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Dual Detox: Treating Physical Dependence on Two or More Substances

One of the most significant changes in detoxification services in recent years is the increase in the number of patients requiring detoxification from more than one substance. This polydrug use often complicates the process of caring for patients considerably.

Detox patient in hospitalWhile detox is not, in itself, technically “treatment,” it is usually the first step toward recovery. It involves the elimination of harmful toxins so the body can function normally. All patients reporting a type of drug dependency should undergo urine drug screening upon admission to a detoxification program in order to determine if other substances have also been abused – then and only then can an appropriate treatment program be administered.[1]

As important as detox is for most drug dependencies, patients who do not receive any further treatment after detox typically resume their drug habit very quickly. A range of care in a tailored treatment program with follow-up options is usually essential to achieving success. Treatment should include both medical and mental health services, as needed.[2]

What Does the Detox Process Involve When There’s Multiple Drug Dependencies?

While substances of abuse may have complex interactions, it is not always possible to determine how those interactions will affect withdrawal. Therefore, it is generally best practice to prioritize the substances an individual is dependent on and treat them sequentially according to the severity of the withdrawal produced by each substance.

The substances with the most serious withdrawal symptoms – those where the withdrawal syndrome could be fatal – are alcohol and the sedative-hypnotics.

When detoxifying a patient who is dependent upon multiple substances, the sedative-hypnotic is top priority. If multiple sedative-hypnotic substances or a sedative-hypnotic and alcohol have been abused, withdrawal should be handled in the same way as withdrawal from one such substance. Management of any opioid dependencies is the next priority. Generally speaking, other substances of abuse – including stimulants, marijuana, hallucinogens and inhalants – do not require specific treatment when sedative-hypnotic and/or opioid detox is conducted.[1]

Specifically Designed Medications Often Assist in Handling Detox

In about 80% of detoxifications, medications are used to help re-establish normal brain function, decrease cravings for alcohol and/or other drugs and, thereby, improve the chance of successful recovery from the vicious cycle of physical dependency or addiction.

Medications are currently available for treatment of opioid (heroin, prescription pain relievers), tobacco (nicotine) and alcohol dependency and addiction. Scientists are developing other medications to treat stimulant (cocaine, methamphetamine) and cannabis (marijuana) dependency and addiction. People who have become physically dependent on more than one drug may need treatment for all of the substances.[2]

Some of the factors that may affect whether or not a medicated detox strategy is appropriate include:

  • Length of addiction to either drug and both drugs together
  • Dosage of regular use
  • How often both drugs are abused at the same time or if one drug is used to counter the effects of the other in an attempt to “come down” or “come up”
  • Existence of a “dual diagnosis” involving another type of mental illness
  • Whether or not you have taken a certain medication before and if that experience was positive or negative[3]

There Are Many Possible Reasons for Taking Multiple Drugs

A common reason for abusing multiple drugs is dependence on an addictive substance that offsets the effects of another. Another common reason is the need to self-medicate withdrawal symptoms or uncomfortable affects (e.g., anxiety, depression, anger, loneliness) related to non-substance-induced mental disorders or difficult life situations.

Initial substance use experiences and continued attraction to drugs may indicate enhancement-avoidance reactions. That is, substances may be used to enhance an experience (e.g., use of alcohol as a social lubricant or cocaine to heighten sexual pleasure) or to avoid or neutralize strong feelings (e.g., rape survivors’ substance use before sex to numb their negative feelings about the act or adolescents’ substance use before sex to avoid feeling guilt or shame for their actions).

Liquor and pillsSome people mix opioid-based drugs like heroin and prescription painkillers with alcohol or other prescription drugs, like benzodiazepines. Some smoke marijuana and drink. Still others use stimulant drugs, like cocaine or crystal meth, and counter it with depressants like alcohol or benzodiazepines.

Many people develop unique drug regimens or routines for “getting through the day,” – for instance, the use of stimulants (such as caffeine or nicotine) in the morning, anxiolytics (anti-anxiety medication) in the afternoon, and sedative-hypnotics (sleep-inducing medication) at night.[3]

Beware: Drug Addiction and Other Mental Issues Often Occur Together

Drug addiction is a disease of the brain that frequently occurs with other mental disorders. In fact, as many as 6 in 10 people with an illicit substance use disorder also suffer from another mental illness. Many factors may be at play. Excess stress. Severed or dysfunctional relationships. Perhaps even trauma.

For these individuals, one condition is now more difficult to treat successfully due to additional condition(s) intertwined. Anyone who enters treatment for either a substance use disorder or mental condition should be assessed for additional issues contributing to an unhealthy state. Research indicates that treating all existing illnesses simultaneously in an integrated fashion is generally the most effective treatment approach for a successful, long-term outcome.

What’s the Difference Between a Physical Dependency and an Addiction?

Addiction is compulsive drug use despite known harmful consequences. It is characterized by: the inability to stop using a drug; failure to meet work, social or family obligations; and sometimes (depending on the drug) tolerance and withdrawal.

Physical dependence consists of only the latter element, in which the body adapts to the drug, requiring more of it to achieve a certain effect (tolerance) and eliciting drug-specific physical or mental symptoms if drug use is abruptly ceased (withdrawal). Physical dependence can happen with the chronic use of many drugs – including many prescription drugs, even if taken as instructed. Thus, physical dependence in and of itself does not constitute addiction, but it often accompanies addiction.[4]

Find the Right Detox Program for You

If you wish to learn more about your options in detox and which program (or combination of programs) would be most effective for you, call us anytime – day or night – on our toll-free line. Michael’s House is eager to serve you in any way needed – substance detox, addiction therapy, treatment of co-occurring dependencies or mental disorders, or whatever physical, psychological or emotional issues may exist. We care…and it shows.


1“Four Physical Detoxification Services for Withdrawal from Specific Substances”, National Center for Biotechnology Information, https://www.ncbi.nlm.nih.gov/books/NBK64116/.

2“Treatment Approaches for Drug Addiction”, National Institute on Drug Abuse, https://www.drugabuse.gov/publications/drugfacts/treatment-approaches-drug-addiction, (July 2016).

3 “Common Medications for Disorders”, National Center for Biotechnology Information, https://www.ncbi.nlm.nih.gov/books/NBK64180/.

4 “Principles of Drug Addiction Treatment: A Research-Based Guide (Third Edition)”, National Institute on Drug Abuse, https://www.drugabuse.gov/publications/principles-drug-addiction-treatment/frequently-asked-questions/, (December 2012).