Rapid Detox Is No Magic Pill

Program Has Its Shortcomings and Dangers

Man Sweating
Rapid Withdrawal Is Not a 'Cure'. © Getty Images

Researchers continue to seek a "magic pill" that can instantly cure alcoholics and addicts, but one new process currently used - rapid detoxification - has found itself in the midst of growing controversy. Chemical Dependency Specialist Shelly Marshall explains the shortcomings of the process, in this two-part article.

One of the main characteristics of the alcoholic or addict is his or her seeking instant happiness in a fix, pill, or drink.

They seem unwilling to earn their happiness through moral behavior, cultivating a happy family, working hard or being devoted to a cause.

They demand happiness - now - and addicts don't care how they have to get there. Today these same addicts are being seduced into “instant recovery” once they find their drug use is destroying their lives.

Dangerous Program?

This "instant recovery," called Rapid Opiate Detoxification (ROD), is spreading to many countries promising addicts a magical solution to drug and alcohol addiction. Although there are legitimate uses for ROD, its very seductiveness and promises of instant "cure" for addiction are misleading and even dangerous.

ROD sounds like paradise to an addict and to the doctor who treats addicts. But there is trouble in paradise. During a four-year period, seven patients from the U.S. Detox Intensive Treatment Unit in New Jersey under the care of Dr. Lance L.

Gooberman, died within days of the procedure. As a result, New Jersey regulators took Gooberman to court to have his medical license removed.

Gooberman said the patients that died had undetected heart problems or took cocaine, triggering a heart attack. But some doctors who perform rapid detoxification say the procedure severely stresses addicts' already ravaged bodies.

To Good to be True?

Just what is ROD and why is it so dangerous? While under sedation, the patient undergoes an accelerated procedure that blocks the brain's opiate receptors from any opiates. Additional medications are administered to accelerate the physical reactions to the rapid withdrawal while the patient is unconscious.

After approximately 4 to 6 hours or 12 to 48 depending on the exact drugs and method used, the patient awakens and supposedly is no longer physically dependent on opiates and has no conscious awareness of experiencing any withdrawal.

Where Is the Evidence?

Sounds too good to be true, doesn't it? Well, it probably is. Most of the research with optimistic results about ROD are sponsored by the institutions that stand to make money from the procedure.

For instance, one study from Mount Sinai Medical Center, University of Miami School of Medicine, Miami Beach, concluded that this treatment (one they make money on) is "One hundred percent successful detoxification." That is like saying that one hundred percent of the people we give shots to, get shots.

It's meaningless, really.

They also claim that 55% reported relapse free status at the six month follow up. But this is relapse only from opiates, not alcohol and other drugs.

Risks are High

A different study showing the less optimistic side of rapid detoxification, appeared in the Journal of Drug and Alcohol Dependence in 1998. Cucchia et al reported that "withdrawal symptoms were still present 24 hours after detoxification and 80 percent of the patients relapsed during a 6-month follow-up."

This is similar to another study from Medizinische Klinik in Muchen, West Germany by Hirtl and Zilker who found the procedure too dangerous to complete, that "No detoxification was finished within 48 hours," and concluded that "there is no obvious benefit from this method, whereas the risks are high."

Withdrawal Symptoms Can Cause Relapse

Traditional forms of opiate detoxification include methadone, buprenorphine, or "cold turkey" where an addict just drops drugs and toughs it out.

Not being able to get through prolonged and painful withdrawals with intense cravings for the drug of choice is often cited as the reason for dismal success rates in addiction treatment. So professionals look for alternatives and the addict looks for Aladdin's Lamp.

Compliance Rates Are Low

"The rapid opiate detoxification procedure physically detoxifies the patient from opiates in a few hours – offering them the chance to begin the recovery process immediately," Dr. Gooberman defends his practice. For follow-up, the patient is put on naltrexone or another opiate antagonist to block the opiate receptors so the addict can't get high and they are encouraged to seek counseling

The compliance rate for taking the opiate antagonists and seeking counseling is dismal because patients going for rapid detoxification often mistakenly believe they are somehow going to be "cured" and can begin using other drugs.

Substituting One Addiction for Another

It is well known that an addict often stops heroin and begins drinking too much or taking too many tranquilizers," explains Loretta Standard LCDC, a counselor in a methadone maintenance clinic in Corpus Cristi, Texas. "If they can't take one drug, they take another. This is because it isn't just heroin they are addicted to. If they are an addict, they will be in trouble with any mind-affecting chemical. Our treatment goal is eventual abstinence."

The self-help program of Narcotic's Anonymous stresses that abstinence combined with a total lifestyle change is the only way to arrest the symptoms of the disease. "An addict will always look for the easier, softer way," says Georgiana G. a 30-year member of NA in California. "If I can't use heroin then I will use something else that gives me instant good feelings."

Naltrexone Can Help

Most addiction experts would agree that you can't just take out the drug and have a happy, well adjusted person. You have to train them to get over the magical thinking and instant happiness, to earn their place in the sun - not look for the lamp with a genie in it.

The important thing to remember about ROD is that it is not a treatment for addiction. It is a treatment for withdrawal and this is all. Because some studies have found that rapid detox followed by naltrexone did seem to keep patients from relapsing long enough to make those necessary lifestyle changes, it probably has its place in a comprehensive treatment approach.

We must, however, be diligent in making it clear that ROD is no Aladdin's Lamp and you can't get well by making a wish.

Shelly Marshall is a Chemical Dependency Specialist from Virginia who trains addiction counselors around the world. You can get more information at her web site day-by-day.org.

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