Section 2
Detox and Recovery
Sobriety is a path many community members may want to choose. While this isn’t the first or primary step for many others, we want to be sure to have a solid understanding of the different options people may want and how to make this process supportive, comfortable, and inclusive as possible. Harm reduction means that all options are available for people to choose what makes the most sense for their bodies, which means having the option of sobriety and sobriety support tools is an important part of harm reduction!
The pain of withdrawal can be supported with prescription aid by medical professionals, a comfortable place to rest, hydration and nutritious foods to the person’s tolerance, and emotional support. Cultural support and connectivity are crucial here to ensure people have the spiritual and emotional support to get through this process. There are many options for people interested in detox and recovery – every option wont work for everybody, and each substance comes with its own considerations.
Opioid Options
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A replacement method of opioid management given out at specialty clinics. Methadone is a monitored dose of opioids that is prescribed to prevent withdrawal. Methadone might be preferred by people who can’t bear withdrawal; who want to either taper or have a stable dose; and people whose primary concern is the stress surrounding their opioid access.
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A method of opioid management that primarily decreases negative withdrawal symptoms. Buprenorphine, also known by the brand Suboxone, is a more easily accessible method than methadone. This might be preferred by people who want support with the withdrawal process and get a “jump start” on their recovery process by reducing the pain associated with it.
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A method of opioid management that primarily decreases opioid cravings. Naltrexone can be provided by any doctor able to prescribe medication which makes it easier to access. While naltrexone requires a full detox versus buprenorphine, they both support people in managing ongoing cravings.
Stimulant Options
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A reward program where people are given cash incentives for decreasing or eventually ceasing stimulant use. These programs can support people struggling with the “reward” system of stimulant dependency, and provide a routine and structure without having to be in an in-patient program.
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A method of therapy that helps people work through impulsive tendencies and reroute decision-making. CBT doesn’t always work for anyone, and this style of therapy can have negative effects on some, but CBT can be a helpful option for those who want support with decision-making and building up tolerance to navigate the intensity of stimulant cravings.
Other Depressant Options
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Because alcohol withdrawals can be fatal, it is widely recommended to enter a detox process with close support from medical providers trained in supporting detox. Generally, a variety of prescription medications like benzodiazepines and anti-convulsants are offered to prevent the most extreme of withdrawal symptoms. However, alcohol withdrawal can become fatal quickly – the priority is ensuring the person detoxing is safe and has someone supervising who can act quickly if things get dangerous.
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Similarly to alcohol withdrawal, benzodiazepine withdrawal can be fatal if not treated properly. The standard for benzo withdrawal is supervised taper, as sudden “cold turkey” withdrawal can be fatal. Unlike alcohol, there are not many directly-applicable medications that can support with the process, and instead focus is placed on monitoring the taper dosage to ensure safety. Benzos also have a risk of long-term withdrawal symptoms (also known as protracted withdrawal) which are symptoms lasting months or even years after initial detox. Benzo recovery has a higher emphasis on physical supports for these symptoms compared to some of the other substances where long-term care is more emotional, spiritual, and mental.
Cultural Care
For any substance, cultural care is one of the most important aspects of supporting our relatives. Each person’s ancestry has their own cultural ways, and part of our role may be to support people in finding or gaining access to some of these culturally-specific healing processes. Below are intertribal recovery models developed for more widespread integration.
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Wellbriety is a culturally-centered model related to the general 12 Step process. Wellbriety is an option that some people strongly prefer due to the ways it supports with cultural connection and being in community, while non-Native 12 Step programs may be culturally irrelevant or even harmful.
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A peer-to-peer program that builds supports and referrals options from a culturally-centered care approach. Warrior Down is a model that supports people already in sobriety, to support people in maintaining their lifestyle as desired. This model is also used to support people returning home after incarceration, and people coming out of treatment centers.
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There are many programs in California that offer culturally-focused inpatient programs for people working to achieve sobriety. The requirements and guidelines vary depending on the program, with many requiring people to have already gone through initial detox.