NEW LEAF TREATMENT CENTER

SEDATIVE/HYPNOTIC DETOXIFICATION PROTOCOL

CLIENT HANDOUT

NLTC has developed a sedative-hypnotic treatment (detoxification) protocol focused on eliminating withdrawal symptoms. This is accomplished by utilizing long-acting replacement medication. The dose of the replacement medication is adjusted to meet each individual's specific needs based the individual's withdrawal symptom scores. As detox progresses, replacement medication is gradually discontinued. Symptom assessment guides are also usedto guide the taper. The tapering schedule is open ended and depends on how the client is responding.

We sincerely commend you for your courage taking on this unfamiliar undertaking. Detox causes the most concern for individuals who have already experienced the discomfort of withdrawal. Everyone who has come to depend on a sedative medication will have some concerns about discontinuing their medication.

The medications and advice provided below makes sedative/hypnotic detox comfortable. Detox has its ups and downs and you will hit some bumps in the road. Clients often start out with unrealistic expectations for a speedy detox. Such expectations lead to discouragement. There is no "quick-fix" for this problem.

Patience, persistence, accurate self-assessments and willingness to ask for help if problems or concerns arise will pay big dividends during the detox process. Anyone who has managed to hold up under the strain and discomfort of sedative-hypnotic dependency has already proven they can withstand tremendous challenges. Remind yourself that you are strong and can do hard things.

Basic Outline the Detoxification Process and What to Expect

  • Provide an honest and complete substance abuse history to NLTC staff. This will enable NLTC staff to determine an appropriate long-acting replacement medication therapy.
  • Provide an accurate list of all medications you are taking.
  • Attitude - we recognize that fear is a typical response to contemplating detox. NLTC staff has extensive experience providing comfortable, humane detox. Patience during the process will be necessary. Detox done correctly takes time. There is no quick fix, however, withdrawal symptoms and discomfort are carefully considered and minimized through symptom monitoring and medication adjustments.
  • Call for advice - another important attitude is willingness to call NLTC if you are having any questions or concerns. On -call staff are available 24/7. If it is afterhours call the usual office number and choose option 5 so the answering service can put you in touch with the staff member on-call. Periods of inadequate symptom management may put you at risk for relapse and it simply isn't necessary to be uncomfortable or to worry unnecessarily.
  • Discontinue using all short-acting sedative-hypnotics. This includes alcohol, short-acting benzodiazepine tranquilizers such as lorazepam (brand name Ativan), alprazolam (brand name Xanax), the sleeping medication Zolpidem (brand name Ambien), the muscle relaxant carisoprodol (brand name Soma) and GHB.
  • Immediately inform NLTC staff if you resume, or are even considering resuming, the use of any short-acting sedative/hypnotic substances while you are taking replacement detox medications. Combining other medications and substances of abuse with detox medications is extremely dangerous and can lead to serious health consequences and even fatal complications.
  • Start long-acting replacement medication - NLTC staff will calculate and prescribe the anticipated replacement medication dose. Chlordiazepoxide (Librium) or phenobarbital will be prescribed. The dose of replacement medication is individualized and adjusted to control withdrawal symptoms.
  • Perform frequent self-assessments - follow the instructions on the NLTC Sedative/Hypnotic Symptom Assessment Key. Self-assessments document the initial severity of withdrawal symptoms and track progress and symptom improvement.
  • Frequent self-assessments will enable NLTC staff to make appropriate adjustments to your medications.You will get tired of doing these assessments. Stick with the process until your medication dose is stabile. The frequency of self-assessments diminishes as your symptoms stabilize.
  • Work with your clinician to adjust the long-acting replacement medication dose to keep all withdrawal symptom scores on the self-assessment key to 0-1 withoutcausing undue sedation. During any dose adjustments it is important to not to drive, operate machinery or make important decisions until yourresponse to the dose stabilizes and you do not show signs of impairment.
  • Patience during the dose adjustment is required. It takes some time for each dose adjustment to reach its full effect. Most of the effect of a dose adjustment occurs in the first day or two, but the full effect of a dose increase or decrease isn't in full effect for about a week.
  • Long-acting medications allow healing to take place, however, such medication do have a lag time while the medication builds up to a steady blood state. Thisis why patience with the process is so important.
  • Over-sedation (a feeling similar to intoxication) versus the need for catching up on sleep - individuals who have become dependent on sedative/hypnotic substances typically have spent a long time not sleeping well. Disrupted sleep patterns mean most individuals must spend some extra time napping and sleeping during the first few days of detox. For severely affected individuals the need for extra sleep can go on for weeks. Getting extra sleep is very important to the healing process. Be assured that the amount of extra sleep required will decline with time.
  • The correct dose of replacement medication allows you to sleep, but doesn't cause over-sedation or force you to sleep all the time.
  • There is a difference between needing to sleep because your sleep cycle has been disrupted while you have been dependent on sedative-hypnotics.
  • Being over-medicated produces symptoms similar to intoxication. The difference between the right dose of replacement medication allowing you to get the extra sleep you need and the dose of detox medication being too much can be determined in this way: too much medication causes signs of intoxication such as slurred speech, imbalance while walking, impaired coordination and nystagmus. These are all symptoms that will get you pulled over for a DUI. This is why we strongly caution you about driving if you medication dose is being increased and during the early adjustment period). Nystagmus is uncontrollable jerking of the eyes when you are looking hard to the side. Friends and family can be taught how to check you for nystagmus.
  • Adequate sleep is important - If at any time you find yourself having trouble sleeping inform NLTC staff. A non-addictive, non-habit forming medication can be prescribed. Getting enough good quality sleep is always an important part of general health and is even more important during detox. The ideal bedtime is no later than 10:30PM. Going to bed at a regular time each night and avoiding staying up late will encourage brain chemistry repair.
  • Call for advice and possible dose adjustment if symptom assessments are not being maintained almost entirely at levels of 0-1. Also call if you are feeling over medicated or intoxicated.
  • Minimizeoverall stress and excessive environmental stimulation - It is important to keep stressors to a minimum during detox. Symptoms of withdrawal can be mimickedby stress and excessive environmental stimulation. This will make proper dosage titration very challenging. Stress can cause a return to substances of abuse. Avoiding stress and excessive stimulation enables accurate self-assessments of withdrawal symptoms thereby allowing replacement medication dosage titration to be more accurate and makes remaining abstinence from short-acting medication easier.
  • Three additional components of an optimal detox program include:

1.Frequent mild exercise. As detox progresses so can the intensity of exercise

2. Positive social interaction

3. Engaging in activities that should be fun even when they are fun (this helps repair your brain's pleasure chemistry).

Even though the damage that has been done to your body and brain make doing things that help you heal more difficult, doing these things facilitate the detox process and healing.

Speeding up neurotransmitter (brain chemistry) repair - NAC and Baclofen are often recommended to assist with the repair of the brain chemistry that has been damaged by sedative-hypnotic dependency.

  • n-acetylcysteine (NAC) - NAC is an important non-prescription component of all sedative/hypnotic detox done at NLTC. NAC is an amino acid available at health food stores, drug stores and online. This nutritional supplement is available in 500mg or 600mg capsules (either strength is acceptable). Over approximately 3-4 days the dose of NAC should be gradually increased to a total of 6 capsules per day. Doses should be taken on a regular schedule, every 8 hours. Day one start with one capsule in the morning and one at night. Add one capsule every day until you are taking 2 capsules, 3 times per day. Do not underestimate the importance of taking the full dose of NAC. You will continue to take this supplement throughout your detox. Start taking n-acetylcysteine as soon as possible. Additionally NAC is has proven effective in the treatment of obsessive compulsive disorders (OCD). Ask your clinician if you should take NAC.
  • Baclofen - Baclofen is another medication which may be prescribed to help repair neurotransmitter damange. The typical dose is 80mg per day, taken 20mg in the morning (7-8AM), 20mg midday (3-4PM) and 40mg at night (10-10:30PM).Research has also demonstrated that Baclofen can decrease cravings for alcohol. Ask your clinician if you should take NAC.
  • Be patient with the detox process and you can recover!