Why Detox Is Not Enough: Reforming Addiction Treatment


Why Detox Is Not Enough: Reforming Addiction Treatment

The patient with a severe heroin addiction—a study participant in my SUMR project—wore a sweater in 95 degree weather to hide the track marks on his arms. He injects more than five times a day, and when asked about his prescription for the addiction medication Suboxone, he says he only uses it when he can’t get heroin. He says he has no confidence. I ask if he’s having trouble dealing with problems in his life, to which he replies, “I don’t deal with them. I do drugs.”

Millions of people use drugs to cope with physical and emotional problems. According to the National Survey on Drug Use and Health, 20.8 million adults, or nearly 9% of the U.S. adult population, were suffering from substance use disorders in 2015. Despite the need, only 11% of them received treatment at a specialized facility.

Even those who do receive treatment aren’t “cured,” because addiction is a chronic disease. Addiction treatment primarily addresses the physical addiction rather than the complex social and emotional factors underlying it. Consequently, relapse is common, with 40-60% of people who completed an addiction treatment program returning to drug use. 

There is no “quick fix” for addiction, and we need to stop pretending that there is.

Traditional addiction treatment begins with a process called detoxification, which is meant to assist with removing drugs from the body and managing withdrawal symptoms. During this time, which can last anywhere from a few days to several weeks, the patient may receive medications such as methadone and buprenorphine to minimize drug cravings and withdrawal symptoms.

The problem with detox is that it isn’t enough.

According to the National Institute on Drug Abuse, medical detoxification alone does little to change long-term drug use, and in fact, it actually increases patients’ risk of mortality from overdose if they do not transition to substance abuse treatment after discharge. While the assumption is that all patients will transition from detox into an outpatient or residential treatment program, the reality is that few patients actually do. A 2012 study of more than 200,000 individuals in California found that less than 11% of detoxification admissions were followed by admission into maintenance treatment within 14 days. This points to a serious flaw in the coordination of care from detox to further substance abuse treatment—one that costs us thousands of lives every year.

Moreover, addiction medications such as methadone or Suboxone carry some risk themselves. Methadone, which has been used for decades to treat opioid dependence, accounts for about one fourth of all prescription-opioid-related deaths, or over 3,400 overdose deaths per year. Guidelines call for these medications to be paired with counseling or behavioral therapies to be effective, but often this is not the case.

For years, substance use disorder treatments have fallen short of the mark. With drug overdoses now killing more people than car crashes and guns, it’s time to reconsider our approach. There is no “quick fix” for addiction, and we need to stop pretending that there is. “Detoxing” your body of harmful and addictive substances, whether that’s alcohol, opiates, or even junk food, requires more than just a week-long medical intervention. It is a long, arduous process that requires social and emotional support and an acknowledgment of the complex underlying factors that led to these behaviors in the first place. It’s time that we adopt a more holistic approach to treating addiction—one that gets at the root of the issue.

Karolina Niedzwiadek is a Wharton Dean's SUMR Scholar.