What is Alcohol and Drug Detox?
A period of medically supervised detoxification often marks the first part of treatment and recovery for individuals with alcohol and/or other substance use disorders. People who have developed various forms of substance dependence require time to move beyond acute intoxication as they clear themselves of any lingering influence of substances.1 Certain substance withdrawal syndromes can be quite unpleasant, and may include symptoms such as nausea, body aches, and anxiety.2 Some substance withdrawal syndromes are more challenging than others and can sometimes present risks to the individual in recovery. For instance, alcohol withdrawal can give rise to certain symptoms like body tremors and irritability but may also be associated with more serious withdrawal complications such as hallucinations and seizures.3
In addition to supervision and support, certain medications are sometimes used to minimize unpleasant withdrawal symptoms and keep people safer during detox. However, while detox and the management of withdrawal symptoms can help make individuals more comfortable—and in some cases, keep people from experiencing serious complications—a successful detox alone is not the end goal of treatment. Instead, professional detox services allow for the evaluation and stabilization of a person in need of withdrawal management, while also providing an opportunity to prepare the individual for additional, ongoing treatment efforts that will more comprehensively address the addiction and a range of recovery needs.3
Why Should I Detox Under Medical Supervision?
Certain types of substance withdrawal are more challenging than others. Even when lethal withdrawal risks aren’t a factor, medical detox may be a huge help in early recovery by preventing needless suffering during the withdrawal process. Many individuals are surprised by how severe the symptoms of opioid withdrawal can be; they find the intensity of nausea, vomiting, and muscle pain to be unbearable.4 Several medications are approved for use in managing opioid withdrawal in these situations.
Though any level of professional detox can help people feel more comfortable and supported during the difficult withdrawal period, medical withdrawal management may be critical in certain situations to minimize the risk of certain harms or withdrawal complications, such potentially deadly seizures during alcohol detox.3
Whether or not a person will experience severe withdrawal is not always easy to predict, which is another reason that medical withdrawal settings are commonly sought—to cover any harmful outcomes, should they arise. When it comes to alcohol withdrawal, there are numerous risk factors for severe or complicated withdrawal. These include:5
- History of longstanding, regular, and heavy alcohol use.
- Prior episodes of withdrawal.
- History of withdrawal delirium or seizures.
- Having a dependence on other substances, such as benzodiazepines.
- Being over the age of 65.
- Co-occurring medical conditions, particularly brain injuries.
- Co-occurring psychiatric conditions.
More substance-specific withdrawal risks and dangers:
- Alcohol withdrawal can be additionally dangerous due to potential complications such as delirium tremens, in which people experience seizures, extreme confusion, fever, coma, and sometimes death.3
- Sedatives such as benzodiazepines and sleep medications can also result in life-threatening seizures if stopped abruptly.4
- Opioids generally have a much lower risk of immediately dangerous complications during detox than other substances, but individuals have been known to develop medical problems, including severe dehydration, during detox.4 Additionally, left unmanaged, the intensely unpleasant symptoms of acute opioid withdrawal can increase relapse likelihood.
Can Detoxing at Home Be Dangerous?
Yes. Attempts to abruptly quit drinking or using certain other drugs without medical withdrawal management can be risky, in some cases. Detoxing alone can be dangerous in the event of withdrawal complications with no contingency for emergent care. Detox from alcohol, for example, can bring about seizures or delirium tremens that can lead to death.4 Even in the absence of immediate health risks, an unpleasant withdrawal may also increase the chance of relapse.
Medical Detoxification: Understanding the Different Levels of Care
Individuals being treated for substance use disorders may undergo detox for a few days to stabilize while the drugs or alcohol clear out of the system. In various settings, a professionally supervised detox can help you navigate the withdrawal period. The range of interventions available to you in each setting does vary though. In general, any level of supervised detox can be thought of as utilizing 2 broad approaches:4
- Medical detox programs most commonly avail a range of medical monitoring and pharmacological interventions (i.e., detox medications) that can help you manage the acute withdrawal period. In the case of alcohol withdrawal, this commonly entails benzodiazepine or other sedative administration to provide symptom management and seizure prophylaxis. Opioid withdrawal management often proceeds with stabilizing opioid agonist medications such as methadone or buprenorphine.
- Social detox programs provide short-term, nonmedical support during the withdrawal period. Though these programs may include patient monitoring and protocols to escalate the level of care in the event of withdrawal complications, the emphasis of a social detox program is in providing a safe, comfortable place to reside with ample interpersonal support during the withdrawal period.
Of note, hospitals or other environments that avail 24-hour medical care, are the preferred setting for withdrawal management for individuals with opioid, alcohol, or other sedative drug dependence.
Detox and ongoing treatment can take place in various outpatient and inpatient settings:4
- Inpatient treatment, where you receive treatment and supervision 24/7. Inpatient treatment will often be the most appropriate option for those at risk for or already experiencing complications during withdrawal. Co-occurring medical or mental health issues may also factor into an inpatient treatment recommendation from your doctor or other treatment professional. Many factors determine the length of stay for inpatient detox. Though many people can expect to remain in detox for just a few days to a week, an assessment by a substance abuse treatment provider will help determine the best course of treatment for you.
- Outpatient treatment, where you go to an outpatient program several hours a week for treatment and go home at night and on weekends. There are various levels of outpatient treatment. Intensive outpatient (IOP) usually meets 2-3 days a week for 3-4 hours a day. As with inpatient counterpart programs, the detox portion of an outpatient program will be determined only after you undergo an assessment and evaluation of your specific needs.
Which Setting and Level of Care Do I Need?
The appropriate level of care—whether inpatient or outpatient—will be best determined after a thorough assessment from your doctor or other healthcare professional. Many factors have to be explored when making a placement decision for treatment. Inpatient treatment may be an ideal option for those dealing with co-occurring medical or mental health conditions, acute anxiety, or those at high risk of complicated withdrawal. Other considerations, such as whether a person is able to consistently arrive at an outpatient clinic each day for treatment may influence the recommendations for specific treatment settings.4
ASAM, the American Society for Addiction Medicine, maintains a list of criteria that clinicians use to help determine what level of treatment a person needs. Ideally, the following 6 dimensions will be closely evaluated prior to a decision being made on the most appropriate level of care for that patient:6
- Acute intoxication and/or withdrawal potential
- Biomedical conditions and complications
- Emotional, behavioral, or cognitive conditions and complications
- Readiness to change
- Relapse, continued use, or continued problem potential
- Recovery/living environment
What Medications Are Used During Medical Detox?
Depending on the type of substance use disorder being treated, several different medications may be used during medical detox. There are medications to help minimize cravings and manage the symptoms of withdrawal associated with opioid use disorders. Other drugs help decrease the risk of seizures for those undergoing alcohol detox. Currently, the most common practice for treating alcohol withdrawal is the use of benzodiazepines, a sedating class of drugs that can help prevent seizures and manage certain other symptoms of acute alcohol withdrawal. Other medications, such as phenobarbital or an anticonvulsant drug, are sometimes used for this purpose as well.4
When managing opioid withdrawal, options include:4
- Methadone, an opioid receptor agonist that helps to manage withdrawal symptoms to stabilize someone in recovery.
- Buprenorphine, a partial opioid agonist with a relatively heightened safety profile that is similarly able to stabilize a person in withdrawal to deter relapse.
- Clonidine, an alpha-adrenergic agonist medication originally used to manage blood pressure, but which may be used off-label to handle some of the symptoms of opioid withdrawal.
- Over-the-counter medications for relief of withdrawal symptoms, such as Tylenol for headaches or Imodium for gastrointestinal issues.
What Medications Are Used After Medical Detox?
There are medications that may be prescribed to you after detox that can help you maintain long-term recovery and reduce the chances of relapse. U.S. Food and Drug Administration (FDA)-approved treatments for opioid use disorders include:4
- Buprenorphine, when used as a maintenance medication, can help individuals control their cravings for opioids and help them stay in long-term recovery.
- Suboxone, a formulation of buprenorphine that also contains a drug called naloxone to deter misuse.
- Naltrexone, which blocks some of the reinforcing effects of opioids to decrease continued use.
- Methadone, which has been used for many years as maintenance treatment for opioid use disorder.
There are also medications that the FDA has approved for long-term use to help individuals stay in recovery and avoid relapse from an alcohol use disorder. These are:7
- Disulfiram, widely known as Antabuse, results in a highly uncomfortable reaction if a person continues to drink while on this medication. The side effects can include nausea, vomiting, and rapid heart rate.
- Acamprosate (previously available as Campral) is thought to restore some of the neurochemical balance upset by problematic drinking and minimize some of the more persistently troublesome symptoms of alcohol withdrawal. Its use can help increase abstinence from alcohol.
- Naltrexone, which though an opioid receptor blocker, is thought to block some of the rewarding effects of drinking. In this manner, naltrexone use may decrease alcohol cravings and deter continued drinking behavior.
What Happens After Medical Detox?
It is important to remember that detox is only the start of a more comprehensive treatment regimen for drug or alcohol addiction.1 For many people, ongoing treatment and aftercare are vital to long-term recovery. In addition to the beneficial treatment medications listed previously, some of the more behavioral therapeutic approaches used to help individuals maintain long-term recovery include:
- Cognitive-behavioral therapy (CBT) helps people recognize and better manage or altogether avoid certain triggering thoughts or situations that might contribute to continued problematic drinking or drug use behavior. A widely used approach in the mental healthcare realm, CBT has been found to be effective for many people dealing with substance use disorders.8,9
- Motivational interviewing in which the therapist encourages positive changes in behavior by helping people overcome their ambivalence about seeking or engaging with treatment for their substance use.9
- Contingency management uses incentives such as rewards and prizes to help bring about positive behavioral changes related to using drugs or alcohol.10
- 12-Step facilitation is used widely in treatment programs. Participants learn the principles of the 12 steps as practiced by groups like Alcoholics Anonymous (AA) and Narcotics Anonymous (NA) as part of their treatment. This process involves 12-Step meetings and encourages sustained participation to help individuals continue their recovery.11
- Sober living homes, halfway houses, or other recovery residences offer a safe environment for ongoing support and stability to further one’s recovery efforts. Though not a formal treatment approach themselves, sober living arrangements provide a substance-free, peer supported, structured environment to help reduce temptations to use drugs or alcohol. Required check-ins and various forms of accountability help people stay sober.9
Drugabuse.com is an American Addiction Centers resource and a leading provider in safe drug and alcohol detoxification. If you’d like to learn more about your available treatment options, including programs that include detox, contact us today at 1-888-744-0069 . You can also use our free and confidential insurance checker below to see if your insurance covers detox at an American Addiction Centers facility.
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