Detoxification
Detoxification
Definition
Detoxification is a process in which the body is allowed to free itself of a drug. During this period, the symptoms of withdrawal are also treated. Detoxification is the primary step in any drug treatment program and is used as the initial phase in treating alcohol, heroin, inhalant, sedative, and hypnotic addictions.
Purpose
The goal of detoxification is to clear the toxins out of the body so that the body can adjust and heal itself after being dependent on a substance. For the recovering person to stay abstinent on a long-term basis, detoxification needs to lead into long-term community residential program treatment or outpatient drug treatment lasting three to six months.
Precautions
When individuals are physically dependent on a substance, they experience withdrawal symptoms when they abstain from the drug. Withdrawal symptoms vary with each drug of abuse , but can be severe, and even dangerous. Patients who want to overcome their dependence need help managing the withdrawal symptoms. The patient’s medical team strives to get the patient off a substance on which he or she is physically dependent, while treating the withdrawal symptoms.
Pregnant women cannot be detoxified from opiates (also called narcotics, including morphine, heroin, and similar drugs) because strict detoxification can increase the risk of spontaneous abortion or premature birth. These women can be treated with methadone as an alternative. Methadone acts as a replacement for the heroin in the woman’s body, but the methadone does not provide the “high” that the heroin provides. In addition, methadone is safer for the fetus than heroin.
To be an effective first step of treatment, detoxification must be an individualized process because patients have varying needs.
Description
The body, when allowed to be free from drugs, detoxifies itself through its normal metabolic processes. The withdrawal symptoms are treated during this process so that the patient will be comfortable while the body detoxifies itself.
The process of substance addiction
Before discussing detoxification, it may be useful to understand how the body becomes addicted and why withdrawal symptoms are experienced. In physical addiction or dependence, as a person uses a substance or chemical over a long period of time, his or her body chemistry changes. Once a substance enters the body through drinking, smoking, injecting, or inhaling, it travels through the bloodstream to the brain. The brain has a complex reward system built in; when people engage in activities that are important for survival (such as eating), special nerve cells in the brain release chemicals (neurotransmitters , including dopamine ) that induce feelings of pleasure. Because of this reward system in the brain, humans are programmed to want to repeat actions that elicit those pleasant sensations. In other words, feelings of pleasure reinforce certain activities or behaviors. Addictive substances interfere with this reward system. Some drugs mimic the effects of a natural chemical, some block the communication between nerve cells, and some substances trigger a larger-than-normal release of neurotransmitters like dopamine. The result of this interference is that dependent drug users physically need the drug to feel pleasure. As they become more dependent, their bodies becomes less responsive to the substance, and need more of it to get the desired response—a phenomenon called tolerance. Also as a result of the interference with the brain’s system, when the dependent user does not have the drug in his or her system, feelings of depression or unpleasant withdrawal symptoms may be experienced. These consequences also reinforce the substance use. People dependent on substances resort to using more drugs to avoid the depression or the withdrawal symptoms.
Withdrawal symptoms
The symptoms and severity of these symptoms vary from one substance to another.
ALCOHOL
After a person who has used alcohol heavily for a long time stops drinking, he or she may experience increased heart rate, shaking, difficulty sleeping, nausea, restlessness, anxiety , and even seizures. The affected person may also experience hallucinations (seeing, hearing, or feeling something that isn’t really present). In some cases, delirium tremens (DTs) may occur as part of the withdrawal. Delirium tremens is a violent delirium (fading in and out of consciousness) with tremors, increased motor activity, visual hallucinations, disorientation, confusion, and fever that happens 48-96 hours after the alcohol-dependent person has had his or her last drink. These symptoms can last anywhere from three to 10 days. This state is a medical emergency because it could be fatal.
HEROIN AND OTHER OPIATES
Heroin is part of a family of drugs called opiates or opioids , which are made up of drugs that come from the seeds of the Asian poppy (heroin, opium and morphine, for example) and also manufactured drugs that act like the natural drugs (meperidine or Demerol). Symptoms of opiate withdrawal include restlessness, insomnia , anxiety, irritability, loss of appetite, diarrhea, abdominal cramps, nausea, sweating, chills, and runny eyes and nose.
SEDATIVES AND HYPNOTICS
Sedatives and hypnotics are drug families that are often considered in one group called the sedative-hypnotics. These drugs depress or slow down the body’s functions, and can be used to calm anxiety or to induce sleep. When taken in high doses or when abused, these drugs can cause unconsciousness or death. These drugs include barbiturates and benzodiazepines. Some barbiturates are amobarbital (Amytal), pentobarbital (Nembutal), and secobarbital (Seconal). Some benzodiazepines include diazepam (Valium), chlordiazepoxide (Librium), and lorazepam (Ativan). When a person dependent on these drugs stops taking them suddenly, he or she might experience restlessness, muscle cramps, anxiety, insomnia, irritability, paranoid behavior, and even seizures or death.
Alcohol detoxification
Patients being detoxified from alcohol can safely be treated with rest, nutrition, vitamins, and thiamin (a B vitamin whose absorption is affected by alcohol abuse). Detoxification can be completed in an inpatient setting, or patients may participate in intensive outpatient (day hospital) treatment. People with mild or moderate withdrawal symptoms undergo detoxification over a five-day period and receive a benzodiazepine or phenobarbital to help ease the withdrawal symptoms. Delirium tremens can be treated with very high-dose benzodiazepines (such as chlordiazepoxide or diazepam) or with antipsychotic medications such as Haldol (haloperidol ). The patient usually receives medication at doses high enough to give 60 mg or more of the medication over a 24- to 36-hour period, and the doses of these medications are gradually decreased by 20% each day. Patients who have liver disease, dementia , or patients who are over the age of 65 or with significant medical problems may receive lorazepam for the withdrawal symptoms.
Heroin detoxification
Patients with heroin dependence may receive help with their detoxification in one of two forms.
Opioid agonists are drugs that act like heroin in the patient’s body but do not provide the same “high,” and are given in gradually decreasing doses. Because these medications “act” like heroin, the person does not experience withdrawal symptoms. Some examples of this kind of medication are methadone and levo-alpha-acetylmethadol (LAAM); buprenorphine is a partial opioid agonist, which means that it acts like heroin or methadone, but it limits the effects of opioids so that higher doses produce no greater effects. It is available as a monotherapy (meaning it is the only drug taken) or in combination with another drug, naloxone, as therapy for heroin detoxification. Some studies have found that buprenoporphine shows promise in treating pregnant women for opiate addiction; however, the current standard of care remains methadone replacement for pregnant women. The second form of help for patients undergoing heroin detoxification is the use of a drug, such as clonidine (Catapres), that blocks some of the withdrawal symptoms. There is also a controversial method of heroin detoxification called ultra-rapid opioid detoxification under anesthesia/sedation, and there is an experimental method using a medication called lofexidine.
METHADONE SUBSTITUTION
Methadone substitution can occur in outpatient or inpatient settings, and is a method of detoxification that involves helping patients off substances such as heroin by substituting these substances with methadone to ease the withdrawal symptoms, and gradually decreasing the dose until no methadone is needed for the symptoms. Patients may begin with a dose of methadone that is between 20 mg and 40 mg per day. The initial dose may be adjusted so that the most beneficial dose can be discovered, based on the patient’s withdrawal symptoms. The dose is then gradually decreased over the next several days. The decrease in methadone dosage is called tapering. If the detoxification is being completed in an inpatient setting, the methadone dose can be tapered more quickly, because medical staff can closely monitor patients for withdrawal, and detoxification can be achieved in about five to 10 days. However, in the case of outpatient detoxification, the taper has to be done much more slowly to assure that the patient does not have an adverse reaction or relapse (use the drug of abuse again) to treat their withdrawal symptoms. The dose may be decreased about 10% per week initially until a dose of 20 mg is reached. Then the dose can be decreased by 3% per week for the rest of the time that the patient needs to be detoxified. Patients are usually comfortable with the slow decrease of the medication until the dose gets below 20 mg/day. At that point, patients tend to become fearful of being off opioids and having symptoms of withdrawal.
Clonidine is used much more frequently than methadone in detoxification. Methadone is used frequently as long-term maintenance treatment for heroin addiction.
BUPRENORPHINE
Buprenorphine is another medication that is used during opioid detoxification. Because it also acts like heroin in the body, the patient does not experience the withdrawal symptoms as the heroin is being eliminated from the body. It is given as an intramuscular injection or intravenously. It begins to work within 15 minutes and its effects last six hours. It is given as part of three phases of detoxification: induction, stabilization, and maintenance. Induction is the initiation of buprenoporphine therapy, which is administered once the patient has not used opiates for 12 to 24 hours. During stabilization, the dose may be adjusted as the patient stops having cravings or experiences fewer side effects. The length of the maintenance phase varies depending on the needs of the individual, and ends with medically supervised withdrawal. This drug has shown greater effectiveness than other replacement therapies in treating opiate withdrawal.
CLONIDINE
Clonidine is a medication that decreases many of the symptoms of opioid withdrawal. Patients may require nonsteroidal anti-inflammatory drugs (NSAIDS, such as ibuprofen) for the treatment of muscle aches. Clonidine’s major side effects include sedation and hypotension (low blood pressure) because it is used to treat high blood pressure. Patients undergoing detoxification using clonidine will have their blood pressure and pulse checked regularly. The starting dose of clonidine is 0.1-0.3 mg every four to six hours—the maximum amount that can be given in one day is 1 mg. During days two through four of the detoxification, the dose of clonidine is adjusted to control the withdrawal symptoms. Again, however, the dose cannot exceed the maximum dose. On the fifth day of detoxification, the dose may be slowly tapered.
The clonidine patch is a transdermal patch, allowing the drug to be delivered through the skin and exposing the patient to a constant amount of the drug over a seven-day period. It also allows the person to experience a more comfortable heroin detoxification. It comes in three doses: 0.1-mg, 0.2-mg, and 0.3-mg. Patients who will use the clonidine patch need to have both the patch on and take oral clonidine during the first two days of the detoxification, because it takes the patch two days to reach a steady state and be effective. The patient takes oral clonidine 0.2 mg three times a day, and the weight of the patient determines the dose of the patch. On day two, the amount of clonidine that the patient takes by mouth is reduced by half and then it is completely stopped after day three. After seven days, the patch is removed and replaced with a patch that is half the amount of the original dose. The patch is continued for as long as the patient continues to have symptoms of withdrawal. Blood pressure is monitored for the patient using the patch, as well. The detoxification process in general takes about seven days using clonidine.
CLONIDINE-NALTREXONE ULTRA-RAPID DETOXIFICATION
Clonidine-naltrexone ultra-rapid detoxification has been attempted as a faster means of detoxification than using clonidine alone, and a similar “ultra-fast” method in combination with anesthesia has also been tested. These approaches remain quite controversial, and published clinical data supporting their efficacy are lacking, as are controlled trials.
LOFEXIDINE
Lofexidine is used experimentally in the United Kingdom for opioid detoxification. It appears to cause less sedation and fewer cases of low blood pressure than clonidine. In the United States, the National Institute of Drug Abuse (NIDA) is conducting studies on treatments using this drug in combination with naltrexone.
Mixed substance abuse
Mixed substance abuse (also called polysubstance abuse) occurs when individuals abuse more than one substance. Many doctors prefer to use phenobarbital to detoxify patients with polysubstance abuse problems. Patients receiving phenobarbital may receive a test dose, and then based on his or her tolerance and symptoms, the dose will be adjusted. Patients cannot receive more than 600 mg of phenobarbital a day. After two to three days, once the patient is doing well, the dose can be reduced by 30-60 mg. Whether detoxification for polysubstance abusers will be completed on an inpatient or outpatient status depends on the drugs the patient abuses.
Benzodiazepines
These medications are often used to help patients during detoxification, but these substances themselves can be abused and addictive. Patients who have taken a prescribed benzodiazepine for two weeks, even in a therapeutic dose, need to be safely detoxified with a slow taper. The amount of drug the person takes is dropped by 10-25% every week if the patient has minimal withdrawal symptoms. If the patient has taken very high doses for long periods of time, he or she is at increased risk for addiction. If the person has been taking a benzodiazepine medication for years, it can take months before he or she can get off the drug. Anticonvulsant medications like carbamazepine (Tegretol) and divalproex sodium (Depakote) can be used to make the detoxification process faster and more comfortable for the patient.
Preparation
The first step in any detoxification, regardless of the substance, is a physical exam and history taken by a physician. This information gathering and examination will help the treatment team assess the patient’s overall health. In general, the healthier the patient is, the better the chances are that the patient will experience a detoxification without serious or life-threatening complications. Patients also need to give urine and blood samples to test for drugs and alcohol.
Aftercare
After the patient has completed detoxification, he or she needs further treatment either at an outpatient, inpatient, residential, or day hospital program in order to remain drug-free for the long term. Patients are treated by trained health care professionals, and some patients are also counseled by people who are recovering from addiction themselves. Many patients also benefit from 12-step programs or self-help groups , such as Alcoholics Anonymous (AA) or Narcotics Anonymous (NA).
Most opioid users are treated with ambulatory or outpatient detoxification or residential treatment followed by outpatient counseling. Some people who have abused opioids and have undergone detoxification and counseling are able to remain drug-free. Many, however, relapse, even after receiving psychotherapy. People recovering from opioid addiction can receive methadone or LAAM as maintenance therapy to prevent relapse. Similar to the aid these medications can give patients during detoxification, when taken daily as a therapy they continue to “act” as heroin, keeping the withdrawal symptoms from appearing. Methadone maintenance therapy can be provided through either residential or therapeutic communities and outpatient drug-free programs. Methadone maintenance treatment therapy is controversial, however, because it does not cure the person’s addiction—it replaces it with another substance. Proponents of methadone maintenance therapy argue that people receiving methadone are able to function much better in society than people addicted to heroin. Because their drug-seeking behavior is reduced, these patients can become productive at work and their interpersonal relations improve.
People recovering from alcoholism can also benefit from counseling and support after detoxification, and a maintenance therapy is available to them, as well. Disulfiram (Antabuse) is a medication that interferes with the body’s breakdown and processing of alcohol. When alcohol is consumed while a patient is taking disulfiram, the medication makes the effects of the alcohol much worse than the patient would normally experience; facial flushing, headache, nausea, and vomiting occurs, even if alcohol is consumed in a small amount. In order for disulfiram to be effective, the patient must want this kind of reinforcement to maintain abstinence and must be committed to it. Patients also must note that any form of alcohol can trigger the undesired effects, including cooking wine or mouthwash with alcohol. This drug, when used in combination with buprenorphine, also appears to be effective in treating cocaine addiction in people who also are addicted to heroin.
Risks
When benzodiazepines are the drug of addiction, they must be discontinued and cannot be given on an outpatient basis because of their potential for abuse. For all patients undergoing detoxification, benzodiazepine use must be monitored carefully because of the potential for new addiction. Elderly patients undergoing detoxification and receiving benzodiazepines must be monitored closely because they are more sensitive to the sedating effects of these drugs and are also more prone to falls while receiving these drugs. If benzodiazepines are not discontinued gradually, patients can have withdrawal symptoms such as irritability, poor sleep, agitation and seizures. Ultrarapid opioid detoxification under anesthesia/sedation is a serious procedure. Patients have died undergoing this procedure, and it remains controversial.
It should also be noted that many substances used in detoxification can themselves cause addiction. An example of this risk has already been given with benzodiazepines—these medications ease withdrawal symptoms during detoxification, but patients can become addicted to these medications, as well.
Normal results
Normal results for a well-managed detoxification would include freedom from the drug of addiction and ability to enter long-term treatment.
Success rates vary among people recovering from substance abuse. As might be expected, patients who successfully complete a full treatment program after detoxification (that includes counseling, psychotherapy, family therapy , and/or group therapy or some combination of those therapy types) achieve higher rates of success at remaining drug-free. Patients who were addicted for shorter periods of time and patients who spend longer periods in treatment are generally more successful at remaining abstinent from drugs over the long term.
Studies indicate that people who abuse alcohol and who want to stop have a higher chance of success if they undergo inpatient detoxification versus outpatient detoxification.
Abnormal results
One abnormal result that may occur is that patients who received nasogastric or tracheal tubes for opioid detoxification under anesthesia may experience adverse effects or complications. These patients are at risk for: trauma to their lips, vocal cords, larynx, and teeth; nosebleeds; high blood pressure; elevated heart rate; irregular heartbeat; and vomiting, which can lead to aspiration pneumonia.
An additional abnormal result would be a new addiction as a consequence of the detoxification.
KEY TERMS
Agonist —A chemical that reproduces the mechanism of action of a neurotransmitter.
Antagonist —A substance whose actions counteract the effects of or work in the opposite way from another chemical or drug.
Buprenorphine —A medication that blocks some of the withdrawal effects during heroin detoxification.
Detoxification —A process in which the body is allowed to free itself of a drug while the symptoms of withdrawal are treated. It is the primary step in any treatment program for drug or alcohol abuse.
Disulfiram —A medication that helps reinforce abstinence in people who are recovering from alcohol abuse. If a person taking disulfiram drinks even a small amount of alcohol, he or she experiences facial flushing, headache, nausea, and vomiting.
Lofexidine —A medication approved for use in Great Britain to aid the opioid detoxification process.
Methadone —A drug often prescribed legally as a replacement for heroin. It induces a slight high but blocks heroin from producing a more powerful euphoric effect. It may be used in heroin detoxification to ease the process, or it may be used daily after detoxification as maintenance therapy. Methadone maintenance therapy is controversial.
Withdrawal —Symptoms experienced by a person who has become physically dependent on a drug, experienced when the drug use is discontinued.
After the detoxification is completed, a patient may relapse. Support is critical for the patient to continue long-term therapy and successfully overcome addiction.
See alsoAddiction; Disease concept of chemical dependency.
Resources
BOOKS
Beers, Mark H., MD, and Robert Berkow, MD, eds. “Alcoholism.” The Merck Manual of Diagnosis and Therapy, 17th ed. Whitehouse Station, NJ: Merck Research Laboratories, 1999.
Jaffe, Jerome H., MD, and others. “Substance-Related Disorders.” Comprehensive Textbook of Psychiatry, 7th ed. Benjamin J. Sadock, MD, and Virginia A. Sadock, MD, eds. Philadelphia: Lippincott Williams and Wilkins, 2000.
Matthews, John. “Substance-Related Disorders: Cocaine and Narcotics.” Psychiatry Update and Board Preparation Thomas A. Stern, MD, and John B. Herman, MD, eds. New York: McGraw Hill, 2000.
PERIODICALS
Fuller, Richard K., MD, and Susanne Hiller-Sturmhofel, PhD. “Alcoholism Treatment in the United States: An Overview.” Alcohol Research and Health 23 (1999): 69–77.
Khantzian, Edward J., MD. “Methadone Treatment for Opioid Dependence.” American Journal of Psychiatry (Nov. 2000): 1895–96.
Leshner, Alan, PhD. “Heroin Abuse and Addiction.” National Institute on Drug Abuse Research Report Series. NIH Publication Number 00-4165, Washington, D.C. 2000.
Shreeram, S. S., MD, and others. “Psychosis After Ultra-rapid Opiate Detoxification.” American Journal of Psychiatry (June 2001): 970.
ORGANIZATIONS
The College on Problems of Drug Dependency (CPDD). CPDD Executive Offices, Department of Pharmacology, 3420 N. Broad Street, Philadephia, PA19140. Telephone: (215) 707-3242. <http://views.vcu.edu/cpdd>.
Institute for Comprehensive Detoxification and Rehabilitation. Telephone: (877) 704-ICDR (4237). <http://www.views.vcu.edu/cpdd/>.
National Institute on Alcohol Abuse and Alcoholism (NIAAA). 6000 Executive Boulevard, Willco Building, Bethesda, MD 20892-7003. <http://www.niaaa.nih.gov>.
National Institute on Drug Abuse (NIDA). 6001 Executive Boulevard, Room 5213, Bethesda, MD 20892-9561. Telephone: (301) 443-1124. <http://www.nida.nih.gov>.
OTHER
Brady, Kathleen T., MD, PhD. “Issues of Substance Abuse in Women.” American Psychiatric Association 2004 Annual Meeting. <http://www.medscape.com/viewarticle/480925>.
Center for Substance Abuse Treatment. “Detoxification and Substance Abuse Treatment.” Treatment Improvement Protocol (TIP) Series 45. DHHS Publication No. (SMA) 06-4131. Rockville, MD: Substance Abuse and Mental Health Services Administration. (2006) <http://download.ncadi.samhsa.gov/prevline/pdfs/DTXTIP45(3-30-06).pdf>.
Mathias, Robert. National Institute on Drug Abuse. “Alcohol-treatment Medication May Reduce Cocaine Abuse Among Heroin Treatment Patients.” NIDA Notes (16) (2005) <http://www.nida.nih.gov/NIDA_notes/NNVol16N1/Alcohol.html>.
National Institute of Drug Abuse. “Effectiveness of Lofexidine to Prevent Stress-Related Opiate Relapse During Naltrexone Treatment.” <http://clinicaltrials.gov/ct/gui/show/NCT00142909;jsessionid=0B14CF2553B3CC2A2D16FE2652613D76?order=48>.
National Library of Medicine. National Institutes of Health. “Opiate Withdrawal.” (2006) <http://www.nlm.nih.gov/medlineplus/ency/article/000949.htm>.
Trachtenberg, Alan I., and Michael F. Fleming. National Institute on Drug Abuse. “Diagnosis and Treatment of Drug Abuse in Family Practice.” NIDA Research Monograph. (2005) <http://www.nida.nih.gov/Diagnosis-Treatment/diagnosis.html>.
U.S. Department of Health and Human Services. Substance Abuse and Mental Health Services Administration. Center for Substance Abuse Treatment. “Buprenorphine.” <http://buprenorphine.samhsa.gov/about.html>.
Susan Hobbs, MD
Emily Jane Willingham, PhD
Detoxification
Detoxification
Definition
Detoxification is one of the more widely used treatments and concepts in alternative medicine. It is based on the principle that illnesses can be caused by the accumulation of toxic substances (toxins) in the body. Eliminating existing toxins and avoiding new toxins are essential parts of the healing process. Detoxification utilizes a variety of tests and techniques.
Purpose
Detoxification is helpful for those patients suffering from many chronic diseases and conditions, including allergies, anxiety, arthritis, asthma, chronic infections, depression, diabetes, headaches, heart disease, high cholesterol, low blood sugar levels, digestive disorders, mental illness, and obesity. It is helpful for those with conditions that are influenced by environmental factors, such as cancer, as well as for those who have been exposed to high levels of toxic materials due to accident or occupation. Detoxification therapy is useful for those suffering from allergies or immune system problems that conventional medicine is unable to diagnose or treat, including chronic fatigue syndrome, environmental illness/multiple chemical sensitivity, and fibromyalgia. Symptoms for those suffering these conditions may include unexplained fatigue, increased allergies, hypersensitivity to common materials, intolerance to certain foods and indigestion, aches and pains, low grade fever, headaches, insomnia, depression, sore throats, sudden weight loss or gain, lowered resistance to infection, general malaise, and disability. Detoxification can be used as a beneficial preventative measure and as a tool to increase overall health, vitality, and resistance to disease.
Description
Origins
Detoxification methods of healing have been used for thousands of years. Fasting is one of the oldest therapeutic practices in medicine. Hippocrates, the ancient Greek known as the "Father of Western medicine," recommended fasting as a means for improving health. Ayurvedic medicine, a traditional healing system that has developed over thousands of years, utilizes detoxification methods to treat many chronic conditions and to prevent illness.
Detoxification treatment has become one of the cornerstones of alternative medicine. Conventional medicine notes that environmental factors can play a significant role in many illnesses. Environmental medicine is a field that studies exactly how those environmental factors influence disease. Conditions such as asthma, cancer, chronic fatigue syndrome, multiple chemical sensitivity, and many others are strongly influenced by exposure to toxic or allergenic substances in the environment. The United States Centers for Disease Control estimate that over 80% of all illnesses have environmental and lifestyle causes.
Detoxification has also become a prominent treatment as people have become more aware of environmental pollution. It is estimated that one in every four Americans suffers from some level of heavy metal poisoning. Heavy metals, such as lead, mercury, cadmium, and arsenic, are by-products of industry. Synthetic agriculture chemicals, many of which are known to cause health problems, are also found in food, air, and water. American agriculture uses nearly 10lb (4.5 kg) of pesticides per person on the food supply each year. These toxins have become almost unavoidable. Pesticides that are used only on crops in the southern United States have been found in the tissue of animals in the far north of Canada. DDT, a cancer-causing insecticide that has been banned for decades, is still regularly found in the fatty tissue of animals, birds, and fish, even in extremely remote regions such as the North Pole.
The problem of toxins in the environment is compounded because humans are at the top of the food chain and are more likely to be exposed to an accumulation of toxic substances in the food supply. For instance, pesticides and herbicides are sprayed on grains that are then fed to farm animals. Toxic substances are stored in the fatty tissue of those animals. In addition, those animals are often injected with synthetic hormones, antibiotics, and other chemicals. When people eat meat products, they are exposed to the full range of chemicals and additives used along the entire agricultural chain. Detoxification specialists call this build up of toxins bioaccumulation. They assert that the bioaccumulation of toxic substances over time is responsible for many physical and mental disorders, especially ones that are increasing rapidly (like asthma, cancer, and mental illness). As a result, detoxification therapies are increasing in importance and popularity.
| Common Herbs Used for Detoxification | ||
|---|---|---|
| Antibiotics | Anticatarrhals (Help Eliminate Mucus) | Blood Cleaners |
| Clove | Boneset | Burdock root |
| Echinacea | Echinacea | Dandelion root |
| Eucalyptus | Garlic | Echinacea |
| Garlic | Goldenseal root | Oregon grape root |
| Myrrh | Hyssop | Red clover blossoms |
| Prickly ash bark | Sage | Yellow dock root |
| Propolis | Yarrow | |
| Wormwood | ||
| Diaphoretics/Skin Cleaners | Diuretics | Laxatives |
| Boneset | Cleavers | Buckthorn |
| Burdock root | Corn silk | Cascara sagrada |
| Cayenne pepper | Horsetail | Dandelion root |
| Elder flowers | Juniper berries | Licorice root |
| Ginger root | Parsley leaf | Rhubarb root |
| Goldenseal root | Uva ursi | Senna leaf |
| Peppermint | Yarrow dock | Yellow dock |
| Oregon grape root | ||
| Yellow dock | ||
Toxins in the body include heavy metals and various chemicals such as pesticides, pollutants, and food additives. Drugs and alcohol have toxic effects in the body. Toxins are produced as normal by-products in the intestines by the bacteria that break down food. The digestion of protein also creates toxic by-products in the body.
The body has natural methods of detoxification. Individual cells get detoxified in the lymph and circulatory system. The liver is the principle organ of detoxification, assisted by the kidneys and intestines. Toxins can be excreted from the body by the kidneys, bowels, skin, and lungs. Detoxification treatments become necessary when the body's natural detoxification systems become overwhelmed. This can be caused by long-term effects of improper diet, stress, overeating, sedentary lifestyles, illness, and poor health habits in general. When a build up of toxic substances in the body creates illness, it's called toxemia. Some people's digestive tracts become unable to digest food properly, due to years of overeating and diets that are high in fat and processed foods and low in fiber (the average American diet). When this happens, food cannot pass through the digestive tract efficiently. Instead of being digested properly or eliminated from the bowel, food can literally rot inside the digestive tract and produce toxic by-products. This state is known as toxic colon syndrome or intestinal toxemia.
Detoxification therapies try to activate and assist the body's own detoxification processes. They also try to eliminate additional exposure to toxins and strengthen the body and immune system so that toxic imbalances won't occur in the future.
Testing for toxic substances
Detoxification specialists use a variety of tests to determine the causes contributing to toxic conditions. These causes include infections, allergies, addictions, toxic chemicals, and digestive and organ dysfunction. Blood, urine, stool, and hair analyses, as well as allergy tests, are used to measure a variety of bodily functions that may indicate problems. Detoxification therapists usually have access to laboratories that specialize in sophisticated diagnostic tests for toxic conditions.
People who have toxemia are often susceptible to infection because their immune systems are weakened. Infections can be caused by parasites, bacteria, viruses, and a common yeast. Therapists will screen patients for underlying infections that may be contributing to illness.
Liver function is studied closely with blood and urine tests because the liver is the principle organ in the body responsible for removing toxic compounds. When the liver detoxifies a substance from the body, it does so in two phases. Tests are performed that indicate where problems may be occurring in these phases, which may point to specific types of toxins. Blood and urine tests can also be completed that screen for toxic chemicals such as PCBs (environmental poisons), formaldehyde (a common preservative), pesticides, and heavy metals. Another useful blood test is a test for zinc deficiency, which may reveal heavy metal poisoning. Hair analysis is used to test for heavy metal levels in the body. Blood and urine tests check immune system activity, and hormone levels can also indicate specific toxic compounds. A 24-hour urine analysis, where samples are taken around the clock, allows therapists to determine the efficiency of the digestive tract and kidneys. Together with stool analysis, these tests may indicate toxic bowel syndrome and digestive system disorders. Certain blood and urine tests may point to nutritional deficiencies and proper recovery diets can be designed for patients as well.
Detoxification therapists may also perform extensive allergy and hypersensitivity tests. Intradermal (between layers of the skin) and sublingual (under the tongue) allergy tests are used to determine a patient's sensitivity to a variety of common substances, including formaldehyde, auto exhaust, perfume, tobacco, chlorine, jet fuel, and other chemicals.
Food allergies require additional tests because these allergies often cause reactions that are delayed for several days after the food is eaten. The RAST (radioallergosorbent test) is a blood test that determines the level of antibodies (immunoglobulins) in the blood after specific foods are eaten. The cytotoxic test is a blood test that determines if certain substances affect blood cells, including foods and chemicals. The ELISA-ACT (enzyme-linked immunoserological assay activated cell test) is considered to be one of the most accurate tests for allergies and hypersensitivity to foods, chemicals, and other agents. Other tests for food allergies are the elimination and rotation diets, in which foods are systematically evaluated to determine the ones that are causing problems.
Detoxification therapists usually interview and counsel patients closely to determine and correct lifestyle, occupational, psychological, and emotional factors that may also be contributing to illness.
Detoxification therapies
Detoxification therapists use a variety of healing techniques after a diagnosis is made. The first step is to eliminate a patient's exposure to all toxic or allergenic substances. These include heavy metals, chemicals, radiation (from x rays, power lines, cell phones, computer screens, and microwaves), smog, polluted water, foods, drugs, caffeine, alcohol, perfume, excess noise, and stress. If mercury poisoning has been determined, the patient will be advised to have mercury fillings from the teeth removed, preferably by a holistic dentist.
Specific treatments are used to stimulate and assist the body's detoxification process. Dietary change is immediately enacted, eliminating allergic and unhealthy foods, and emphasizing foods that assist detoxification and support healing. Detoxification diets are generally low in fat, high in fiber, and vegetarian with a raw food emphasis. Processed foods, alcohol, and caffeine are avoided. Nutritional supplements such as vitamins, minerals, antioxidants, amino acids, and essential fatty acids are often prescribed. Spirulina is a sea algae that is frequently given to assist in eliminating heavy metals. Lipotropic agents are certain vitamins and nutrients that promote the flow of bile and fat from the liver.
Many herbal supplements are used in detoxification therapies as well. Milk thistle extract, called silymarin, is one of the more potent herbs for detoxifying the liver. Naturopathy, Ayurvedic medicine, and traditional Chinese medicine (TCM) recommend numerous herbal formulas for detoxification and immune strengthening. If infections or parasites have been found, these are treated with herbal formulas and, in difficult cases, antibiotics.
For toxic bowel syndrome and digestive tract disorders, herbal laxatives and high fiber foods such as psyllium seeds may be given to cleanse the digestive tract and promote elimination. Colonics are used to cleanse the lower intestines. Digestive enzymes are prescribed to improve digestion, and acidophilus and other friendly bacteria are reintroduced into the system with nutritional supplements.
Fasting is another major therapy in detoxification. Fasting is one of the quickest ways to promote the elimination of stored toxins in the body and to prompt the healing process. People with severe toxic conditions are supervised closely during fasting because the number of toxins in the body temporarily increases as they are being released.
Chelation therapy is used by detoxification specialists to rid the body of heavy metals. Chelates are particular substances that bind to heavy metals and speed their elimination. Homeopathic remedies have also been shown to be effective for removing heavy metals.
Sweating therapies can also detoxify the body because the skin is a major organ of elimination. Sweating helps release those toxins that are stored in the subcutaneous (under the skin) fat cells. Saunas, therapeutic baths, and exercise are some of these treatments. Body therapies may also be prescribed, including massage therapy, acupressure, shiatsu, manual lymph drainage, and polarity therapy. These body therapies seek to improve circulatory and structural problems, reduce stress, and promote healing responses in the body. Mind/body therapies such as psychotherapy, counseling, and stress management techniques may be used to heal the psychological components of illness and to help patients overcome their negative patterns contributing to illness.
Practitioners and treatment costs
The costs of detoxification therapies can vary widely, depending on the number of tests and treatments required. Detoxification treatments can be lengthy and involved since illnesses associated with toxic conditions usually develop over many years and may not clear up quickly. Detoxification treatments may be lengthy because they often strive for the holistic healing of the body, mind, and emotions.
Practitioners may be conventionally trained medical doctors with specialties in environmental medicine or interests in alternative treatment. The majority of detoxification therapists are alternative practitioners, such as naturopaths, homeopaths, ayurvedic doctors, or traditional Chinese doctors. Insurance coverage varies, depending on the practitioner and the treatment involved. Consumers should review their individual insurance policies regarding treatment coverage.
Preparations
Patients can assist diagnosis and treatment by keeping detailed diaries of their activities, symptoms, and contact with environmental factors that may be affecting their health. Reducing exposure to environmental toxins and making immediate dietary and lifestyle changes may speed the detoxification process.
Side effects
During the detoxification process, patients may experience side effects of fatigue, malaise, aches and pains, emotional duress, acne, headaches, allergies, and symptoms of colds and flu. Detoxification specialists claim that these negative side effects are part of the healing process. These reactions are sometimes called healing crises, which are caused by temporarily increased levels of toxins in the body due to elimination and cleansing.
Research and general acceptance
Although environmental medicine is gaining more respect within conventional medicine, detoxification treatment is scarcely mentioned by the medical establishment. The research that exists on detoxification is largely testimonial, consisting of individual personal accounts of healing without statistics or controlled scientific experiments. In the alternative medical community, detoxification is an essential and widely accepted treatment for many illnesses and chronic conditions.
KEY TERMS
Allergen— A foreign substance, such as mites in house dust or animal dander, that when inhaled causes the airways to narrow and produces symptoms of asthma.
Antibody— A protein, also called immunoglobulin, produced by immune system cells to remove antigens (the foreign substances that trigger the immune response).
Fibromyalgia— A condition of debilitating pain, among other symptoms, in the muscles and the myofascia (the thin connective tissue that surrounds muscles, bones, and organs).
Hypersensitivity— The state where even a tiny amount of allergen can cause severe allergic reactions.
Multiple chemical sensitivity— A condition characterized by severe and crippling allergic reactions to commonly used substances, particularly chemicals. Also called environmental illness.
Resources
PERIODICALS
Alternative Therapies Magazine. P.O. Box 17969, Durham, NC 27715. (919) 668-8825. 〈http://www.alternative-therapies.com〉.
Journal of Occupational and Environmental Medicine. 1114 N. Arlington Heights Rd., Arlington Heights, IL 60004. (847) 818-1800.
ORGANIZATIONS
American Holistic Medical Association. 4101 Lake Boone Trail, Suite 201, Raleigh, NC 27607. 〈http://www.holisticmedicine.org/index.html〉.
Cancer Prevention Coalition. 2121 West Taylor St., Chicago, IL 60612. (312) 996-2297. 〈http:\\www.preventcancer.com〉.
Center for Occupational and Environmental Medicine. 7510 Northforest Dr., North Charleston, SC 29420. (843) 572-1600. 〈http:\\www.coem.com〉.
Northeast Center for Environmental Medicine. P.O. Box 2716, Syracuse, NY 13220. (800) 846-ONUS.
Northwest Center for Environmental Medicine. 177 NE 102nd St., Portland, OR 97220. (503) 561-0966.
OTHER
A Citizens Toxic Waste Manual. Greenpeace USA, 1436 U St. NW, Washington, DC 20009. (202) 462-1177.
Detoxification
Detoxification
Definition
Detoxification is a process in which the body is allowed to free itself of a drug. During this period, the symptoms of withdrawal are also treated. Detoxification is the primary step in any drug treatment program, and is used as the initial phase in treating alcohol, heroin, inhalant, sedative, and hypnotic addictions.
Purpose
The goal of detoxification is to clear the toxins out of the body so that the body can adjust and heal itself after being dependent on a substance. In order for the recovering person to stay abstinent on a long-term basis, detoxification needs to lead into long-term community residential program treatment or outpatient drug treatment lasting three to six months.
Precautions
When individuals are physically dependent on a substance, they experience withdrawal symptoms when they abstain from the drug. Withdrawal symptoms vary with each drug of abuse, but can be severe, and even dangerous. Patients who want to overcome their dependence need help managing the withdrawal symptoms. The patient's medical team strives to get the patient off a substance on which he or she is physically dependent, while treating the withdrawal symptoms.
Pregnant women cannot be detoxified from opiates (also called narcotics, including morphine, heroin, and similar drugs) because strict detoxification can increase the risk of spontaneous abortion or premature birth. These women are treated with methadone as an alternative. (Methadone acts as a replacement for the heroin in the woman's body, but the methadone does not provide the "high" that the heroin provides. In addition, methadone is safer for the fetus than heroin.)
In order to be an effective first step of treatment, detoxification must be an individualized process because patients have varying needs.
Description
The body, when allowed to be free from drugs, detoxifies itself through its normal metabolic processes. The withdrawal symptoms are treated during this process so that the patient will be comfortable while the body detoxifies itself.
The process of substance addiction
Before discussing detoxification, it may be useful to understand how the body becomes addicted and why withdrawal symptoms are experienced. In physical addiction or dependence, as a person uses a substance or chemical over a long period of time, his or her body chemistry changes. Once a substance enters the body through drinking, smoking, injecting or inhaling, it travels through the bloodstream to the brain . The brain has a complex reward system built in— when people engage in activities that are important for survival (such as eating), special nerve cells in the brain release chemicals (neurotransmitters , including dopamine) that induce feelings of pleasure. Because of this reward system in the brain, humans are programmed to want to repeat actions that elicit those pleasant sensations. In other words, feelings of pleasure reinforce certain activities or behaviors. Addictive substances interfere with this reward system. Some drugs mimic the effects of a natural chemical, some block the communication between nerve cells, and some substances trigger a larger-than-normal release of neurotransmitters like dopamine. The result of this interference is that dependent drug users physically need the drug to feel pleasure. As they become more dependent, their bodies becomes less responsive to the substance, and need more of it to get the desired response—a phenomenon called tolerance. Also as a result of the interference with the brain's system, when the dependent user does not have the drug in his or her system, feelings of depression or unpleasant withdrawal symptoms may be experienced. These consequences also reinforce the substance use— people dependent on substances resort to using more drugs to avoid the depression or the withdrawal symptoms.
Withdrawal symptoms
The symptoms and severity of these symptoms vary from one substance to another.
ALCOHOL. After a person who has used alcohol heavily for a long time stops drinking, he or she may experience increased heart rate, shaking, difficulty sleeping, nausea, restlessness, anxiety, and even seizures . The affected person may also experience hallucinations (seeing, hearing, or feeling something that isn't really present). In some cases, delirium tremens (DTs) may occur as part of the withdrawal. Delirium tremens is a violent delirium (fading in and out of consciousness) with tremors, increased motor activity, visual hallucinations, disorientation, confusion, and fever that happens 48-96 hours after the alcohol-dependent person has had his or her last drink. These symptoms can last anywhere from three to 10 days. This state is a medical emergency because it could be fatal.
HEROIN AND OTHER OPIATES. Heroin is part of a family of drugs called opiates or opioids, which are made up of drugs that come from the seeds of the Asian poppy (heroin, opium and morphine, for example) and also manufactured drugs that act like the natural drugs (meperidine or Demerol). Symptoms of opiate withdrawal include restlessness, insomnia , anxiety, irritability, loss of appetite, diarrhea, abdominal cramps, nausea, sweating, chills, and runny eyes and nose.
SEDATIVES AND HYPNOTICS. Sedatives and hypnotics are drug families that are often considered in one group called the sedative-hypnotics. These drugs depress or slow down the body's functions, and can be used to calm anxiety or to induce sleep. When taken in high doses or when abused, these drugs can cause unconsciousness or death. These drugs include barbiturates and benzodiazepines. Some barbiturates are amobarbital (Amytal), pentobarbital (Nembutal), and secobarbital (Seconal). Some benzodiazepines include diazepam (Valium), chlordiazepoxide (Librium), and lorazepam (Ativan). When a person dependent on these drugs stops taking them suddenly, he or she might experience restlessness, muscle cramps, anxiety, insomnia, irritability, paranoid behavior, and even seizures or death.
Alcohol detoxification
Patients being detoxified from alcohol can safely be treated with rest, nutrition, vitamins, and thiamin (a B vitamin whose absorption is affected by alcohol abuse). Detoxification can be completed in an inpatient setting, or patients may participate in intensive outpatient (day hospital) treatment. People with mild or moderate withdrawal symptoms undergo detoxification over a five-day period and receive a benzodiazepine or phenobarbital to help ease the withdrawal symptoms. Delirium tremens can be treated with very high-dose benzodiazepines (such as chlordiazepoxide or diazepam) or with antipsychotic medications such as Haldol (haloperidol ). The patient usually receives medication at doses high enough to give 60 mg or more of the medication over a 24- to 36-hour period, and the doses of these medications are gradually decreased by 20% each day. Patients who have liver disease, dementia , or patients who are over the age of 65 or with significant medical problems may receive lorazepam for the withdrawal symptoms.
Heroin detoxification
Patients with heroin dependence may receive help with their detoxification in one of two forms. Opioid agonists are drugs that act like heroin in the patient's body but do not provide the same "high," and are given in gradually decreasing doses. Because these medications "act" like heroin, the person does not experience withdrawal symptoms. Some examples of this kind of medication are methadone and levo-alpha-acetylmethadol (LAAM); buprenorphine is a partial opioid agonist, which means that it acts like heroin or methadone, but it limits the effects of opioids so that higher doses produce no greater effects. The second form of help for patients undergoing heroin detoxification is the use of a drug, such as clonidine (Catapres), that blocks some of the withdrawal symptoms. There is also a new method of heroin detoxification called ultra-rapid opioid detoxification under anesthesia/sedation, and there is an experimental method using a medication called lofexidine.
METHADONE SUBSTITUTION. Methadone substitution can occur in outpatient or inpatient settings, and is a method of detoxification that involves helping patients off substances such as heroin by substituting these substances with methadone to ease the withdrawal symptoms, and gradually decreasing the dose until no methadone is needed for the symptoms. Patients may begin with a dose of methadone that is between 20 mg and 40 mg per day. The initial dose may be adjusted so that the most beneficial dose can be discovered, based on the patient's withdrawal symptoms. The dose is then gradually decreased over the next several days. The decrease in methadone dosage is called tapering. If the detoxification is being completed in an inpatient setting, the methadone dose can be tapered more quickly, because medical staff can closely monitor patients for withdrawal, and detoxification can be achieved in about five to 10 days. However, in the case of outpatient detoxification, the taper has to be done much more slowly to assure that the patient does not have an adverse reaction or relapse (use the drug of abuse again) to treat their withdrawal symptoms. The dose may be decreased about 10% per week initially until a dose of 20 mg is reached. Then the dose can be decreased by 3% per week for the rest of the time that the patient needs to be detoxified. Patients are usually comfortable with the slow decrease of the medication until the dose gets below 20 mg/day. At that point, patients tend to become fearful of being off opioids and having symptoms of withdrawal.
Clonidine is used much more frequently than methadone in detoxification. Methadone is used frequently as long-term maintenance treatment for heroin addiction.
BUPRENORPHINE. Buprenorphine is another medication that is used during opioid detoxification. Because it also acts like heroin in the body, the patient does not experience the withdrawal symptoms as the heroin is being eliminated from the body. It is given as an intramuscular injection or intravenously. It begins to work within 15 minutes and its effects last six hours. A patient receiving buprenorphine receives this medication for at least three days, and then the medication is either gradually withdrawn or discontinued abruptly.
CLONIDINE. Clonidine is a medication that decreases many of the symptoms of opioid withdrawal. Patients may require nonsteroidal anti-inflammatory drugs (NSAIDS, such as ibuprofen) for the treatment of muscle aches. Clonidine's major side effects include sedation and hypotension (low blood pressure). Patients undergoing detoxification using clonidine will have their blood pressure and pulse checked regularly. The starting dose of clonidine is 0.1–0.3 mg every four to six hours— the maximum amount that can be given in one day is 1 mg. During days two through four of the detoxification, the dose of clonidine is adjusted to control the withdrawal symptoms. Again, however, the dose cannot exceed the maximum dose. On the fifth day of detoxification, the dose starts to get slowly tapered.
The clonidine patch is a transdermal patch, meaning that the drug is delivered through the skin and causes the patient to be exposed to a constant amount of the drug over a seven-day period. It also allows the person to experience a more comfortable heroin detoxification. It comes in three doses: 0.1-mg, 0.2-mg, and 0.3-mg. Patients who will use the clonidine patch need to have both the patch on and take oral clonidine during the first two days of the detoxification, because it takes the patch two days to reach a steady state and be effective. The patient takes 0.2 mg of oral clonidine three times a day, and the weight of the patient determines the dose of the patch. On day two, the amount of clonidine that the patient takes by mouth is reduced by half and then it is completely stopped after day three. After seven days, the patch is removed and replaced with a patch that is half the amount of the original dose. The patch is continued for as long as the patient continues to have symptoms of withdrawal. Blood pressure is monitored for the patient using the patch, as well. The detoxification process in general takes about seven days using clonidine.
CLONIDINE-NALTREXONE ULTRA-RAPID DETOXIFICATION. Clonidine-naltrexone ultra-rapid detoxification is a faster means of detoxification than using clonidine alone. The higher the dose of naltrexone that the person receives, the faster he or she can be detoxified. Very close monitoring for withdrawal symptoms is necessary, however, particularly during the first eight hours of the detoxification process. (Naltrexone accelerates the withdrawal.) On the first day of the detoxification process, the patient is premedicated with oxazepam and clonidine. A couple hours later, the patient receives naltrexone. Throughout the rest of the first day, the patient receives oxazepam and clonidine every four to six hours. On the second and third days, the patient receives a larger dose of naltrexone, and continues to receive oxazepam and clonidine throughout the day. After day three, the naltrexone is no longer given, and the patient continues to take the clonidine and oxazepam for two to three more days. Additional medications to help with muscle cramping and nausea may be necessary. In an inpatient setting, the naltrexone can be increased so that the patient can complete detoxification in two to three days.
LOFEXIDINE. Lofexidine is approved for use in England for opioid detoxification. It appears to cause less sedation and fewer cases of low blood pressure than clonidine. In the United States, the National Institute of Drug Abuse (NIDA) is conducting studies on this drug.
ULTRA-RAPID OPIOID DETOXIFICATION UNDER ANESTHESIA/SEDATION. In this new procedure, anesthesia is induced and the patient receives a tracheal tube— a tube in the throat— and a tube in the nose (a nasogastric tube). The patient is given intravenous naloxone or naltrexone through the nasogastric tube. The procedure takes only eight hours and the patient can leave the hospital in one or two days. The patient's withdrawal symptoms are treated with a variety of medications including clonidine, antidiarrheal medications, and benzodiazepines.
Mixed substance abuse
Mixed substance abuse (also called polysubstance abuse) occurs when individuals abuse more than one substance. Many doctors prefer to use phenobarbital to detoxify patients with polysubstance abuse problems. Patients receiving phenobarbital may receive a test dose, and then based on his or her tolerance and symptoms, the dose will be adjusted. Patients cannot receive more than 600 mg of phenobarbital a day. After two to three days, once the patient is doing well, the dose can be reduced by 30-60 mg. Whether detoxification for polysubstance abusers will be completed on an inpatient or outpatient status depends on the drugs the patient abuses.
Benzodiazepines
These medications are often used to help patients during detoxification, but these substances themselves can be abused and addictive. Patients who have taken a prescribed benzodiazepine for two weeks, even in a therapeutic dose, need to be safely detoxified with a slow taper. The amount of drug the person takes is dropped by 10-25% every week if the patient has minimal withdrawal symptoms. If the patient has taken very high doses for long periods of time, he or she is at increased risk for addiction. If the person has been taking a benzodiazepine medication for years, it can take months before he or she can get off the drug. Anticonvulsant medications like carbamazepine (Tegretol) and divalproex sodium (Depakote) can be used to make the detoxification process faster and more comfortable for the patient.
Preparation
The first step in any detoxification, regardless of the substance, is a physical exam and history taken by a physician. This information-gathering and examination will help the treatment team assess the patient's overall health. In general, the healthier the patient is, the better the chances are that the patient will experience a detoxification without serious or life-threatening complications. Patients also need to give urine and blood samples to test for drugs and alcohol.
Aftercare
After the patient has completed detoxification, he or she needs further treatment either at an outpatient, inpatient, residential, or day hospital program in order to remain drug-free for the long term. Patients are treated by trained health care professionals, and some patients are also counseled by people who are recovering from addiction themselves. Many patients also benefit from 12-step programs or self-help groups , such as Alcoholics Anonymous (AA) or Narcotics Anonymous (NA).
Most opioid users are treated with ambulatory or outpatient detoxification or residential treatment followed by outpatient counseling. Some people who have abused opioids and have undergone detoxification and counseling are able to remain drug-free. Many, however, relapse, even after receiving psychotherapy . People recovering from opioid addiction can receive methadone or LAAM as maintenance therapy to prevent relapse. Similar to the aid these medications can give patients during detoxification, when taken daily as a therapy, they continue to "act" as heroin, keeping the withdrawal symptoms from appearing. Methadone maintenance therapy can be provided through either residential or therapeutic communities and outpatient drug-free programs. Methadone maintenance treatment therapy is controversial, however, because it does not cure the person's addiction— it replaces it with another substance. Proponents of methadone maintenance therapy argue that people receiving methadone are able to function much better in society than people addicted to heroin. Because their drug-seeking behavior is reduced, these patients are able to become productive at work and their interpersonal relations improve.
People recovering from alcoholism can also benefit from counseling and support after detoxification, and a maintenance therapy is available to them, as well. Disulfiram (Antabuse) is a medication that interferes with the body's breakdown and processing of alcohol. When alcohol is consumed while a patient is taking disulfiram, the medication makes the effects of the alcohol much worse than the patient would normally experience—facial flushing, headache, nausea and vomiting occurs, even if alcohol is consumed in a small amount. In order for disulfiram to be effective, the patient must want this kind of reinforcement to maintain abstinence and must be committed to it. Patients also must note that any form of alcohol can trigger the undesired effects, including cooking wine or mouthwash with alcohol.
Risks
When benzodiazepines are the drug to which a person is addicted, they have to be discontinued and cannot be given on an outpatient basis because of their potential for abuse. For all patients undergoing detoxification, benzodiazepine use must be monitored carefully because of the potential for new addiction. Elderly patients undergoing detoxification and receiving benzodiazepines must be monitored closely because they are more sensitive to the sedating effects of these drugs, and are also more prone to falls while receiving these drugs. If benzodiazepines are not discontinued gradually, patients can have withdrawal symptoms such as irritability, poor sleep, agitation and seizures. Ultra-rapid opioid detoxification under anesthesia/sedation remains a new and serious procedure. Patients have died receiving this procedure, and this procedure is still being researched.
It should also be noted that many of the substances used in detoxification can themselves cause addictions. An example of this risk has already been given with benzodiazepines—these medications ease withdrawal symptoms during detoxification, but patients can get addicted to these medications, as well.
Normal results
Normal results for a well-managed detoxification would include freedom from the drug of addiction and ability to enter long-term treatment.
Success rates vary among people recovering from substance abuse. As might be expected, patients who successfully complete a full treatment program after detoxification (that includes counseling, psychotherapy, family therapy , and/or group therapy or some combination of those therapy types) achieve higher rates of success at remaining drug-free. Patients who were addicted for shorter periods of time and patients who spend longer periods in treatment are generally more successful at remaining abstinent from drugs over the long term.
Studies indicate that people who abuse alcohol and who want to stop have a higher chance of success if they undergo inpatient detoxification versus outpatient detoxification.
Abnormal results
One abnormal result that may occur is that patients who received nasogastric or tracheal tubes for opioid detoxification under anesthesia may experience adverse effects or complications. These patients are at risk for: trauma to their lips, vocal cords, larynx, teeth; nose bleeds; high blood pressure; elevated heart rate; irregular heartbeat; and vomiting, which can lead to aspiration pneumonia.
An additional abnormal result would be a new addiction as a consequence of the detoxification.
After the detoxification is completed, patients may relapse. Support is critical for patients to continue long-term therapy and successfully overcome addiction.
See also Addiction; Disease concept of chemical dependency; Individual entries on various substances and related disorders
Resources
BOOKS
Beers, Mark H., M.D., and Robert Berkow, M.D., eds. "Alcoholism." The Merck Manual of Diagnosis and Therapy. 17th edition. Whitehouse Station, NJ: Merck Research Laboratories, 1999.
Jaffe, Jerome H., M.D., and others. "Substance-Related Disorders." In Comprehensive Textbook of Psychiatry, edited by Benjamin J. Sadock, M.D. and Virginia A. Sadock, M.D. 7th edition. Philadelphia: Lippincott Williams and Wilkins, 2000.
Matthews, John. "Substance-Related Disorders: Cocaine and Narcotics." In Psychiatry Update and Board Preparation,edited by Thomas A. Stern, M.D. and John B. Herman, M.D. New York: McGraw Hill, 2000.
PERIODICALS
Fuller, Richard K., M.D. and Susanne Hiller-Sturmhofel, Ph.D. "Alcoholism Treatment in the United States: An Overview." Alcohol Research and Health 23 (1999): 69-77.
Khantzian, Edward J., M.D. "Methadone Treatment for Opioid Dependence." American Journal of Psychiatry November 2000: 1895-1896.
Leshner, Alan Ph.D. "Heroin Abuse and Addiction." National Institute on Drug Abuse Research Report Series. NIH Publication Number 00-4165, Washington, D.C. Supt.of doc. US. Govt. Print. Off., 2000.
Shreeram, S. S., M.D., and others. "Psychosis After Ultrarapid Opiate Detoxification." American Journal of Psychiatry June 2001: 970.
ORGANIZATIONS
The College on Problems of Drug Dependency (CPDD). CPDD Executive Offices, Department of Pharmacology, 3420 N.Broad Street,Philadephia, PA,19140. (215) 707-3242. <http://views.vcu.edu/cpdd>.
Institute for Comprehensive Detoxification and Rehabilitation. (877) 704-ICDR (4237). <http://www.views.vcu.edu/cpdd/>.
National Institute on Alcohol Abuse and Alcoholism (NIAAA). 6000 Executive Boulevard, Willco Building, Bethesda, MD, 20892-7003.<http://www.niaaa.nih.gov>.
National Institute on Drug Abuse (NIDA). 6001 Executive Boulevard, Room 5213, Bethesda, MD, 20892-9561. (301) 443-1124. <http://www.nida.nih.gov>.
Susan Hobbs, M.D.
Detoxification
Detoxification
Definition
Detoxification is one of the more widely used treatments and concepts in alternative medicine. It is based on the principle that illnesses can be caused by the accumulation of toxic substances (toxins) in the body. Eliminating existing toxins and avoiding new toxins are essential parts of the healing process. Detoxification utilizes a variety of tests and techniques.
Origins
Detoxification methods of healing have been used for thousands of years. Fasting , a method used often in detoxification treatments, is one of the oldest therapeutic practices in medicine. Hippocrates, the ancient Greek known as the father of Western medicine, recommended fasting as a means for improving health. Ayurvedic medicine , a traditional healing system that has developed over thousands of years, utilizes detoxification methods to treat many chronic conditions and to prevent illness.
Detoxification treatment has become one of the cornerstones of alternative medicine. Conventional medicine notes that environmental factors can play a significant role in many illnesses. Environmental medicine is a field that studies exactly how those environmental factors influence disease. Conditions such as asthma, cancer, chronic fatigue syndrome, multiple chemical sensitivity , and many others are strongly influenced by exposure to toxic or allergenic substances in the environment. The United States Centers for Disease Control estimate that over 80% of all illnesses have environmental and lifestyle causes.
Detoxification has also become a prominent treatment as people have become more aware of environmental pollution. It is estimated that one in every four Americans suffers from some level of heavy metal poisoning . Heavy metals, such as lead, mercury, cadmium, and arsenic, are by-products of industry. Synthetic agriculture chemicals, many of which are known to cause health problems, are also found in food, air, and water. American agriculture uses nearly 10 pounds of pesticides per person on the food supply each year. These toxins have become almost unavoidable. Pesticides that are used only on crops in the southern United States have been found in the tissue of animals in the far north of Canada. DDT, a cancer-causing insecticide that has been banned for decades, is still regularly found in the fatty tissue of animals, birds, and fish, even in extremely remote regions such as the North Pole.
The problem of toxins in the environment is compounded because humans are at the top of the food chain
| COMMON HERBS USED FOR DETOXIFICATION | ||
| Antibiotics | Anticatarrhals (Help Eliminate Mucus) | Blood Cleansers |
| Clove | Boneset | Burdock root |
| Echinacea | Echinacea | Dandelion root |
| Eucalyptus | Garlic | Echinacea |
| Garlic | Goldenseal root | Oregon grape root |
| Myrrh | Hyssop | Red clover blossoms |
| Prickly ash bark | Sage | Yellow dock root |
| Propolis | Yarrow | |
| Wormwood | ||
| Diaphoretics/Skin Cleaners | Diuretics | Laxatives |
| Boneset | Cleavers | Buckthorn |
| Burdock root | Corn silk | Cascara sagrada |
| Cayenne pepper | Horsetail | Dandelion root |
| Elder flowers | Juniper berries | Licorice root |
| Ginger root | Parsley leaf | Rhubarb root |
| Goldenseal root | Uva ursi | Senna leaf |
| Peppermint | Yarrow dock | Yellow dock |
| Oregon grape root | ||
| Yellow dock | ||
and are more likely to be exposed to an accumulation of toxic substances in the food supply. For instance, pesticides and herbicides are sprayed on grains that are then fed to farm animals. Toxic substances are stored in the fatty tissue of those animals. In addition, those animals are often injected with synthetic hormones, antibiotics, and other chemicals. When people eat meat products, they are exposed to the full range of chemicals and additives used along the entire agricultural chain. Detoxification specialists call this build up of toxins bioaccumulation. They assert that the bioaccumulation of toxic substances over time is responsible for many physical and mental disorders, especially ones that are increasing rapidly (like asthma, cancer, and mental illness). As a result, detoxification therapies are increasing in importance and popularity.
Benefits
Detoxification is helpful for those patients suffering from many chronic diseases and conditions, including allergies, anxiety , arthritis, asthma, chronic infections, depression , diabetes, headaches, heart disease , high cholesterol , low blood sugar levels, digestive disorders, mental illness, and obesity . It is helpful for those with conditions that are influenced by environmental factors, such as cancer, as well as for those who have been exposed to high levels of toxic materials due to accident or occupation. Detoxification therapy is useful for those suffering from allergies or immune system problems that conventional medicine is unable to diagnose or treat, including chronic fatigue syndrome, environmental illness/multiple chemical sensitivity, and fibromyalgia . Symptoms for those suffering these conditions may include unexplained fatigue, increased allergies, hypersensitivity to common materials, intolerance to certain foods and indigestion , aches and pains, low grade fever , headaches, insomnia , depression, sore throats, sudden weight loss or gain, lowered resistance to infection, general malaise, and disability. Detoxification can be used as a beneficial preventative measure and as a tool to increase overall health, vitality, and resistance to disease.
Description
Toxins in the body include heavy metals and various chemicals such as pesticides, pollutants, and food additives. Drugs and alcohol have toxic effects in the body. Toxins are produced as normal by-products in the intestines by the bacteria that break down food. The digestion of protein also creates toxic by-products in the body.
The body has natural methods of detoxification. Individual cells get detoxified in the lymph and circulatory systems. The liver is the principle organ of detoxification, assisted by the kidneys and intestines. Toxins can be excreted from the body by the kidneys, bowels, skin, and lungs. Detoxification treatments become necessary when the body's natural detoxification systems become overwhelmed. This can be caused by long-term effects of improper diet, stress , overeating, sedentary lifestyles, illness, and poor health habits in general. When a build up of toxic substances in the body creates illness, it's called toxemia. Some people's digestive tracts become unable to digest food properly, due to years of overeating and diets that are high in fat and processed foods and low in fiber (the average American diet). When this happens, food cannot pass through the digestive tract efficiently. Instead of being digested properly or eliminated from the bowel, food can literally rot inside the digestive tract and produce toxic by-products. This state is known as toxic colon syndrome or intestinal toxemia.
Detoxification therapies try to activate and assist the body's own detoxification processes. They also try to eliminate additional exposure to toxins and to strengthen the body and immune system so that toxic imbalances won't occur in the future.
Testing for toxic substances
Detoxification specialists use a variety of tests to determine the causes contributing to toxic conditions. These causes include infections, allergies, addictions, toxic chemicals, and digestive and organ dysfunction. Blood, urine, stool, and hair analyses, as well as allergy tests, are used to measure a variety of bodily functions that may indicate problems. Detoxification therapists usually have access to laboratories that specialize in sophisticated diagnostic tests for toxic conditions.
People who have toxemia are often susceptible to infection because their immune systems are weakened. Infections can be caused by parasites, bacteria, viruses, and a common yeast. Therapists will screen patients for underlying infections that may be contributing to illness.
Liver function is studied closely with blood and urine tests because the liver is the principle organ in the body responsible for removing toxic compounds. When the liver detoxifies a substance from the body, it does so in two phases. Tests are performed that indicate where problems may be occurring in these phases, which may point to specific types of toxins. Blood and urine tests can also be completed that screen for toxic chemicals such as PCBs (environmental poisons), formaldehyde (a common preservative), pesticides, and heavy metals. Another useful blood test is a test for zinc deficiency, which may reveal heavy metal poisoning. Hair analysis is used to test for heavy metal levels in the body. Blood and urine tests check immune system activity, and hormone levels can also indicate specific toxic compounds. A 24-hour urine analysis, where samples are taken around the clock, allows therapists to determine the efficiency of the digestive tract and kidneys. Together with stool analysis, these tests may indicate toxic bowel syndrome and digestive system disorders. Certain blood and urine tests may point to nutritional deficiencies and proper recovery diets can be designed for patients as well.
Detoxification therapists may also perform extensive allergy and hypersensitivity tests. Intradermal (between layers of the skin) and sublingual (under the tongue) allergy tests are used to determine a patient's sensitivity to a variety of common substances, including formaldehyde, auto exhaust, perfume, tobacco, chlorine, jet fuel, and other chemicals.
Food allergies require additional tests because these allergies often cause reactions that are delayed for several days after the food is eaten. The RAST (radioallergosorbent test) is a blood test that determines the level of antibodies (immunoglobulins) in the blood after specific foods are eaten. The cytotoxic test is a blood test that determines if certain substances affect blood cells, including foods and chemicals. The ELISA-ACT (enzymelinked immunoserological assay activated cell test) is considered to be one of the most accurate tests for allergies and hypersensitivity to foods, chemicals, and other agents. Other tests for food allergies are the elimination and rotation diets, in which foods are systematically evaluated to determine the ones that are causing problems.
Detoxification therapists usually interview and counsel patients closely to determine and correct lifestyle, occupational, psychological, and emotional factors that may also be contributing to illness.
Detoxification therapies
Detoxification therapists use a variety of healing techniques after a diagnosis is made. The first step is to eliminate a patient's exposure to all toxic or allergenic substances. These include heavy metals, chemicals, radiation (from x rays, power lines, cell phones, computer screens, and microwaves), smog, polluted water, foods, drugs, caffeine , alcohol, perfume, excess noise, and stress. If mercury poisoning has been determined, the patient will be advised to have mercury fillings from the teeth removed, preferably by a holistic dentist.
Specific treatments are used to stimulate and assist the body's detoxification process. Dietary change is immediately enacted, eliminating allergic and unhealthy foods, and emphasizing foods that assist detoxification and support healing. Detoxification diets are generally low in fat, high in fiber, and vegetarian with a raw food emphasis. Processed foods, alcohol, and caffeine are avoided. Nutritional supplements such as vitamins, minerals, antioxidants, amino acids , and essential fatty acids are often prescribed. Spirulina is a sea algae that is frequently given to assist in eliminating heavy metals. Lipotropic agents are certain vitamins and nutrients that promote the flow of bile and fat from the liver.
Many herbal supplements are used in detoxification therapies as well. Milk thistle extract, called silymarin, is one of the more potent herbs for detoxifying the liver. Naturopathy, Ayurvedic medicine, and traditional Chinese medicine (TCM) recommend numerous herbal formulas for detoxification and immune strengthening. If infections or parasites have been found, these are treated with herbal formulas and antibiotics in difficult cases.
For toxic bowel syndrome and digestive tract disorders, herbal laxatives and high fiber foods such as psyllium seeds may be given to cleanse the digestive tract and promote elimination. Colonics are used to cleanse the lower intestines. Digestive enzymes are prescribed to improve digestion, and acidophilus and other friendly bacteria are reintroduced into the system with nutritional supplements.
Fasting is another major therapy in detoxification. Fasting is one of the quickest ways to promote the elimination of stored toxins in the body and to prompt the healing process. People with severe toxic conditions are supervised closely during fasting because the number of toxins in the body temporarily increases as they are being released.
Chelation therapy is used by detoxification specialists to rid the body of heavy metals. Chelates are particular substances that bind to heavy metals and speed their elimination. In 2002, a new five-year clinical trial was funded to explore the use of chelation therapy in patients with heart disease. Homeopathic remedies have also been shown to be effective for removing heavy metals.
Sweating therapies can also detoxify the body because the skin is a major organ of elimination. Sweating helps release those toxins that are stored in the subcutaneous (under the skin) fat cells. Saunas, therapeutic baths, and exercise are some of these treatments. Body therapies may also be prescribed, including massage therapy, acupressure, shiatsu , manual lymph drainage, and polarity therapy . These body therapies seek to improve circulatory and structural problems, reduce stress, and promote healing responses in the body. Mind/body therapies such as psychotherapy , counseling, and stress management techniques may be used to heal the psychological components of illness and to help patients over-come their negative patterns contributing to illness.
Practitioners and treatment costs
The costs of detoxification therapies can vary widely, depending on the number of tests and treatments required. Detoxification treatments can be lengthy and involved since illnesses associated with toxic conditions usually develop over many years and may not clear up quickly. Detoxification treatments may be lengthy because they often strive for the holistic healing of the body, mind, and emotions.
Practitioners may be conventionally trained medical doctors with specialties in environmental medicine or interests in alternative treatment. The majority of detoxification therapists are alternative practitioners, such as naturopaths, homeopaths, ayurvedic doctors, or traditional Chinese doctors. Insurance coverage varies, depending on the practitioner and the treatment involved. Consumers should review their individual insurance policies regarding treatment coverage.
Preparations
Patients can assist diagnosis and treatment by keeping detailed diaries of their activities, symptoms, and contact with environmental factors that may be affecting their health. Reducing exposure to environmental toxins and making immediate dietary and lifestyle changes may speed the detoxification process.
Side effects
During the detoxification process, patients may experience side effects of fatigue, malaise, aches and pains, emotional duress, acne , headaches, allergies, and symptoms of colds and flu. Detoxification specialists claim that these negative side effects are part of the healing process. These reactions are sometimes called healing crises, which are caused by temporarily increased levels of toxins in the body due to elimination and cleansing.
Research & general acceptance
Although environmental medicine is gaining more respect within conventional medicine, detoxification treatment is scarcely mentioned by the medical establishment. The research that exists on detoxification is largely testimonial, consisting of individual personal accounts of healing without statistics or controlled scientific experiments. In the alternative medical community, detoxification is an essential and widely accepted treatment for many illnesses and chronic conditions.
Resources
BOOKS
Goldberg, Burton. Chronic Fatigue, Fibromyalgia and Environmental Illness. Tiburon, CA: Future Medicine, 1998.
Lappe, Marc. Chemical Deception: The Toxic Threat to Health and the Environment. San Francisco: Sierra Club, 1991.
Lawson, Lynn. Staying Well in a Toxic World. Chicago: Noble, 1993.
Randolph, Theron G., M.D. Environmental Medicine: Beginnings and Bibliographies of Clinical Ecology. Fort Collins, CO: Clinical Ecology Publications, 1987.
PERIODICALS
Alternative Therapies Magazine. P.O. Box 17969, Durham, NC 27715. (919) 668-8825. www.alternative-therapies.com.
Journal of Occupational and Environmental Medicine. 1114 N. Arlington Heights Rd., Arlington Heights, IL 60004. (847) 818-1800.
"Physician Group Backs New NIH Chelation Therapy Study for Heart Disease." Heart Disease Weekly (September 29, 2002): 13.
ORGANIZATIONS
American Holistic Medical Association. 4101 Lake Boone Trail, Suite 201, Raleigh, NC 27607.
Cancer Prevention Coalition. 2121 West Taylor St., Chicago, IL 60612. (312) 996-2297. http://www.preventcancer.com.
Center for Occupational and Environmental Medicine.7510 Northforest Dr., North Charleston, SC 29420. (843) 572-1600. http://www.coem.com.
Northeast Center for Environmental Medicine. P.O. Box 2716, Syracuse, NY 13220. (800) 846-ONUS.
Northwest Center for Environmental Medicine. 177 NE 102nd St., Portland, OR 97220. (503) 561-0966.
OTHER
A Citizens Toxic Waste Manual. Greenpeace USA, 1436 U St. NW, Washington, DC 20009. (202) 462-1177.
Douglas Dupler
Teresa G. Odle
Detoxification
Detoxification
When many toxic substances are introduced into the environment , they do not remain in their original form, but are transformed to other products by a variety of biological and non-biological processes. The chemicals and their transformation products are degraded, converted progressively to smaller molecules, and eventually utilized in various natural cycles, such as the carbon cycle . Toxic metals are not degraded but are interconverted between available and nonavailable forms. Some organic compounds, such as polychlorinated biphenyl (PCBs), are degraded over a period of many years to less toxic compounds, while compounds such as the organophosphate insecticides may break down in only a few hours.
The chemical transformations that occur may either increase (referred to as intoxication, or activation if the parent compound was nontoxic) or decrease (referred to as detoxification) the toxicity of the original compound. For example, elemental mercury , which has low toxicity, can be converted to methylmercury, a very hazardous chemical, through methylation . Parathion is a fairly nontoxic insecticide until it is converted in a living system or by photochemical reactions to paraoxon, an extremely toxic chemical. However, parathion can also be degraded to less toxic products by the process of hydrolysis.
In microbial degradation, the ultimate fate of the toxic chemicals may be mineralization (that is, the conversion of an organic compound to inorganic products), which results characteristically in detoxification; however, intermediates in the degradation sequence, which may be toxic or have unknown toxicity, may persist for a period of time, or even indefinitely. Likewise, since degradation pathways may contain many steps, detoxification may occur early in the degradation pathway, before mineralization has occurred. Detoxification may also be accomplished biologically through cometabolism , the metabolism by microorganisms of a compound that cannot be used as a nutrient ; cometabolism does not result in mineralization, and organic transformation products remain. Studies have also shown that the structure and toxicity of many organic compounds can be altered by plants.
In modifying a toxic chemical, detoxifying processes destroy its actual or potential harmful influence on one or more susceptible animal, plant, or microbial species . Detoxification may be measured with the use of bioassays. A bioassay involves the determination of the relative toxicity of a substance by comparing its effect on a test organism with the conditions of a control. The scale or degree of response may include the rate of growth or decrease of a population, colony, or individual; a behavioral, physiological, or reproductive response; or a response measuring mortality . Bioassays can be used for environmental samples through time to determine detoxification of chemicals.
Both acute and chronic bioassays are used to assess detoxification. In an acute bioassay, a severe and rapid response to the toxic chemical is observed within a short period of time (for example, within four days for fish and other aquatic organisms and within 24 hours to two weeks for mammalian species). Detoxification of a chemical may be detected if there is a decrease in the observed toxicity of a test solution over the time of the acute test, indicating removal of the toxic chemical by degradation or other processes. Similarly, an increase in toxicity could indicate the formation of a more toxic transformation product.
Chronic bioassays are more likely to provide information on the rates of degradation, transformation, and detoxification of toxic compounds. Partial or complete life cycle bioassays may be used, with measurements of growth, reproduction, maturation, spawning, hatching, survival, behavior, and bioaccumulation .
Detoxification of chemicals should also be measured by toxicity testing that involves changes in different organisms and interactions among organisms, especially if the chemicals are persistent and stable and may accumulate and magnify in the food chain/web . Model ecosystems can be used to simulate processes and assess detoxification in a terrestrial-aquatic ecosystem . A typical ecosystem could include soil organisms, lake-bottom fauna , a plant, an insect, a snail, an alga, a crustacean, and a fish species maintained under controlled conditions for a period of time.
Most major types of reactions that result in transformation and detoxification of toxic chemicals can be accomplished either by biological (enzymatic) or by non-biological (nonenzymatic) mechanisms. Although significant changes in structure and properties of organic compounds may result from non-biological processes, the biological mechanism is the major and often the only mechanism by which organic compounds are converted to inorganic products. Microorganisms are capable of degrading and detoxifying a wide variety of organic compounds; presumably, every organic molecule can be destroyed by one or more types of microorganisms (referred to as the "principle of microbial infallibility.") However, since some organic compounds do accumulate in the environment, there must be factors such as unfavorable environmental conditions that prevent the complete degradation and detoxification of these persistent compounds. There are many examples where certain microorganisms have been identified as capable of detoxifying specific organic compounds. In some cases, these microorganisms can be isolated, cultured, and inoculated into contaminated environments in order to detoxify the compounds of concern.
The major types of transformation reactions include: oxidation, ring scission, photodecomposition, combustion , reduction, dehydrohalogenation, hydrolysis, hydration, conjugation, and chelation. Conjugation is the only reaction mediated by enzymes alone, while chelation is strictly nonenzymatic. Primary changes in organic compounds are usually accomplished by oxidative, hydrolytic, or reductive reactions.
Oxidation reactions are reactions in which energy is used in the incorporation of molecular oxygen into the toxic molecule. In most mammalian systems, a monooxygenase system is involved. One atom of molecular oxygen is added to the toxic chemical, which usually results in a decrease in toxicity and an increase in water solubility, as well as provides a reaction group that can be used in further transformation processes such as conjugation. Microorganisms use a dioxygenase system, in which oxidation is accomplished by adding both atoms of molecular oxygen to the double bond present in various aromatic (containing benzene-like rings) hydrocarbons .
Ring scission, or opening, of aromatic ring compounds also can occur through oxidation. Though aromatic ring compounds are usually stable in the environment, some microorganisms are able to open aromatic rings by oxidation. After the aromatic rings are opened, the compounds may be further degraded by other organisms or processes. The number, type, and position of substituted molecules on the aromatic ring may protect the ring from enzymatic attack and may retard scission.
Photodecomposition can also result in the detoxification of toxic chemicals in the atmosphere , in water, and on the surface of solid materials such as plant leaves and soil particles. The reaction is usually enhanced in the presence of water; photodecomposition is also important in the detoxification of evaporated compounds. The ultraviolet radiation in sunlight is responsible for most photodecomposition processes. In photooxidation, for example, photons of light provide the necessary energy to mediate the reactions with oxygen to accomplish oxidation.
Combustion of toxic chemicals involves the oxidation of compounds accompanied by a release of energy. Often combustion does not completely result in the degradation of chemicals, and may result in the production of very toxic combustion products. However, if operating conditions are properly controlled, combustion can result in the detoxification of toxic chemicals.
Under anaerobic conditions, toxic compounds may be detoxified enzymatically by reduction. An example of a reductive detoxifying process is the removal of halogens from halogenated compounds. Dehydrohalogenation is another anaerobic process that also results in the removal of halogens from compounds.
Hydrolysis is an important detoxification mechanism in which water is added to the molecular structure of the compound. The reaction can occur either enzymatically or nonenzymatically. Hydration of toxic compounds occurs when water is added enzymatically to the molecular structure of the compound.
Conjugation reactions involve the combination of foreign toxic compounds with endogenous, or internal, compounds to form conjugates that are water soluble and can be eliminated from the biological organism. However, the toxic compound may still be available for uptake by other organisms in the environment. Endogenous compounds used in the conjugation process include sugars, amino acid residues, phosphates , and sulfur compounds.
Many metals can be detoxified by forming complexes with organic compounds by sharing electrons through the process of chelation. These complexes may be insoluble or nonavailable in the environment; thus the toxicant can not affect the organism. Sorption of toxic compounds to solids in the environment, such as soil particles, as well as incorporation into humus , may also result in detoxification of the compounds.
Generally, the complete detoxification of a toxic compound is dependent on a number of different chemical reactions, both biological and non-biological, proceeding simultaneously, and involving the original compound as well as the transformation products formed.
See also Biogeochemical cycles; Biomagnification; Chemical bond; Environmental stress; Incineration; Oxidation reduction reaction; Persistent compound; Water hyacinth
[Judith Sims ]
RESOURCES
BOOKS
Burnside, O. C. "Prevention and Detoxification of Pesticide Residues in Soils." In Pesticides in Soil and Water, edited by W. D. Guenzi. Madison, WI: Soil Science Society of America, 1974.
Dauterman, W. C., and E. Hodgson. "Chemical Transformations and Interactions." In Introduction to Environmental Toxicology, edited by F. E. Guthrie, and J. J. Perry. New York: Elsevier, 1980.
Rand, G. M. "Detection: Bioassay." In Introduction to Environmental Toxicology, edited by F. E. Guthrie, and J. J. Perry. New York: Elsevier, 1980.
Detoxification
Detoxification
The term "detoxification" describes the process that a drug- or alcohol-dependent person goes through when reducing the level of the substance in his or her body, or eliminating it entirely. Chronic (long-term) use of a drug can result in physical dependence . Stopping the use of that drug can cause a withdrawal syndrome. The goal of detoxification is to help the drug abuser make a safe and comfortable transition from withdrawal to being drug-free.
The detoxification process usually takes place in a supportive environment, often a hospital or clinic. It might also involve the use of medications to control or suppress symptoms and signs of withdrawal. The level of care and whether medications are used depends on which substance was abused and the severity of the withdrawal syndrome. It also depends on medical complications the person might have as a result of the drug or other conditions. The most severe complications of withdrawal occur from substances such as alcohol and sedative-hypnotics (such as the barbiturate Seconal and the benzodiazepine Valium). Detoxification is generally the first step in the process of recovering from alcohol or drug addiction.
see also Addiction: Concepts and Definitions; Alcohol: Withdrawal; Benzodiazepine Withdrawal; Cocaine: Withdrawal; Nonabused Drugs Withdrawal; Treatment Types: An Overview.