Detox (also known as “medically supervised withdrawal”) refers to treatment to help patients withdraw from substances that cause physical dependence, such as alcohol, sedative-hypnotics, and opioids. But detox is far more than a several-day process of ridding the body of an addictive substance. It should be considered an important component in the overall care and treatment of addiction.

Currently in the US, cannabis has evolved into an issue of individual freedom, leading to full legalization in some states on the presumption that the substance isn’t addictive. Unfortunately, cannabis use disorder is indeed a problem for many patients, Kevin Hill, MD, tells us. In fact, says Dr. Hill, one of the greatest challenges you’ll encounter while treating patients is convincing them that cannabis use disorder is a real thing. Here are some treatment strategies.

Kratom (Mitagyna speciose) is a tropical evergreen tree in the coffee family whose leaves have been used for centuries in South Asian countries as a stimulant and pain reliever. Recently, kratom has entered US and European markets and is now sold in various forms, both online and at local head shops.

Opioid withdrawal protocols often rely on a buprenorphine taper, but other medications are regularly used either in addition to or in the place of buprenorphine. In particular, tramadol ER, a mild opiate, may be effective and was recently studied at Johns Hopkins University School of Medicine.

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Patients with co-occurring disorders (COD, also known as “dual diagnosis”) are often regarded as among the most challenging patients to treat. You need to track two conditions that interact in unpredictable ways, with patients who may not be inclined to follow your recommendations. It’s no surprise that such patients typically have poorer outcomes than those with either disorder in isolation. And these patients are far from rare.

Despite an increased awareness of co-occurring disorders, there remains a fair amount of confusion about how to treat a mental health issue and a substance abuse issue at the same time without causing more harm. To further complicate the issue, when patients first walk in you often don’t know whether they are dealing with two conditions concurrently. Charles Atkins’ book, Co-Occurring Disorders: Integrated Assessment and Treatment of Substance Use and Mental Disorders, addresses these problems. We turned to him for some practical guidance.

Although studies have demonstrated the effectiveness of contingency management (CM) for illicit drug use, there’s less evidence for treatment of alcoholism—in part because a standard breathalyzer has a short detection window of 12 hours, meaning patients must only abstain from drinking since the previous night to pass the test.

After reading these articles, you should be able to…