Drug Tapering: Why it is the Safer Way to Detox

Drug weaning and tapering are ways to gradually — and often more safely — reduce the usage of a specific substance, thereby cutting cravings and dependence. The drug that is given up should inform the strategy behind quitting.

Last Edited: 04/22/2021

Author: Angeline Gormley Angeline Gormley

Clinically Reviewed:

04/27/2021

Medical Reviewer:

Dr. Neil Shah

Dr. Neil Shah

Going cold turkey when trying to quit a drug habit has its appeal. During the depths of addiction, cutting out all usage and going clean all at once can sound like the best kind of breakup.

In some cases, that’s a perfectly good approach. In others, weaning or tapering medications or other drugs may be the better alternative.

Drug weaning and tapering are ways to gradually — and often more safely — reduce the usage of a specific substance, thereby cutting cravings and dependence. The drug that is given up should inform the strategy behind quitting.

For example, substances like cocaine are best to quit cold turkey as tapering cocaine would be difficult and continued use of cocaine is very risky. By contrast, alcohol, heroin, and nicotine are examples of substances that should be tapered to optimize chances of successfully quitting as these substances produce severe withdrawal symptoms and cravings. Additionally, failing to taper alcohol can be fatal.

In rehab centers, tapering of these drugs is typically done with substitutes that can reduce withdrawal symptoms and cravings. For example, benzodiazepines are commonly used to taper alcohol and nicotine patches are typically used to taper tobacco.

How Do You Define Tapering and Weaning Off?

Tapering or weaning is cutting back on medications, drugs, or alcohol. It’s a form of detoxification drawn out for the comfort and safety of the person quitting the substance.

According to the Centers for Disease Control and Prevention (CDC), drug tapering is advised when:

  • A person asks for it
  • There is no reduction of pain or progress is minimal
  • Dosages are becoming too high
  • A person is taking both opioids and benzodiazepines (Xanax, etc.)
  • There are signs of substance use disorder
  • People may have a high chance of overdosing or have already experienced overdoses or other serious events

Typically a doctor will tailor a plan for a person’s needs and monitor progress to ensure that the treatment proceeds as seamlessly as possible. Sometimes medication is prescribed to manage the most painful symptoms of detox and withdrawal, which may help toward long-term sobriety.

Simply going clean is never  enough by itself to conquer addiction, however. One must also address the issues that led to addiction in the first place, and develop and main healthier coping mechanisms tend to ensure a better outcome.

Why Taper?

One can quit some substances abruptly without many detrimental side effects, aside from creating unpleasant withdrawal symptoms and physical and/or psychological cravings. Other substances, however, pose real dangers. Quitting the benzodiazepine Xanax too quickly, for example, can trigger seizures and, in rare cases, can even be fatal. For these cases, slowly reducing the dosage (ideally under medical supervision) is a safer way to stop.

Stopping and then starting opioids can be troublesome, too, if one has grown accustomed to lower doses. The person may not be accustomed to higher amounts and may be more likely to overdose which can inhibit their ability to breath and be fatal. Relapse is a whole other can of worms and may also create considerable problems.

Withdrawal can cause any number of unpleasant symptoms, both physical and emotional.

Physically, any of the following may occur:

  • Nausea, vomiting
  • Diarrhea
  • Pains, aches
  • Sweating
  • Insomnia
  • Rapid or slowed heartbeat
  • Chills, shaking, goosebumps

There also are emotional and mental side effects from withdrawal, including:

  • Anxiety
  • Irritation
  • Depression
  • Cravings
  • Confusion
  • Hallucinations
  • Paranoia

A medical professional or a treatment center can make the process less painful, letting clients know what to expect and offering strategies and coping mechanisms to ease or alleviate discomfort significantly. A medical professional can also treat serious side effects that can lead to permanent damage or death if untreated. Furthermore, by helping to reduce withdrawal symptoms and cravings, seeking the help of a medical professional can reduce the chances of restarting the substance and overdosing.

What Are the Dangers of Not Tapering?

An addict’s brain begins to depend on the drug (or drugs) in question, and stopping them suddenly can lead to potentially life-threatening complications, depending on the drug. It doesn’t just have to be from trying to overcome addiction to illicit drugs. Stopping prescription medications such as Xanax or even alcohol can be just as dangerous.

If you are trying to quit a substance and experience any of the following, seek immediate emergency medical attention:

  • Fever
  • Seizures
  • Frequent or severe vomiting
  • Chest pain or pressure
  • Breathing difficulty or shortness of breath
  • Severe and persistent headache
  • Hallucinations including tactile hallucinations such as feeling like spiders are crawling on your skin
  • Confusion or altered mentation
  • Irregular heartbeat and very fast heartbeat
  • Loss of consciousness or the feeling you are about to lose consciousness
  • Severe tremor or muscle spasms

What Kinds of Drugs Require Tapering?

Stopping any drug should be handled cautiously. Consulting with a professional is strongly advised. Stories have peppered the media about people quitting antidepressants and committing suicide not long after, but other drugs pose other risks. For example, when certain cardiac medication is suddenly halted, one may be at a significantly increased risk of an imminent cardiac arrest, stroke, or sudden death.

The nature of the drug, the person’s pattern of using the drug, and the individual circumstances of the person including medical history will dictate the medication’s tapering schedule. In general, a slower taper is better. Regular checkups are recommended to ensure that tapering dose protocols are going smoothly. If so, a smaller dose may be prescribed.

People who have a history of depression or anxiety (dual diagnosis cases, when a mental illness is paired with an addiction) should be especially cautious.

Benzodiazepines are medications that are commonly prescribed to treat anxiety. Alprazolam (Xanax), lorazepam (Ativan), diazepam (Valium), and clonazepam (Klonopin) are four common examples.

Almost always for these substances, tapering medications should be used, because suddenly stopping these drugs can be fatal.

Depending on how long a treatment drug stays in the system (i.e., its half-life), places an important role in its utility to help with a taper schedule. Benzodiazepines are good at reducing anxiety, but they are easy to get addicted to. Higher doses will then be sought to produce the same anxiety relief as before.

Taking benzodiazepines for even just a month, may mean that tapering is needed. The following people are more likely to need weaning:

  • People older than the age of 65, especially given their risks of falling escalate and it is more likely that they have cognitive impairments
  • People taking more than one type of benzodiazepine (or pairing them with opioids or amphetamines, or using doses exceeding prescribed strength)
  • People with cognitive disorders, traumatic brain injuries, or current or past substance use disorders
  • People using large amounts of a drug, using a drug frequently, or using a drug for a long period of time

The U.S. Department of Veterans Affairs also offers advice and schedules for gradually reducing drug dosages in a controlled and safe manner.

How to Taper Off Medication?

When helping someone wean off an addictive substance, several approaches may work:

  • Taper off the existing medication until the withdrawal risk is almost non-existent
  • Using a treatment medication that has a longer-lasting effect
  • Prescribe multiple medications to complement the weaning off meds and reduce withdrawal symptoms

Weaning or tapering off medications and other drugs is only part of recovery. Substance abuse and addiction is a complex disorder, and it should be noted that weaning or tapering is only part of the treatment experience.

For treatment to be effective, a number of factors come into play. Besides helping individuals to stop using, they will also have to learn to live a drug- or alcohol-free lifestyle and adjust to new, sober family, social, and workplace dynamics.

Getting clean is only the first step. But it is a huge one, and a leap worth taking.

Tapering Methods

Drug tapering different methods and the choice all depends on the following factors:

  • Type of substance
  • Co-occurring conditions
  • Biological differences
  • Psychological differences

When all these pointers are considered, medical professionals will prescribe a specific tapering method that is a custom fit for a patient’s needs. Below are the general types of drug tapering methods.

Direct Tapering

Direct tapering is the method of using the same addictive substance but lowering its dosage over time until the person is fully functional even without the drug. Direct tapering is advised for substances that have potentially fatal side effects when quitting cold turkey, such as:

  • Alcohol
  • Benzodiazepines such as Xanax

Removing these substances in the body abruptly shakes one’s brain chemical balance, causing seizures, heart problems, dehydration, or neurological disorders.

Substitution Tapering

Substitution tapering from the name itself means replacing the addictive substance with another similar medication that presents the same effects but is designed to remove the individual’s drug dependence.

Commonly, substitution tapering works well for substances that are hard to measure during the point of addiction such as alcohol or street drugs. This method can also be used for drugs that are highly addictive such as the class of opioids.

Many treatment centers have medications such as methadone, naloxone, or any other short-acting version of a drug to eliminate the dangerous effects of withdrawal. This will be used during the detox process in order to eliminate the dependency safely and effectively.

Titration Tapering

Titration tapering is the method of lowering the dosage through dilution. The addictive substance is diluted in water or any other liquid to decrease the effects and eliminate drug dependency.

The method can be used for substances that are easily diluted in water, such as alcohol or other medications that are ingested orally by the patient. The previous dosage before going to treatment will be determined and a gradual decrease of amount through dilution will be done through this process.

How Do Tapering Methods Work?

The tapering methods mentioned above work by helping the body adjust gradually to lower dosages until it is fully functional without the addiction. It also helps in the following areas of care:

  • Making withdrawal safer and easier: The main purpose of drug tapering is to decrease the potentially fatal side effects of substance withdrawal. As the body receives gradual weaning of the addictive substance, it can slowly adjust to the changes without biological systems going haywire.
  • Controlled use of substances: Drug tapering also helps in controlled substance use during detox. When within a treatment facility, there is a lesser chance of relapse or overdose because medical professionals provide the accurate dosages for tapering.
  • Biological and psychological adjustments: Tapering also makes it easier for the body to cope with biological and psychological differences without the drug. Symptoms are less intense and formal tapering in a medical facility also gives the patient enough support during detox.

Withdrawal Management In Recovery

There’s another part of the addiction recovery journey related to drug tapering called withdrawal management. During detox, the withdrawal symptoms are felt strongly. However, after the treatment, there will also be instances where a person can experience milder yet uncomfortable withdrawal symptoms from time to time. These can be:

  • Nausea
  • Cravings
  • Emotional turmoil
  • Fatigue
  • Restlessness
  • Malaise

Withdrawal management techniques are essential to prevent relapse even after treatment. Some ways to manage withdrawal symptoms during and after treatment include:

Inpatient care

The first line of care in managing withdrawal symptoms is through inpatient treatment. Also called medical detox, individuals are given a safe, comfortable place for resting, nutritious meals, and medications when needed in order to wean off from the addictive substance.

Inpatient care is typically done with the help of medical professionals within an addiction treatment facility.

Relapse prevention guides

Relapse prevention guides are those which are given after an individual is done with formal substance abuse treatment. These are strategies which include:

  • Nutrition and fitness plans: Guides for the person to follow in order to maintain a healthy lifestyle and avoid addiction cravings.
  • Continued therapies: Virtually all  people would benefit from continued psychotherapy to treat co-occurring conditions such as anxiety and depression.
  • Support groups: Treatment centers can also recommend support groups that others can join within their local community.
  • Stress management: Medical professionals may provide protocols to manage stress such as journaling, meditation, and other forms of self-therapies.

Can You Taper Without Withdrawal?

Someone who is heavily dependent on a certain substance would want to taper off their dosages. Often, this is done to decrease the intensity of withdrawal symptoms. However, in a scenario when addiction is evident, it is exceedingly rare that one will not experience withdrawal symptoms.

Some discomforts may be felt, but the tapering process helps decrease the chances of deadly side effects.

For mild cases of substance use, it is possible to have fewer difficulties in withdrawal. Nevertheless, there will still be symptoms felt depending on one’s sensitivity.

Medical Detox Treatment

As shortly discussed in inpatient care, one of the ways to taper off successfully is through medical detox. Although some individuals can attempt to try drug tapering by themselves, the lack of professional guidance may cause a cycle of relapse or even life-threatening withdrawal symptoms.

Thus, medical detox is highly recommended for a better chance of recovering from addiction. Some things to expect during a medical detox are:

  1. Getting admitted to a safe, comfortable lodging
  2. Having nutritious meals and snacks
  3. 24/7 medical assistance on standby
  4. Ample space for leisure, rest, and other treatment options

The ultimate goal of medical detox is to make the person functional and feeling well even without the addictive substance. Once the individual is stable, they can proceed to the treatment proper to target the underlying cause of substance abuse.

Drug Tapering: A Way To Manage Withdrawals

If you’ve been trying for a long time to quit an addiction without much success, in-depth knowledge of drug tapering may help you consider this route of care. By slowly removing the drug’s effects in your body, withdrawal symptoms can be manageable as you get closer to addiction recovery.

Sources

  1. Statnews.com – “With a new guide to tapering opioids, federal health officials seek a balanced approach to prescribing”.
  2. Dziegielewski, S.F – “Psychopharmacology Handbook for the Non-medically Trained”.
  3. Pubmed.ncbi.nlm.nih.gov – “Gradual Versus Abrupt Smoking Cessation: A Randomized, Controlled Noninferiority Trial”.
  4. Ncbi.nlm.nih.gov – “The Mechanistic Classification of Addictive Drugs”.
  5. Health.gov.au – “Withdrawal symptoms and the rebound effect”.
  6. Mind.org.uk – “About Benzodiazepines”.
  7. Pubmed.ncbi.nlm.nih.gov – “Assessment of outcomes following high-dose opioid tapering in a Veterans Healthcare System”.
  8. Pubmed.ncbi.nlm.nih.gov – “Detoxification with titration and tapering in gamma-hydroxybutyrate (GHB) dependent patients: The Dutch GHB monitor project”.
  9. Ncbi.nlm.nih.gov – “Overview, Essential Concepts, and Definitions in Detoxification”.

Medical disclaimer:

Sunshine Behavioral Health strives to help people who are facing substance abuse, addiction, mental health disorders, or a combination of these conditions. It does this by providing compassionate care and evidence-based content that addresses health, treatment, and recovery.

Licensed medical professionals review material we publish on our site. The material is not a substitute for qualified medical diagnoses, treatment, or advice. It should not be used to replace the suggestions of your personal physician or other health care professionals.

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