Bath salts, also known as synthetic cathinones, are a class of designer drugs that are used as a cheap substitute for other illicit drugs such as amphetamines, MDMA and cocaine. Bath salts are used for their psychostimulant properties and short-term use can cause serious side effects such as psychosis, excited delirium and death. When used over an extended time, bath salts can lead to the development of dependence on the drug, with subsequent discontinuation of the drug resulting in adverse withdrawal symptoms. These withdrawal symptoms from bath salts can lead to relapse. Receiving treatment at a detox facility may be necessary to cope with these symptoms.
What is Bath Salt Withdrawal?
Use of synthetic cathinones over an extended period can lead to the development of physiological dependence on the drug. Drug dependence is characterized by the necessity to use the drug to function normally and involves the adaptation of the brain’s reward system to the use of the drug. Frequent use of bath salts also results in the development of tolerance with larger quantities of the drug being required to produce the desired effects. Discontinuation of the use of bath salts after developing drug dependence results in a physiological and emotional response. This response to the absence of the rewarding stimulus (i.e., drug use) results in withdrawal symptoms involving depression, other mood disturbances, fatigue and insomnia.
Signs and Symptoms of Bath Salt Withdrawal
Synthetic cathinones are a family of designer drugs with more than 30 drugs belonging to this category. Mephedrone, methylone and MDPV (methylenedioxypyrovalerone) are a few of the better-characterized drugs. The knowledge about the consequences of the long-term use of synthetic cathinones is mostly based on these drugs. Due to the different chemical structures and biological properties of each synthetic cathinone, each bath salt may produce a slightly different profile of withdrawal symptoms.
So far only withdrawal symptoms of mephedrone have been characterized and include depression, anxiety, nasal congestion, tiredness, a lack of focus, irritability and drug cravings.
Bath Salt Withdrawal Duration and Timeline
There is very limited research regarding the withdrawal symptoms emerging due to the use of bath salts and the precise time course of these withdrawal symptoms has not been characterized. Abstinence from the use of synthetic cathinones is marked by a phase of descent or “crash” within the first 48 hours and involves symptoms such as lack of focus, tiredness, tachycardia, anxiety and headaches.
Given the similarity of synthetic cathinones with amphetamines, the withdrawal symptoms emerging due to bath salt abstinence may be severe during the first week and continue at a lower intensity for the subsequent 2-3 weeks. Some symptoms such as cravings and a lack of energy may persist for several weeks after discontinuation of drug use.
Some of the short-term symptoms of withdrawal from bath salt use include:
- Hypothermia or hyperthermia
- Difficulty concentrating
- Nasal congestion
- Drug cravings
Most of the withdrawal symptoms due to abstinence from the use of synthetic cathinones resolve themselves in the first few days. However, symptoms such as intense cravings, anhedonia (inability to experience pleasure) and lack of energy persist for several weeks after discontinuing drug use.
Managing Withdrawal Symptoms
Withdrawal symptoms emerging as a result of the discontinuation of the use of bath salts generally involve sleep disturbances, depression, anxiety and intense cravings. These adverse symptoms may lead to drug relapse, making it necessary to manage those withdrawal symptoms. Although there are no medications approved for the treatment of the withdrawal symptoms, certain medications can help alleviate the individual symptoms that emerge during withdrawal. For example, benzodiazepines may be used to reduce anxiety, whereas antidepressants may be used to treat symptoms of depression. Psychosocial support is also beneficial in the management of withdrawal symptoms.
Bath Salt Detox
Detoxification involves the elimination of the bath salts from the system and management of the withdrawal symptoms that emerge due to discontinuation of drug use. Detoxification from bath salts may also involve the management of the symptoms of acute intoxication. Detoxification may be undertaken at a detox facility or at home, with detox at home carrying a greater potential for relapse due to exposure to triggers that cause drug use. Detoxification may be undertaken at home if family members are available to provide the necessary supervision and emotional support. In the case of detoxification at home, care must be taken to gradually reduce drug intake rather than stopping cold turkey. Stopping drug use all at once may result in more severe adverse symptoms.
Medications for specific withdrawal symptoms may also be used as prescribed by a doctor. Detoxification at an inpatient or outpatient treatment facility generally involves the use of both medications and behavioral therapy and reduce the chances of relapse. Detoxification is the first step in the recovery from bath salt addiction but treatment at a rehabilitation facility is necessary to address the issues underlying the drug use.
Bath Salt Detox Programs & Treatment Centers
Detoxification at home often leads to relapse due to the severe adverse symptoms and exposure to triggers. Enrolling in an inpatient or an outpatient detox center can help prevent relapse by providing the necessary medical care and support to cope with the withdrawal symptoms.
- Medical Detox
This process requires residence at the detox center and involves round-the-clock care from medical professionals. Treatment at a medical detox center helps the patient cope with the adverse withdrawal symptoms with the help of medications. Detox is especially useful for individuals with severe dependence or patients with co-occurring psychiatric or substance use disorders who are more likely to experience more severe withdrawal symptoms. Inpatient detox not only provides intensive care and support but also a drug-free environment without triggers that may cause cravings.
- Outpatient Detox
Outpatient detox like inpatient medical detox also involve the use of medications and behavioral therapy to manage the withdrawal symptoms. However, this does not involve residence at the treatment facility and generally involves multiple visits to the detox center over the duration of treatment. This format allows individuals to continue their daily life and fulfill their obligations as they seek treatment. However, this may expose the individual to triggers that may result in relapse. Outpatient detox is less expensive than inpatient detox but is more suitable for less severe cases of dependence on synthetic cathinones.
Detox is only the first step toward recovery. Rehabilitation is necessary to ensure long-term sobriety. In general, a longer duration between the completion of detoxification and enrollment in a rehab center is associated with a higher rate of relapse. Various options exist for the treatment of addiction to synthetic cathinones, including enrollment in an inpatient or outpatient rehab, partial hospitalization programs. Treatment for bath salt addiction involves the use of various behavioral approaches such as cognitive behavioral therapy, contingency management programs and motivational enhancement therapy.
If you or a loved one struggle with bath salts, contact The Recovery Village Palm Beach at Baptist Health to speak with a representative about getting the help needed to address addiction and any co-occurring mental health disorders.
Cottencin, Olivier; Rolland, Benjamin; Karila, Laurent. “New designer drugs (synthetic cannabinoids and synthetic cathinones): review of literature.” Current Pharmaceutical Design, January 2014. Accessed July 27, 2019.
Coppola, M.; R. Mondola. “Synthetic cathinones: chemistry, pharmacology and toxicology of a new class of designer drugs of abuse marketed as “bath salts” or “plant food.” Toxicology Letters, June 2012. Accessed July 27, 2019.
Substance Abuse and Mental Health Services Administration. “Detoxification and Substance Abuse Treatment.”. 2006. Accessed July 27, 2019.
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