Rapid detox: understanding new treatment approaches for the addicted patient.

TOPIC. Despite substantive advances in understanding of genetic and biochemical basis of substance abuse and addiction in the last decade, little information has been translated into alternative treatment models for the addicted patient. Rapid detox, an alternative form of detox treatment, is gaining in both acceptance and popularity. PURPOSE. To increase readers' understanding of the neurobiology of addiction and the mode of action of new detox approaches for patients addicted to opiate drugs. SOURCES. A review of the current literature pertaining to rapid detox. CONCLUSIONS. Rapid detox is a viable alternative for selected patients attempting to detox from opiate agents of abuse. Increasing knowledge of new treatment approaches allows nurses working to assist addicted patients in planning and receiving treatment based on new awareness of the neurobiology of addiction. Key words: Detox, neurobiology of addiction, opiate, rapid detox Substance abuse and dependency persist as major health concerns in America. While the economic costs to our society are huge, the human cost is harder to quantify and remains far more damaging. Enormous healthcare resources have been devoted to reducing substance abuse and dependency (Scott, 1996), with the number of drug and alcohol treatment facilities almost doubling between 1980 and 1994 (Substance Abuse & Mental Health Services Administration [SAMHSA], 1996), and with national and state expenditures doubling during the same period (Huber, Pope, & Dayhoff, 1994). Current drug abuse treatment approaches, developed primarily during the 1960s and 1970s, have changed very little since their inception (Metzger, McKay, Durell, Alterman, & O'Brien, 1996). The changes that have occurred in treatment in the last decade have been primarily structural and have been propelled by the tide of managed care reforms rather than the emergence of new treatment models. Managed care and cost-containment policies have affected substance abuse treatment by decreasing the type and intensity of services; shifting treatment from inpatient and residential care to outpatient settings, with 87% of patients now treated in outpatient programs (SAMHSA, 1996); and in the blurting of public and private programs (D'Aunno & Vaughn, 1995). While these structural changes have altered the landscape in which treatment occurs, the nature of treatment has remained constant. The Development of New Models of Treatment Substantive advances have occurred in our understanding of the genetic and biochemical basis of substance abuse and addiction in the last decade, yet little of this information has been translated into alternative treatment models for the addicted patient. Abstinence remains the goal of traditional addiction treatment. Abstinence, and the concomitant sudden cessation of drug use in addicted individuals, causes a predictable cascade of symptoms collectively referred to as withdrawal syndrome. Medically supervised detoxification treatment has traditionally been seen as the gold standard and as the logical starting point of treatment. Traditional detox has involved treatment with prescription medications, which produce similar physiological responses, less psychoactivation, and which can be more precisely regulated and tapered as the patient's metabolism readjusts to functioning without the addictive drug (McLellan, Arndt, Metzger, Woody, & O'Brien, 1993). Taking an average of 3 to 15 days, depending on the abused drug, medical detox controls but does not eliminate subjectively uncomfortable withdrawal symptoms (Delfs, Zhu, Druhan, & Aston-Jones, 2000). Universally accepted addiction treatment approaches are beginning to be challenged by the emergence of innovative treatment approaches based on new understanding of the neurochemistry of addiction. One such approach, rapid detox, has emerged as an alternative that is gaining in both acceptance and popularity, evidenced by its recent showcasing in television episodes of both "E. …