Detox and withdrawal from addictive substances can be challenging, but a drug taper can make this process less uncomfortable.
While a home detox can be effective for some mild addictions, a supervised medical detox in a licensed detoxification center provides continuous clinical and emotional care as well as medication management.
Recovery from addiction is a lifelong process rather than a time-limited event like detox. While a drug taper might not offer the swiftest route to sobriety, it is more important to build a firm foundation for sustained sobriety than to approach recovery like a race.
Let’s start with a drug taper definition so you can determine whether this gradual method of drug withdrawal is suitable for you.
What Is a Drug Taper?
A drug taper is a protracted form of detoxification. Tapering, also known as weaning, involves reducing the consumption of alcohol, prescription medications, or illicit drugs rather than abruptly discontinuing use.
Drug tapering is a method used primarily for the safety and comfort of the person who is detoxing.
CDC (Centers for Disease Control and Prevention) recommend drug tapering in the following scenarios:
- If an individual requests tapering.
- When there is minimal progress and no pain reduction.
- If dosages are becoming too high.
- For those taking both benzodiazepines like Xanax and opioids like OxyContin.
- When there are signs of a substance use disorder (the formal descriptor for drug addiction).
- If a person has previously experienced drug overdose or other adverse outcomes during detox and withdrawal.
If you become addicted to drugs, whether prescription medications or illicit substances, this triggers structural and functional brain changes. The body also becomes accustomed to the presence of the addictive substance.
Physical dependence often occurs with abuse and addiction. It is characterized by both tolerance and withdrawal. When tolerance forms, you will need more of the substance to achieve the same effects. Withdrawal symptoms are a physical and emotional response as your system struggles to function in the absence of the substance.
Dependence can also occur with the following prescription medications:
Drug withdrawal ranges from mildly unpleasant to life-threatening and potentially lethal. This is especially true of withdrawal from the following substances:
Drug tapering is one approach that helps mitigate the more severe symptoms of drug withdrawal while promoting sustained recovery.
ASAM (American Society of Addiction Medicine) provides physicians and clinicians with a set of tapering guidelines. Drug tapering should always be administered by an experienced medical professional.
While drug tapering can be a highly effective approach, drug withdrawal management and tapering should be considered the starting point for treatment rather than a replacement for rehab. Tapering is always most beneficial as part of a comprehensive treatment program including individual and group counseling as well as psychotherapy like CBT (cognitive behavioral therapy).
How Does A Drug Taper Work?
There are three main approaches to tapering which we’ll outline below:
- Direct tapering
- Substitution tapering
- Titration tapering
ASAM recommends as slow an approach to tapering as possible. This minimizes withdrawal symptoms and also allows physicians to rapidly adjust medications in the event of any complications.
The duration of a drug taper depends on how the person responds to gradual dosage reduction. Some people find that more aggressive dosage reductions provoke more intense withdrawal symptoms. Ideally, dosages should be reduced incrementally enough that significant withdrawal symptoms are eliminated.
The drug taper process will vary depending on the substance being used, the individual using the substance, and the physician administering the taper. This is an overview of the basic drug tapering process:
- The taper starts with the physician administering enough of the substance to the person to eliminate significant symptoms of withdrawal. Starting dosages will differ and will be adjusted if necessary. The first dosage reduction is typically 10% of the starting dosage of the substance.
- Subsequent reductions in dosage are usually spaced a week or two apart. Smaller dosage reductions may be required to continue staving off withdrawal symptoms.
- Once the person is only receiving 5% of the initial starting dosage, they are ready to be discontinued from the substance.
- If complications occur among those physically dependent on multiple substances, administration of multiple tapering medications on different schedules may be required.
- Mild withdrawal symptoms may still present. These can be addressed with behavioral therapy and nutritional support. Occasionally, other medications may be administered to counter symptoms like headaches or nausea.
If the person experienced severe withdrawal symptoms, this is normally indicative of an overly aggressive tapering schedule or of the tapering process being initiated prematurely.
A successful taper occurs when all withdrawal symptoms subside and the person no longer requires the substance.
Here are the three most common methods of delivering a drug taper:
A direct taper involves a gradual reduction. The duration of a direct taper varies according to the following variables:
- Substance being used
- Duration of substance use
- Individual using the substance
Each week, the substance will be reduced incrementally until it is discontinued completely.
Substitution tapering is often effective for those addicted to illicit and short-acting substances like opioids or benzodiazepines. The substance of abuse is replaced by a similar but more readily tapered substance with a low abuse potential. Common examples include:
In most cases, opioid replacement medications such as Suboxone and methadone are used to treat opioid and opiate withdrawal. Benzodiazepines can be effective for tapered reductions of many substances, including alcohol, benzodiazepines, and stimulants like meth.
As with a direct taper, the ratio of dosages is gradually adjusted until the substance of abuse is no longer required.
With some drugs – benzodiazepines and opiates, for instance – it can become difficult to taper with lower dosages.
Titration tapering involves dissolving the substance in water and delivering tiny daily decreases in dosage. This form of tapering usually leads to a smooth and comfortable withdrawal process, but it is only suitable for water-soluble substances and must be administered by an experienced medical professional.
Drug Tapers Involving Multiple Substances
A drug taper can still be effective in the event of withdrawal from multiple substances. The intensity of these withdrawals means additional caution is advisable.
The optimum tapering approach in this scenario is to taper one substance at a time. While this extends the duration of the drug taper, any withdrawal symptoms will be much easier to manage. Tapering each substance in isolation should also prevent cravings from manifesting, minimizing the chance of relapse.
Tapering should be one component of an evidence-based treatment plan including counseling and psychotherapy in either an inpatient or outpatient setting.