Detox Types and Options
Formal detox is often the first and one of the most important steps in the drug addiction recovery process, as a person may better benefit from the efforts of counseling and therapy after first being physically stabilized. According to the National Institute on Drug Abuse (NIDA), detox involves getting rid of the foreign substances and managing withdrawal symptoms on an as-needed basis.
Just as there are different types of drug rehab, there are also various forms of drug detox, each one designed to meet the needs of a particular type of addiction and a specific type of individual. The following gives a glimpse into the options that an individual who is ready to break the addiction cycle has at his disposal.
What Is Drug Detoxification?
When an individual consistently or repeatedly uses a substance, it is likely that they will develop physical dependence over time. Physical dependence is the body’s natural adaptation to the presence of a drug and, once it is significantly established, the body requires the drug to function as normal.
When someone dependent on a substance abruptly discontinues or dramatically reduces use, withdrawal symptoms are likely to emerge. Withdrawal symptoms vary from substance to substance, and while some may be only mildly uncomfortable, some can be life-threatening. See below for symptoms of withdrawal for common substances.
- Excessive sweating
- Rapid pulse
- Repetitive, purposeless movements
- Hand tremors
- Hallucinations or illusions
- Delirium tremens (DTs)
Opioids (e.g., heroin, prescription painkillers):1
- Muscle aches
- Goose bumps
- Increased sweating
- Watery eyes and runny nose
- Excessive yawning
- Depressed mood
Sedative, hypnotic, or anxiolytic drugs (e.g., Xanax, Ativan, Valium, Ambien):1
- Increased pulse rate
- Excess sweating
- Unintentional and purposeless movements, such as pacing
- Illusions or hallucinations
Stimulants (e.g., cocaine, meth, Ritalin, Adderall):1
- Insomnia or hypersomnia
- Increased appetite
- Slowed movements and thought
- Anhedonia, or an inability to feel pleasure
- Suicidal ideation or behavior
How Long Does The Process Take?
The withdrawal timeline varies from drug to drug and even within drug classes. Generally, the emergence and resolution of withdrawal symptoms are impacted by the half-life of the substance (which influences the average duration of drug effects), the mode of administration, the frequency of use, and the average dose used.1 While you might feel symptoms right away for some drugs, others will not produce immediate withdrawal symptoms: 1
- For stimulant drugs, withdrawal symptoms typically appear within a few hours to a couple days after the last dose.
- Sedative withdrawal symptoms may appear as quickly as a few hours after or as delayed as several days following last use. For someone who is addicted to Xanax, withdrawal symptoms may appear within 6-8 hours of the last dose and improve by the 4th or 5th day. Meanwhile, Valium may produce withdrawal symptoms a full week after the most recent dose and may not resolve for 3-4 weeks.
- For opioid drugs, such as heroin and painkillers, symptoms typically emerge within 6-12 hours after the most recent dose and subside within 5-7 days.
- Long-acting opioid drugs, such as methadone, may have a longer and more delayed timeline, with symptoms appearing 2-4 days after the last dose and taking longer to dissipate entirely.
- Alcohol withdrawal symptoms tend to emerge within a few hours to several days after quitting or reducing consumption.
Withdrawal severity will vary among individuals. A person’s physiology, age, gender, and mental and physical health impact the severity and timeline of symptoms. Likewise, the different types of interventions may affect the duration of withdrawal symptoms, since the administration of medication in a medical detox setting could somewhat lengthen the process, while a social detox program doesn’t intervene medically.
Non-Medical or “Social” Detox
Social detox, which is a non-medical type of detox program, involves the individual stopping the use of the drugs entirely—essentially going “cold turkey” while under the care of treatment professionals. This social model of detox involves professionals providing the patient with emotional and psychological support throughout the withdrawal process but not administering medications to manage symptoms and complications.
While this method can help people successfully withdraw from psychoactive substances, it is not without its challenges. The potential for an unpleasant withdrawal syndrome presents perhaps the most prominent challenges associated with natural detox, as an individual must endure several potentially uncomfortable withdrawal symptoms as their body adjusts to a lack of drugs in their system. Depending on the specific drug, withdrawal symptoms can be severe, causing the individual great distress and even putting them in medical danger in some cases. As a result, individuals may relapse in an effort to relieve their symptoms and cravings for the drug.
One of the major risks associated with relapse is that of overdosing. During a significantly long period of abstinence, a person’s tolerance will markedly decrease, which means that they don’t require as much of the drug as they once did. Many people who relapse return to using the dose they previously abused, which can lead to an accidental, and potentially deadly, overdose.
Other risks associated with entering a natural detox program include the potential development of psychological issues over the course of withdrawal and, next, a decreased capacity to adequately manage such issues. Oftentimes, withdrawal syndromes from various substances—such as opioids, stimulants, and benzodiazepines—include mental health symptoms, such as depression, suicidal ideation or attempts, anxiety, delirium, emotional blunting, and insomnia.1
Medical complications may arise during withdrawal. Generally speaking, natural or social detox is not recommended for the management of withdrawal from alcohol, benzodiazepines, barbiturates, or opioids, due to humanitarian and safety concerns.2 The symptoms that emerge when an individual stops using these substances are often painful and, with the exception of those associated with opioids, potentially fatal.1,2
Unlike the "natural" method, medical detox provides patients with medication and medical treatment in order to prevent and address complications. As previously mentioned, withdrawing from alcohol, benzodiazepines, and barbiturates can be dangerous to attempt alone, due to the risk of serious symptoms. Seizures may emerge that require immediate medical management, which may not be available in a social detox program. Further, withdrawal can lead to delirium, a confused, agitated state, in which the person may experience hallucinations and exhibit dangerous, unpredictable behaviors.1
Disturbances in consciousness and cognition can lead to accidents, erratic behavior, and even violence. If you are addicted to one of these substances, medical detox can help to ensure your safety while withdrawing. For example, to prevent some of the complications of alcohol withdrawal, medical intervention with drugs like benzodiazepines or anticonvulsants may be initiated.6
While withdrawal from opioids such as heroin is not generally medically dangerous, it can cause intense discomfort, so much so that many people return to using them to relieve the painful symptoms. For this reason, medical detox can also be beneficial for those addicted to these drugs. Medication-assisted treatment (MAT), which involves administering medications to alleviate withdrawal symptoms and cravings, is an important aspect of medical detox for opioids. The medications are used to minimize the distress caused by withdrawal, reduce cravings, and prevent medical complications. They include:3,4,5
- Methadone: This full opioid agonist attaches to and activates opioid receptors in the brain, which decreases cravings and reduces unpleasant withdrawal symptoms. For treatment of opioid dependence, methadone is administered as an orally disintegrating wafer, an oral concentrate liquid, or a pill. It can only be dispensed by opioid treatment programs (OTPs).
- Buprenorphine: This partial opioid agonist produces a less pronounced opioid effect than a full agonist, like methadone. It can be prescribed by doctors who have been authorized to treat opioid dependence with buprenorphine. Suboxone is a formula containing a combination of buprenorphine and naloxone, a medication that blocks opioid effects. This combination formula helps to curb abuse of the medication.
Both methadone and buprenorphine may be used solely as detox medications or may be continued as part of maintenance management to prevent relapse. Another MAT drug used in a maintenance capacity is naltrexone. This opioid antagonist blocks the rewarding effects of opioids. If someone who is on naltrexone uses an opioid, they won’t experience any euphoria. It is available as a pill or an extended-release, intramuscular suspension known as Vivitrol. Combined with behavioral therapy, continued use of opioid dependence medications can help to prevent relapse and promote long-term sobriety.
Is Ultra Rapid Detox Safe?
Ultra rapid detox, which touts an ability to ease the process of opioid withdrawal, is a controversial method that can produce dangerous outcomes.
Someone who undergoes rapid detox is placed under general anesthesia and is administered medication (such as naltrexone) to initiate the withdrawal process. Under anesthesia, the individual theoretically won’t experience the full spectrum of painful symptoms associated with withdrawal. Rapid detox can seem appealing to those who are apprehensive about enduring these symptoms.7 However, one problem with this method is that the length of withdrawal is different for each person and is complicated by the combination of medications administered. For this reason, many people wake up still in the throes of withdrawal, experiencing intense symptoms for days after the procedure.8
Some patients may fail to disclose preexisting health issues during medical and psychiatric screenings in order to be approved for rapid detox, which can have dire consequences.
Researchers have posited that there is no evidence in support of anesthesia-assisted detox for the management of opioid withdrawal. Further, there are many risks associated with undergoing rapid detox. These risks include:7
- Exacerbation of mental health problems, such as bipolar disorder, panic attacks, and depression.
- Metabolic complications of diabetes.
- Fluid accumulation in the lungs.
Individuals who are at particularly high risk of experiencing harmful effects include those who have preexisting conditions, such as AIDS, heart disease, hepatitis, prior pneumonia, elevated blood sugar, insulin-dependent diabetes, and psychiatric conditions. Some patients may fail to disclose preexisting health issues during medical and psychiatric screenings in order to be approved for rapid detox, which can have dire consequences.7 Case reports of people who underwent anesthesia-assisted rapid opioid detox (AAROD) showed patients experiencing complications ranging from cardiac arrhythmias to rhabdomyolysis. If your health is already in peril for one reason or another, AAROD can cause especially serious and even life-threatening problems.9
Where to Find a Suitable Program
If you’re interested in entering a detox program but aren’t sure where to begin, you can always ask your physician or therapist for recommendations on various centers in your area. Once you’ve received some recommendations, you will want to do your own research regarding the different types of detox services available. It’s important to determine your priorities when it comes to treatment so that you can find the program that is the best fit for you. Some questions you may want to ask when calling various detox programs include:
- What detox method is utilized (social vs. medical)?
- What is the typical length of the program?
- What is the price of the program?
- Does the program accept insurance? If so, which plans?
- What are the credentials of the staff members?
- What amenities and services are offered?
- Are rooms private or shared?
- Does the treatment team help patients transition into addiction treatment?
You are not limited to the above questions but they should help jumpstart your search for the appropriate detox program for your needs. Each program will have its advantages and disadvantages.
You have options for where you receive drug detox. They include:10
- Medically managed inpatient detox: The most intensive level, which occurs in a hospital setting or psychiatric facility, you receive around-the-clock treatment and monitoring in this environment.
- Medically monitored inpatient detox: You’ll receive 24-hour medical care in a location other than an acute care setting—typically a legitimate center.
- Clinically managed residential detox: This option, also known as social or natural detox, offers around-the-clock supervision but lacks constant medical care, preferring to offer emotional and psychological support instead.
- Ambulatory detox with extended onsite monitoring: Detox, as well as treatment, takes place at an outpatient facility in which you’ll spend several hours in treatment before returning home.
- Ambulatory detox without extended onsite monitoring: As the least intensive level available, you’ll attend appointments at a physician’s office or through a home health care agency.
Oftentimes, people complete a detox program and subsequently, with help from their treatment team, transition into a comprehensive addiction treatment program, which can address the underlying issues driving drug abuse. The program may provide you with referrals or even help you to enroll into a program so that your transition into treatment is smooth.
If you haven’t completed a detox program and are looking for an addiction treatment program, you can ask any medical or mental health professional for guidance. If you have insurance, you may also want to call your insurance company to learn what your individual plan covers before making a decision. You can then acquire a list of treatment programs that accept your insurance in order to narrow down your search.
What Happens Next?
Once detoxification is complete, you’ll likely be considered stable enough to continue on with the remainder of drug rehab treatment. It is important to note that this is NOT addiction treatment in and of itself. Completing the process of detoxification means you have overcome your physical dependence on drugs, not your psychological dependence.
In order to maintain sobriety in the months and years to come, you must also address the thoughts, feelings, and behaviors that lead you to use substances; this is accomplished through drug addiction therapy.
Just as detox programs vary greatly, there are many different types of recovery programs available at varying levels of intensity. The most common types of addiction treatment programs include:
- Inpatient: You reside at the treatment facility for the duration of the program, which is usually between 30 and 90 days, but may be longer if needed. Amenities, services, and policies vary amongst inpatient programs.
- Outpatient: You live at home while receiving addiction treatment services. This option is appropriate for you if you have strong social support and need to continue living at home, for example to take care of your family, continue working, etc.
- Holistic: Some inpatient programs utilize a mind-body-spirit approach to recovery and employ alternative and complementary methods, such as meditation, yoga, and creative arts therapy.
- Luxury: More expensive inpatient options provide you with upscale amenities, such as gourmet meals, massage, and horseback riding.
- Executive: These inpatient programs cater to working professionals who don’t want treatment to disrupt work or negatively impact their reputations. If you must continue working while addressing your addiction, this is a good option.
- Faith-based: Select inpatient programs will integrate religious beliefs with traditional treatment methods, such as individual and group counseling.
- Population-specific: Some facilities have experience in addressing the unique needs of certain populations, such as LGBT, veterans, teens, women, and men.
Detox can occur in a separate facility before transitioning into an addiction treatment program, or the substance abuse center may offer both detox and addiction treatment services. It all depends on the individual program.
Regardless of the type of treatment program offered, drug counseling is a major component. Drug counseling makes up the bulk of time most individuals will spend in a rehab center. There are many specific varieties of counseling but the primary types include individual, group, experiential, and family therapy.
- Individual counseling. The patient meets in private with a therapist to discuss the underlying causes of their addiction. The patient and therapist work together to help the patient develop life strategies that will promote a lifetime of sobriety.
- Group counseling. Group sessions are a chance for the individual to form a support network with other recovering individuals in the program. These meetings are, for many, the first time they ever talk openly and honestly about their addictions with other people. Most group counseling sessions are led by licensed therapists; however, 12-step meetings in the community are often led by others also recovering from an addiction.
- Experiential therapy. Experiential therapy can take on many forms, such as adventure therapy, art therapy, drama therapy, music therapy, or animal-assisted therapy. These different forms of therapy focus on the experience rather than talking about it. Therapists guide the patient through activities where they may experience victories and learn to overcome obstacles. These lessons can then be applied to their thoughts and behaviors toward drugs or alcohol.
- Family therapy. Addiction puts a great deal of strain on the family unit. Family therapy is a chance to heal damaged relationships and to learn how to communicate with one another in a more productive way that enhances the recovery efforts of the individual.
It’s never too late to start down the right path. If you need help, reach out today.
- American Psychiatric Association. (2013). Diagnostic and statistical manual of mental disorders (5th ed.). Arlington, VA: American Psychiatric Publishing.
- Center for Substance Abuse Treatment. (2006). Detoxification and Substance Abuse Treatment.
- National Institute on Drug Abuse. (2012). Principles of Drug Addiction Treatment: A Research-Based Guide.
- Substance Abuse and Mental Health Services Administration. (2015). Medication and Counseling Treatment.
- Substance Abuse and Mental Health Services Administration. (2011). Medication-Assisted Treatment for Opioid Addiction.
- Sachdeva, A., Choudhary, M., & Chandra, M. (2015). Alcohol Withdrawal Syndrome: Benzodiazepines and Beyond. Journal of clinical and diagnostic research, 9(9).
- National Institute on Drug Abuse. (2006). Study Finds Withdrawal No Easier With Ultrarapid Opiate Detox.
- California Society of Addiction Medicine. (2011). Anesthesia-Assisted Rapid Opioid Detoxification.
- Centers for Disease Control and Prevention. (2013). Deaths and Severe Adverse Events Associated with Anesthesia-Assisted Rapid Opioid Detoxification — New York City, 2012.
- Substance Abuse and Mental Health Services Administration. (2015). Detoxification and Substance Abuse Treatment.