Substance Abuse, Withdrawal and Detox
Having had recent occasion to commission a medical hyperbaric unit at a private hospital specialising in the treatment of substance abuse recovery and detox, and having had personal exposure to the loss associated with drug abuse, the subject of withdrawal and detox comes up for discussion. I confess, prior to this, it had barely crossed my mind that HBOT may be of benefit in the detox and withdrawal phase of drug, alcohol and substance abuse rehabilitation.
It made immediate sense though because it brought back to mind an ill-advised practice some divers engage in following a heavy night. It is not unknown in the diving world, and it certainly happens, that divers from all disciplines in the industry, on occasion, hit it hard the night before diving. As you can imagine this creates a problem in that intoxication while diving is extremely dangerous and in most cases of a heavy night, blood alcohol levels remain high the following day, not only generating the obvious risks, but also changing blood chemistry which leads to physiology not behaving as predicted in the various diving exposure tables. The way “some divers” (and pilots I have known), deal with this is to breathe pure oxygen or have an oxygen session in a hyperbaric chamber first thing in the morning to conquer the hangover and “scrub” the system of remaining alcohol. It is so effective that it would return different results on a breathalyser following treatment, in the same way a 12 hour period of no drinking post consumption would do. Just quicker.
In fact, for better or worse, there are some hyperbaric units who actively advertise this as a service.
What this fundamentally amounts to is simply detoxification of blood and cells by accelerating metabolism.
The body deals with toxins in the blood stream and cells by metabolising them. As we know by now, metabolism is accelerated under hyperbaric conditions when breathing oxygen. This accelerates the removal of toxins. At least those that are capable of being metabolised. This extends to accidental poisoning as well as intentional poisoning in the case of drug and alcohol use. And as far as oxygenation goes, it acts on chemicals as poisons.
That’s about the long and short of the motivation for using HBOT to detox. People suffering from addiction, specifically cocaine, opiate and alcohol addiction, can accelerate the detoxification process by undergoing as little as 2 or 3 HBOT sessions. More may be required but some treatment remains better than none.
It follows then that if detox can be accelerated by promoting a more active metabolism at the cellular level, withdrawal symptoms and the effect of withdrawal can be reduced as well.
This is well supported in the paper entitled Hyperbaric Oxygenation in Treatment of Alcohol Dependence Syndrome a trial conducted in 2016 which concluded in their primary outcomes measures:
” Faster recovery from DTs and withdrawal symptoms.”
The reduction of withdrawal symptoms such as tremors is further supported and documented in another trial conducted on morphine dependant mice in 2014 entitled: Hyperbaric oxygen treatment suppresses withdrawal signs in morphine-dependent mice which concluded:
“That treatment with HBO2 can suppress physical signs of withdrawal syndrome in morphine-dependent mice. “
Since the gold standard in trials based medicine is animal based trials, it is accepted by most that the results would most likely also apply to human subjects.
The benefit that can be derived from the use of HBOT in detox and withdrawal are not limited to alcohol alone. There is established benefit in cases of toxicomania, narcomania of various kinds, and of course alcoholism. This position is supported by the original, and first study of its kind conducted in Russia in 1995 entitled, Hyperbaric oxygenation in the treatment of patients with drug addiction, narcotic addiction and alcoholism in the post-intoxication and abstinence periods.
“Such a favorable time course of events appears to be due to the antihypoxic detoxifying and bio-energetic effects of hyperbaric oxygen.”
Beyond the above established benefits to the detox and withdrawal phase of rehabilitation and recovery in substance dependant addicts, there are further benefits to the general physiology of patients. As we have established in previous articles, the injury and illness healing benefits of hyperbaric oxygenation cannot be understated.
Drug, alcohol and toxin use have devastating effects on various organ systems in the body including liver, kidneys and most importantly the brain. These are essentially microscopic injuries brought on by chemical abuse and should be treated as such. In fact many studies suggest that it is these injuries that are responsible for relapse and the perpetuation of dependency, making alcoholism and drug dependency a genuine disease rather than a moral failing.
Currently health departments worldwide do not recognise HBOT for the treatment of opiate or other addictions. Despite the fact that opiate addiction is a global pandemic. There is currently only one facility in the UK capable of delivering this therapy to patients in recovery.
It stands to reason that if detox, withdrawal and long term damage can benefit from HBOT it would unburden the heath care system in countries such as the UK which consistently demonstrates an annual increase in drug related deaths.
This news article in the Pharmaceutical Journal published 25 September 2019 reports the drug death figures for Scotland in 2018. It goes a ways to promoting and calling for new strategic approaches to treating what they deem a public health emergency, but doesn’t go quite as far as including HBOT in their recommendations.
The Telegraph reports figures for England and Wales in this article that confirms that drug related deaths are indeed on the rise and indeed they constitute a public health emergency.
The wider use of hyperbaric oxygen therapy, to our minds, is indeed indicated for the treatment of drug dependency and can be a useful tool and adjunctive and complementary therapy in the recovery of those suffering from addition.
Established in a very recent study entitled Alcohol-induced brain damage continues after alcohol is stopped, its is established that brain damage, specifically the impact on white matter, continues for up to 6 weeks following the cessation of alcohol consumption. This goes directly against the current and prevailing belief that the brain begins to normalise immediately upon cessation. These are monumental findings and the implications are clear. A therapy or bridging therapy is needed that is capable of arresting the ongoing brain damage that is now found to continue after cessation for up to 6 weeks.
Hyperbaric oxygen does just that for all the reasons stated above. It accelerates the metabolism of existing toxins remaining in the body, reduces withdrawal symptoms by up to half, improves sleep patterns, reduces irritability and discomfort and restores and rejuvenates blood flow and oxygenation in organ systems such as the brain, kidneys and liver. This leads to more rapid recovery of damaged organs and arrests brain damage following cessation. The reduction of the effects of withdrawal, coupled with the repair of injury in the brain is likely to help reduce the incidences of relapse studies suggest.
While we don’t advocate the use of HBOT as an excuse to drink more because it helps with the detox, (and some will see it that way), and we aren’t in favor of providing hangover cures, the anecdote at the start of this article does indicate that personal experience indicates that oxygen indeed has the power to improve and better facilitate the recovery process.