Many people begin substance use disorder treatment with a period of detoxification and withdrawal management. As an important element of early recovery, detox can provide supportive care and access to medical interventions, when needed, for certain types of withdrawal. Professional detox can keep people safe and comfortable in withdrawal as their body clears itself of the influence of drugs and/or alcohol.1
What is Detox?
Some people may think of detoxification and substance use treatment as identical concepts, but detox is not exactly the same as treatment or rehab. Though it is a very important element of treatment, detox is only the first part of a longer treatment process for people with substance use disorders.2 A medical detox setting allows for doctors and other treatment professionals to closely monitor patients while providing specific medications to manage withdrawal.2 Undergoing supervised medical detox under the guidance of professionals can keep you safe and prevent serious, even life-threatening complications during detox and withdrawal.1
Though individual experiences may vary somewhat, there are three fundamental elements of many professional detox processes. These elements include:3
- Evaluation, a period during which you will undergo a full assessment to best determine the full range of medical, psychological, social, or other specific detox and treatment needs.
- Stabilization, which involves supportive care and, when necessary, medical interventions to help people manage the acute withdrawal period. The stabilization period also provides a good opportunity for programs to help you to understand the upcoming treatment process.
- Fostering patient readiness for treatment, which may involve setting up ongoing substance use treatment and emphasizing the importance of continued treatment after the detox period. In addition, counselors work to increase your treatment engagement, motivate you to continue treatment, and may even develop a written contract for you to attend ongoing treatment.
What Are Withdrawal Symptoms Experienced During Detox?
Certain types of substances are associated with the development of physiological dependence with regular use—a phenomenon that involves the body adapting to the consistent presence of drugs and/or alcohol. If you become dependent on alcohol or certain other drugs, you are likely to experience some symptoms of withdrawal when you stop using them. The character and severity of these symptoms will vary depending on the substance involved and the degree of dependence present. With certain substances, including opioids, alcohol, and other sedating drugs, medications can be used to help manage the symptoms of withdrawal.2 Some general, substance-specific withdrawal syndromes may include:
- When a person withdraws from opioids, they may experience body aches, fever, sweating, chills, goosebumps, and gastrointestinal distress (i.e., nausea, vomiting, diarrhea).3
- Alcohol withdrawal symptoms may include tremors, irritability, and insomnia, as well as more severe withdrawal symptoms including hallucinations, extreme confusion, and seizures.3
- Withdrawal from benzodiazepines can be similar to withdrawal from alcohol; many individuals withdrawing from benzodiazepines will experience acute anxiety, in addition to agitation and insomnia, and potentially experience hallucinations or seizures.3
- Stimulant withdrawal, while often relatively less physically challenging than some of the other withdrawal syndromes mentioned here, can result in fatigue, depression, agitation, slowed body movements, and cravings for stimulants.3
Who Should go to Detox?
A professional detox program and, in particular, medical detox may be the preferred route of care for individuals at risk of experiencing certain types of withdrawal. For instance, for reasons of safety and avoidance of needless discomfort, medical detox may be the most appropriate setting for people experiencing acute alcohol, sedative-hypnotic, and/or opioid withdrawal syndromes.3
Assessing your need for detox, including the level of intensity of care and specific treatment setting in which it may most safely take place, is often best determined after a thorough assessment by a treatment professional. To these ends, the American Society for Addiction Medicine (ASAM) offers placement criteria as guidelines for professionals to assess multiple areas to determine the best course of detox and treatment for each individual seeking treatment help. Such a multi-dimensional assessment takes into consideration:4
- Acute intoxication and withdrawal potential.
- Medical conditions and complications that might require treatment attention.
- Emotional, behavioral, or cognitive conditions that could influence the course of treatment.
- An individual’s readiness to change.
- A person’s potential for relapse, continued use, or other continued problems.
- The recovery/living environment of the person seeking recovery help.
How Long Does Detox Take?
From start to completion, the total length of detox will vary for each individual. It is tough to provide a universal timeline that fits every person’s situation for detox. Numerous factors are involved, including the type of substance being used, how severe the person’s dependence is, overall health, and how long or how much they used the substance.
Some estimated timelines for withdrawal from certain substances are as follows:
- Alcohol: For many people, symptoms of alcohol withdrawal may begin as early as a few hours after their last drink and peak in intensity between 24–48 hours later. Seizures and other signs of over-excitation in brain activity may manifest within 12 hours to 2 days after the last drink; more rarely, some people remain susceptible to severe alcohol withdrawal delirium (also known as delirium tremens, or DTs), for as long as 3 days after the last use of alcohol.5
- Benzodiazepines: These are associated with an acute withdrawal syndrome that may first develop within several hours to days after a person quits using relatively shorter-acting benzos (such as Xanax and Ativan), or as long as one week for relatively longer-acting medications (such as Valium).6 Benzodiazepine withdrawal symptoms can remain troublesome for several days to weeks before resolving. Some people experience protracted withdrawal symptoms, which if left unmanaged, can reportedly continue for years.7
- Opioids: Withdrawal can vary based on the duration of action of the involved opioid drugs. Short-acting opioids, such as heroin, are often associated with an onset of withdrawal symptoms around 8–24 hours after the last use and may last anywhere from 4–10 days. Dependence on longer-acting opioids, such as methadone, more commonly results in withdrawal symptoms at 12–48 hours after the last use, with the total duration of withdrawal being 10–20 days.8
What Are the Dangers of Detoxing Alone or at Home?
People may consider detoxing alone at home but must understand the potential for complications in trying to detox without medical oversight or access to potential life-saving interventions. Detoxing alone may be particularly risky when a person is withdrawing from alcohol or benzodiazepines, since people can sometimes develop seizures or even die from withdrawal.3 In addition, while opioid withdrawal is not usually dangerous, it is still possible to become very ill during withdrawal and as a result need medical attention for things like electrolyte disturbances as a result of acute gastrointestinal distress.3 Another danger in trying to detox from opioids at home is the potential for relapse, as acute opioid withdrawal can be severely unpleasant, prompting some to quickly start using drugs again to stop the symptoms.9
How Are Medications Used in Detox?
Certain types of medication may be used for withdrawal management. The most common practice for managing alcohol withdrawal is the use of a relatively long-acting benzodiazepine to minimize symptoms such as agitation and decrease the risk of seizures. Phenobarbital or other anticonvulsant drugs are sometimes used for this purpose as well.3
For opioids, several medications may be used to manage some of the difficult symptoms of withdrawal. These medication options include:3
- Methadone, an opioid agonist medication that helps manage withdrawal symptoms and decrease cravings for opioids.
- Buprenorphine is a partial opioid agonist medication that, similar to methadone, interacts with the opioid receptors in the brain to control withdrawal symptoms and manage cravings to use opioids.
- Clonidine is a non-opioid medication that can relieve some of the symptoms of opioid withdrawal.
- Lofexidine, with a similar mechanism of action to clonidine, is a relatively recently approved medication used to manage some symptoms of opioid withdrawal.10
Where Does Detox Take Place?
Though detox approaches vary from one program to the next, many broadly follow either a social or medical detox framework:3
- Social detox relies more heavily on interpersonal support as individuals navigate withdrawal and early recovery. These programs have historically been short-term, nonmedical, and may not provide medications for withdrawal management. Access to medical and nursing services under a social detox model may be highly variable.
- In contrast, medical detox programs will utilize medications for managing withdrawal from substances such as alcohol and opioids. Such programs may better facilitate the escalation of care in the event of withdrawal complications or when the need for more intensive services otherwise arises.
- Inpatient treatment settings offer 24/7 oversight and support. Inpatient detox is an appropriate level of care for people at risk of severe/complicated withdrawal, who have underlying mental health issues, or who have physical illnesses that may need attention during withdrawal. Some inpatient programs are inside hospitals, but others are in freestanding facilities. Medically monitored inpatient detox programs will always have nurses onsite, while doctors will be at least reachable by phone 24 hours a day.
- Residential detox programs vary a great deal from one to another in terms of how much supervision and oversight people receive while there. Some of these residential detox programs may emphasize social detox rather than using medications to manage withdrawal.
- Outpatient programs may provide an appropriate level of care to people experiencing mild to moderate withdrawal symptoms. Some programs are classified as intensive outpatient programs (IOP) in which the participants meet at least 9 hours each week, usually 3 hours at a time, 3 days per week. Others offer partial hospitalization programs (PHP), which meet 20 hours each week. These types of outpatient programs offer the same types of assessments, supervision, and interventions as inpatient programs, but allow people to go home at night and sometimes keep going to work or school while getting treatment.
- Ambulatory detox is an appropriate option for certain people and circumstances and involves regular visits to a doctor’s office or clinic for monitoring during detox.
What Happens After Detox?
Professional detox services should not be viewed as a substitute for more comprehensive rehabilitation. Detox is only the first stage of treatment and long-term recovery from substance use disorders.1 Ongoing rehabilitation involves ample behavioral therapy as a cornerstone of treatment. For people recovering from alcohol use disorders and opioid use disorders, medications may continue to be an important component of treatment.2
A handful of FDA-approved medications can help people manage cravings for opioids and facilitate long-term recovery from opioid use disorder. These medications are:3
- Buprenorphine, a maintenance medication that can be used to help people in recovery continue to manage their cravings for opioids without feeling the euphoria associated with opioids.
- Suboxone, which is buprenorphine combined with an opioid antagonist drug called naloxone. This formulation was created to deter misuse of the treatment medication itself.
- Methadone, which like buprenorphine, can be used as a maintenance medication for those recovering from opioid use disorder.
- Naltrexone, an opioid antagonist medication that blocks the reinforcing effects of opioids and, in doing so, may decrease the likelihood of continued opioid misuse. Naltrexone is not initiated during the detox/withdrawal management phase as it could worsen or precipitate withdrawal.11
For those who have an alcohol use disorder, the FDA also has approved medications that can help people to avoid relapse and maintain longer periods of recovery.12
- Antabuse, also known as disulfiram, can deter alcohol use by causing a highly unpleasant reaction if the person drinks while taking the medication.
- Campral, which is the brand name for acamprosate, is medication that can help people maintain sobriety by reducing some of the more protracted symptoms of alcohol abstinence.
- Naltrexone, the same opioid antagonizing medication that blocks the reinforcing effects in the treatment of opioid use disorder also decreases the rewards of drinking. Consequently, if a person is on naltrexone and then drinks, they will not experience the fully reinforcing effects of alcohol, helping to decrease the likelihood of drinking alcohol in the future.
In addition to the use of medication for some substance use disorders, ongoing treatment beyond detox is critically important to lasting recovery.1 Several approaches to behavioral therapy are commonly used in treatment programs, including cognitive-behavioral therapy, contingency management, 12-Step programs (such as AA and NA), and sober living homes.
These approaches can be completed independently or in combination. To discuss options for detox and drug abuse treatment, call us now at 1-888-744-0069 Questions about what your insurance will cover? Verify your insurance coverage now.