community. I said at the time that I would provide feedback on any discussion to the list. In the event, I thought the simplest thing would be to show you the whole discussion thread. So here it is (see if you can spot the contribution from the doctor!!):



Home Detoxification

Some of you will know that I host an e-discussion list for the European Federation of Therapeutic Communities (EFTC). The list has been buzzing in the last few weeks with a discussion about the merits/dangers of home-detox (or non-medically assisted detox). It was sparked off be a suggestion from the new CEO at Ley Community (a TC in Oxford – see: http://www.ley.co.uk/ – their Guestbook is worth a read) that they were exploring the possibility of offering non-medical detox. It’s an interesting suggestion. The current position in the UK I guess is that this would be decried as irresponsible. They’ll probably be told they are bungling amateurs and that as non-doctors they wouldn’t be prepared for any complications. So I just wondered what the Wired-In community thought of it. Have you come across people using “cold turkey” a lot? My guess is that it’s still much more widespread than the treatment industry is aware of. And what about those dreaded complications? Anyone come across any of them? Personally, I’ve never heard of anyone coming a serious cropper doing a cold turkey, but I recognise that’s not very scientific of me. My own experience of organising them at Lifeline in the 1970s was that the discomfort could be significantly reduced. We used to get people to take lots of warm soapy baths. We tried to create a warm supportive atmosphere – playing people’s favourite music (Roy Harper and Al Stewart were big favourites I remember); plenty of fruit in “bite-sizes” and so on. It worked pretty well and we never experienced any significant problems – are things really so different today? The real advantage for people, of course was that they could get it over with quickly and have people they liked/trusted around them for the whole period (not easy to arrange if you’re doing a 28 day detox on methadone – assuming you can find a doctor that thinks “you’re ready”!!). Anyway, I’d like to hear people’s views, experiences and so on. As some of you will know, I’m in the middle of writing a book on Pathways to Recovery based on our seminar series (see: http://www.dass.stir.ac.uk/old-site/DRUGS/pathways/index2.html ), so I’d like to include non-medical detox in there somewhere if only so that people know it’s a legitimate option. I may have to come back and organise an interview with you, but that’s something I can talk to you about later.



Comments

They do it in Australia and have been for many years (ambulatory detox). Results are certainly mixed as the user may still well be in the same environment as when using. The client would attend wherever (clinic or GP)each day to get BP taken before taking clonidine. This and other symptomatic relief helped quite a bit for at least the detox. It is just as important to change a routine as stop actual use. Getting clients to swallow amphetamine instead of injecting was often an important first step to stopping, as with baking cookies instead of smoking cannabis, heroin was more problematic due to the perceptions and myths involved around injecting.
By erasmus on 15/01/2009 at 10:29 AM - Report this comment



Erasmus - I think you’re missing the point here. What I was talking about was a non-medical detox. No drugs involved. A strange concept I know in these times when we have all been brainwashed into thinking it’s not possible to do ANYTHING without methadone or some similar silver bullet.
By Rowdy Yates on 15/01/2009 at 11:20 AM - Report this comment



Hi Rowdy,
We often have people looking for help to self detox and will often point them in the direction of their local pharmacy for symptomatic relief ( if you consider withdrawal as a group of symptoms and treat each one individually it can make it a bit easier)and help them plan the event e.g getting the right foods in, plenty of fluids, someone to keep an eye on them etc.. sometimes it works sometimes it doesn’t. Complications? We are very careful to point out the risks in particular those related to loss of tolerance, dehydration, suicide risk.
i have in the past worked with people who have been hospitalised and close to multi organ failure due to severe dehydration, I also new two people who took their own lives, and in my opinion this was related to an inabilty to cope with withdrawal and the feeling of abject failure. It is a difficlut balance to encourage people while also being realistic. G
By Gareth on 15/01/2009 at 4:21 PM - Report this comment



Hello Rowdy - As a practitioner I have had countless clients on Methadone, some for 25 years and others for just a couple of weeks. I have also helped or known many people who have gone “cold turkey” at home, prison, vacation(?), in a caravan, etc. who have done it without medical assistance. Many of those efforts were successful. People rarely die of heroin (or other opiate) withdrawals. Alcohol, benzodiazepine, barbiturate withdrawal can be more dangerous and in need of supervision. Having said that, there is an experimental project in Nottingham where people with drink problems (mostly those who are very heavy drinkers for many years) are detoxed in a hostel with their favourite drink – which is administered in an agreed decreasing regime by the hostel staff. Trained staff give them support, counselling, lots of tea, etc. but no medication. The project is being evaluted now. In my opinion, the means by which people detox is far less important to the outcome than the other factors – such as individual motivation, support, good planning, help from family, friends, the vicar up the road, etc. I leave you with a little advise – get hold of the old Blenheim Project pamphlet – “How to stop – a do it yourself guide to opiate withdrawal” from the early 1980s. I still keep it on my desk at work.
By Ira Unell on 15/01/2009 at 4:34 PM - Report this comment




I have concerns about ‘cold turkey’, some of which Gareth mentions above. The safest home detox is likely to be from opiates, but even here there is no risk-free detox. Intractable vomiting or diarrhoea is not common, but it does happen leading to dehydration, biochemical imbalance and the risk of multi-organ failure or cardiac arrest. The norm these days is for people to present with polydrug dependence. We are often faced with complex detoxifcation needs, not just from opiates. It’s methadone AND alcohol or methadone AND benzodiazepines or some other combination. That needs careful handling. Risk management (considering and actively managing the risks) is an important part of detox planning. We need to be alert to the possibility of seizures; psychosis; Wernicke’s encephalopathy, depression and the other possible complications above. I’ve seen all of these in the past. Knowing the past medical and psychiatric histories is part of this safe planning process. Active management of the risks afforded by loss of tolerance including overdose awareness and training is advisable. In general, the client is not best placed to be their own risk assessor. By definition they will be impaired in decision making to some extent in active addiction and certainly during detox. I dont vote ‘yes’ for self-detox on these grounds. The ‘risk assessor’ would need to be someone who knew and understood the risks and had competence in managing them. Perhaps advice on how to make the process safer would help those determined to go ahead, but I feel it would be a foolhardy practitioner or organisation which encouraged clients to self-detox without the support and supervision of experienced, clinically aware practitioners.
By David McCartney on 15/01/2009 at 6:06 PM - Report this comment




Rowdy, my experiences have been similar to yours, in that i’ve not been aware, clinically or anecdotally, of anyone “coming a serious cropper doing a cold turkey”. I’d like to know if, by “non-medically” assisted, you are also referring to the use of herbal/nutritional medicines? I have been working here in Melbourne as, amongst other things, a naturopath, in a range of different community health programmes specialising in working with drug-users across the entire drug-use spectrum. The value of complementary therapies in adult residential withdrawal units has very recently been officially recognised by the Victorian Department of Human Services, which oversees provision of drug and alcohol services in Victoria. I have supported a number of community-based clients who have wanted to detox in an environment other than a dedicated residential withdrawal service, but am not sure if my cases fit into your definition.
By Duncan Kirkland on 16/01/2009 at 1:30 AM - Report this comment



I tried to go “cold turkey” once, about 11 years ago. At that point I had been using just over a year, the waiting lists for a ‘script were a mile long so I decided to do it myself. I found the physical withdrawal bad enough but what was going on in my head was the worse!! I have ADHD and find it hard dealing with extremes of emotion at the best of times without rattling on top!! I got really paranoid, angry and to some degree aggressive. I kept thinking the whole world was against me and friends were out to poison me! After two days I admitted defeat!! I continued to use for the next 10 years, during this time I went on methadone countless times but never managed to stop using. Until 18 months ago, something just clicked!! I got on methadone, stable on 75ml and have not used since. I am now on 28ml. Sometimes I think if it wasn’t for the mental side of “cold turkey” I may have got clean years ago, but then I think, for me addiction had to run it’s course. If the right help and support is in place then for some people home detox could work, I think it is important that people wishing to stop using are aware of ALL options. After all, what works for some might not work for others!!
By pixie on 17/01/2009 at 12:25 PM - Report this comment



Pixie – I hope you don’t think for a moment, when I said I hadn’t known anyone to come a cropper, that I meant to imply cold turkey isn’t pure hell for most people. I also didn’t mean to imply that suddenly and completely stopping is necessarily better or worse than any other method. [And to be extra clear, of course I recognise that there are situations in which cold turkey is totally inappropriate.] I agree with you absolutely that all options should be on the table: everybody’s path to recovery is unique and this should be recognised and reflected in the range of supports available. There are no ‘silver bullets’ – complex problems usually require complex solutions. Your experiences are very valuable, and I appreciate you sharing them. It’s always great to hear about people who are on the way to where they want to be :)
By Duncan Kirkland on 18/01/2009 at 5:28 AM - Report this comment



Is paracetemol medically assisted? Nicotonic acid, folic acid, vitamin B etc. Clonidine is non opiate, can be prescribed once and then if wanted, bp can be taken by yourself. Some people use clonidine for day 3 only, some try and not use it at all. As with all things drugs there there are many grey areas. Not giving anything for symptomatic relief is taking a point too far. Yes, warm baths, massage, low stimulation etc are all fine but when the receptors are firing and there aint nothing attaching, give me a silver bullet to hit ol’ wolfy anyday (and that silver bullet can be herbal or even auricular acupuncture, point being both are still medically assisted in the base sense and how I think of it). I agree with David that due to poly substance use , detoxs are becoming more dangerous. The most psychotic I have ever seen anyone is an ex vietnam vet who tried to cut down on his rohees.
By erasmus on 19/01/2009 at 9:25 PM - Report this comment



OK. Thanks for these comments. My own experience is not so dissimilar to most of the thoughts posted here. I self-detoxed three or four times. Significantly, the fourth and final time was in the house of a couple of very good, non-using friends. Very warm and comfortable, someone else answering the door, running you a bath and so on. I couldn’t believe the subjective difference it made. That really coloured my approach when I started to work at Lifeline. We always put a lot of planning into our home detoxes. Tracking down non-using friends, making sure the venue was warm and safe (plenty of shillings for the meter – that sort of thing). By and large people did OK. For some reason, I don’t have a formal record of them (I do have a record of funerals I attended – 27 in 1974 – does that put the “dangers” of cold turkey into some sort of context?) but I’m fairly sure I would have been integrally involved in about 35 – 40 so I’m not talking hypothetically here. Mostly, the individuals involved would have been using palfium or pethidine (street heroin was virtually unknown outside London in the early 1970s unless it was BP heroin stolen from a chemists – in which case purity would have been 100%) or latterly diconal. Often they had a serious barbiturate (in the early days – mandrax) habit too which required careful management. BUT in all that time, I never saw or had reported to me any complication that required medical intervention. Sure, it was really uncomfortable but the discomfort could be reduced and most people preferred it to a hospital detox (That shows how old I am!! I can remember when the NHS would give you an inpatient detox!!). I’m not saying that David is wrong. but I do think that his position is the natural legacy of the demonisation of detox and the mythologising of addiction by the medical profession over the past two decades. Air crashes happen with some regularity but we don’t say that travelling by plane is therefore irresponsible. As for this notion that people are now poly-drug users now and weren’t before so detoxes are more complicated. Sorry – that’s just ignorance. Those of us who were around in those days (and remember speedballing; the full-monty; mandrax and barbs; ritalin; physeptone) know that poly-drug use was always there. So what I’m saying is it would be nice to see home-detox (which people are doing anyway because drug services are so anti-recovery they won’t offer it) considered rationally and not demonised as some sort of malpractice. It has a number of very significant advantages over other approaches to detoxification which may more than compensate for the downsides.
By Rowdy Yates on 20/01/2009 at 11:55 AM - Report this comment



Rowdy Yates
Senior Research Fellow
Scottish Addiction Studies
Dept. of Applied Social Science
University of Stirling
Scotland

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