For many individuals, a physical dependence on alcohol or drugs must be addressed before he/she can fully and safely participate in substance abuse treatment.

Substance abuse treatment is intended to address the biological, psychological and social aspects of addiction. Individuals who are having issues with the use of drugs or alcohol have often developed a physical dependence on substances. This means that the body has adapted to the drug or alcohol and the individual requires more in order to achieve the same effect. This physical dependence must be addressed before the individual can benefit from any type of substance abuse treatment. Many people who have become physically dependent are no longer using substances to feel euphoric, but are rather using to feel “normal” and prevent the body from going through withdrawals. If the individual stops using drugs or alcohol suddenly, the body begins to go through the withdrawal process.

There are a number of drugs that can cause physical dependence. The following is a common list of substances that can cause physical dependence if used consistently over a period of time:

• Opioids (includes heroin, morphine, oxycodone, methadone, fentanyl, dilaudid, hydrocodone)
• Alcohol
• Benzodiazepines (e.g. Valium, Xanax)
• Barbiturates

The physical withdrawal symptoms from drugs and alcohol vary from substance to substance. While some individuals may experience mild discomfort, others may need medical monitoring to reduce the risk of serious complications such as seizures. Even individuals who are using substances that do not cause physical dependence can experience withdrawal symptoms. It is important to note that the withdrawal process from some substances can be dangerous. In particular, it is highly recommended to seek medical monitoring for the detoxification from alcohol and benzodiazepines. Withdrawal symptoms can include:

• Intense worry or anxiety
• Irritability
• Depression
• Restlessness or insomnia
• Sweating or hot flashes
• Flu-like symptoms: body aches, headaches, weakness
• Muscle and bone pain
• Lack of appetite
• Nausea, vomiting or diarrhea
• Confusion
• Hallucination
• Shaking or tremors

Detoxification is the process of allowing the body time to rid itself of the substance(s) on which it is dependent. This process can take anywhere from three to ten days, on average, and the length and severity depend on the type of substance and the length of time that the person has been using the substance. Many individuals who are physically dependent on substances continue using simply due to the fear of the withdrawal symptoms. Opiate users who are physically dependent, for example, often talk about a fear of being “dope sick.” Daily opiate use becomes not about getting high, but instead about preventing the flu-like symptoms that come with the withdrawal from opiates. Medical detoxification can be very useful in these circumstances. The medical staff monitors vitals and symptoms on a regular basis and provides medical treatment as appropriate to make the individual as comfortable as possible.

Pathways Florida has a 30-bed medically-supervised detoxification unit. Upon admission, each client is evaluated by a Registered Nurse. Testing is conducted to determine what substances are involved and a full medical history is gathered. Based on the results of the testing and the evaluation, a detoxification protocol is initiated. Each client is also oriented to the detox unit by an Admissions Counselor.

Detox clients meet regularly with the physician staff to address possible protocol adjustments and to determine when the client has safely completed the detoxification process. Once admitted onto the detox unit, clients are guided through the physical and emotional crisis of withdrawal. In addition to the challenges of physical detoxification, many individuals also struggle with the psychological aspects of no longer using substances. The education and support for ongoing recovery begin during the stay at detox in order to build a foundation for the ongoing care at the Pathways Florida residential program. There is an emphasis on good nutrition, linking to self-help support groups and planning for continuing care. During the average stay of three to ten days, clients participate in structured, daily activities including educational groups, 12-Step meetings and discharge planning.