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Do I Need Detox?
The National Institute on Drug Abuse (NIDA) characterizes addiction as a complex but treatable condition that affects the brain and behavior.2,3 While addiction is treatable, no single treatment works for everyone. 3
Because withdrawal symptoms may be uncomfortable, severe, and sometimes even life-threatening, it is not recommended that those attempting to quit drugs or alcohol do so alone.
There are several different types of detox programs available and people should consult with a health professional or otherwise conduct considerable research to determine which program is the most appropriate option for their unique needs.
Types of Detox Centers
Because withdrawal symptoms may be uncomfortable, severe, and sometimes even life-threatening, and because people may not know their risk of a complicated withdrawal, it is often not advisable that those attempting to quit drugs or alcohol do so alone.1 Withdrawal symptoms vary in duration and intensity based on the substance(s) used, the duration and amount of use, and the user’s overall health.6 The acute withdrawal syndromes associated with some substances (e.g., alcohol, opioids, and sedatives) may be significantly severe, while others (e.g., marijuana and stimulants) mainly consist of emotional and mental withdrawal symptoms.6
While addiction is treatable, no single treatment works for everyone.
In some instances of substance dependence, people may be able to detox by meeting with their physician regularly to slowly taper their dose over time in order to avoid markedly unpleasant withdrawal symptoms, as a tapering strategy allows the patient’s system the time to adjust to decreasing doses of the drug.4 However, as is often the case with more severe addictions, patients may need to attend a more structured detox facility for full monitoring and care. Medically supervised detox provides patients with medical monitoring and care throughout the detox process. In some cases, severe withdrawal may necessitate emergency treatment or a brief stay in a hospital prior to moving on with addiction treatment.1 Each treatment plan should be continually assessed and revised to meet the patient’s changing needs.3
Some outpatient programs provide detox treatment services at a medical facility during the day and allow patients to return home each night. Such detox services may cost between $100 and $500 per treatment session, though this price can vary by the length and frequency of treatment.5 Outpatient detox may be most suitable for people with relatively recent or less severe addictions, those with good support systems at home, and individuals with no other complicating medical or psychological issues.4
Outpatient treatment may be most useful for those patients with little risk of experiencing severe withdrawal so they will not need intensive 24-hour care. Additional advantages may include great social support outside of treatment by maintaining contact with friends and family; maintaining employment, school, or other personal and professional duties; and more flexibility during treatment.
Inpatient detox protocols may be somewhat similar to those found in an outpatient setting, but care takes place with the additional supervision afforded by the inpatient environment. In contrast to their outpatient counterparts, inpatient facilities have patients reside at the treatment center rather than going home in the evenings. An inpatient or residential detox stay may cost $200 to $900 per day depending on the length of the program and amenities offered at the facility.5
One of the main advantages to this type of treatment program is that patients are removed from the temptations and old habits of prior drug and alcohol use. This can help decrease the likelihood of relapse prior to treatment completion. Another benefit is the enhanced access to medical services, should they be needed. Those at risk of severe and/or dangerous withdrawal symptoms and drug cravings may benefit most from an inpatient detox center.
Alcohol, or ethanol, is one of the most abused drugs among people in addiction treatment, as reported by a 2017 survey from Recovery Brands. The survey found that nearly 70% of people in recovery underwent treatment for a drinking problem, and a surprising 52.87% of those who responded sought treatment for alcohol abuse more than for any other substance. Regardless of how many abused substances exist, alcohol is the most pervasive. View Large Graph
Social and Medical Detox Services
At somewhat distinct ends of the detox program spectrum are two general models of detox—social detox and medical detox. Social, or clinically managed residential detox programs generally offer short-term, nonmedical treatment services.1 They may provide patients with emotional and psychological support while they withdraw from a substance or substances, but they don’t usually provide medication or medical care. Patients are typically transferred to a medical facility in the event of complications. This type of detox is often reserved for those who aren’t at risk of experiencing complicated withdrawal (i.e., those without significant physiological dependence in association with opioid, alcohol, or sedative addictions).1
Since withdrawal from alcohol and sedatives can be potentially fatal, due to grand mal seizures, people addicted to either of these substances would highly benefit from medical detox.
Conversely, medical detox protocols provide patients with medical care, detox medications, and other symptomatic/supportive medications. These programs are well equipped to ensure someone’s safety and comfort during the distressing withdrawal experience.7 Since withdrawal from alcohol and sedatives can be potentially fatal, due to grand mal seizures, people addicted to either of these substances would highly benefit from medical detox.1 They will receive medications that reduce or mitigate withdrawal symptoms and prevent complications.1,7 In the event that a complication arises, medical staff can intervene immediately. Although opioid withdrawal is not typically life-threatening, it can be so painful and uncomfortable that many patients choose medical detox to reduce withdrawal symptoms and achieve stability.1
Professional detox helps many people navigate the early recovery period. Regardless of whether a more social or medical model is recommended—you don’t have to face withdrawal alone.
How to Choose a Detox Center
Choosing a detox center is not always a quick and easy decision. There are several factors to consider when selecting the right alcohol or drug detox center to best meet your needs and give you the greatest chance of long-term recovery. Some important questions to ask yourself and to inquire about directly with a detox program include:
- What amenities would I like the facility to have?
- Will I be allowed to see my family and friends?
- Does the facility accommodate dietary issues?
- Will I be allowed to use my cell phone or computer?
- Does the facility accept my insurance, or will I need to pay out of pocket to cover some of the costs?
- How far away is the treatment facility?
- How long will my treatment last?
What Happens During Detox?
When you first arrive at the treatment facility, you will go through an intake process. You will be assigned a therapist who will work with you on your recovery. During this process you will be asked questions on your drug history and prior use. It is important to answer all questions as honestly and completely as possible in order to receive the best care. Your therapist will help devise a treatment plan that is specific to your individual needs. Detox services on their own may cost as much as $1,000 per day, depending on the level of care needed, severity of addiction, and length of time it takes to detox.5
Detoxing from alcohol, opioids, and other drugs can take anywhere from a few days to several weeks, depending on your general level of health, addiction severity, level of physical dependence, and other factors such as whether or not you have been using multiple substances. In some instance—such as with alcohol and opioid addictions—you may be given medications to help you deal with the withdrawal symptoms and to help lessen your cravings.
Medication Management of Withdrawal from Alcohol and Opioids
The method of treatment—including specific treatment medications—received during detox will depend on the specific substance(s) being abused.3 Prior to detox, you will be assessed by professional medical personnel to determine certain withdrawal risks and the likelihood of a complicated withdrawal, as well as the specific types of medical intervention(s) that may be needed to mitigate these risks during detox.3 [This is not an exhaustive list; there are other medications that may be used to address detox symptoms. Read more here.]
The precise pharmacotherapeutic regimen needed during detox may differ according to type of substance dependence as well as the potential severity of the associated withdrawal syndrome. However, some detox medications that are commonly used to manage potentially-serious withdrawal syndromes—such as acute alcohol or opioid withdrawal—include:3,9
These sedative drugs are often used during alcohol detox to decrease the intensity of withdrawal symptoms and minimize the risk of serious complications such as agitation and seizures.
Methadone is a full opioid agonist medication used for stabilization and maintenance therapy. When used during heroin or other opioid detox, once an effective stabilizing dose of methadone is achieved, continued dosing may be slowly reduced over time. Some of those recovering, however, continue to take methadone for years—or even for the rest of their lives.
A partial opioid agonist drug, buprenorphine is also used during heroin and prescription opioid detox. As with methadone, though at some point after being stabilized on buprenorphine (or Suboxone—a treatment formulation that combines buprenorphine with naloxone) some may eventually taper off the medication, many people benefit from maintenance therapy in the longer-term.
Individuals given medications during detox are closely monitored to help prevent any adverse reactions.
Alcohol and Drug Withdrawal Symptoms
In many cases, withdrawal symptoms emerge within 12 hours after you have last used alcohol or drugs and, in many cases, fully resolve within about two weeks. In rarer instances, some individuals report experiencing more persistent withdrawal effects that may last in the range of months. Some of the general symptoms of withdrawal common to many types of substances may include:1,6
- Mood swings.
- Panic attacks.
- Muscle aches.
- Back and joint pain.
- Trembling or shaking.
- Difficulty breathing.
- Clammy skin.
Addiction Therapy After Detox
It is important to understand that medical detox and successful withdrawal management, while important, does not constitute comprehensive addiction treatment.7,8 In order to maximize chances of long-term sobriety, most detox programs will facilitate a transition into longer-term treatment and therapy when the withdrawal period has abated.
It is important to understand that medically assisted detox is only one aspect of your work toward recovery.
Cognitive behavioral therapy can help addicted people identify and cope with triggers that contribute to their drug and alcohol use.7
Group therapy is also an important component of the treatment process. It allows other individuals in treatment to meet in a small group setting that is facilitated by a professional.
Family therapy is often used to help family members deal with the destructive behavior of the addicted person. Family therapy identifies common warning signs and gives families a plan of action on what to do should a relapse occur. It also helps families learn how to be supportive during rehab and recovery.
Getting Help for Alcohol or Drug Addiction
Quitting alcohol or drugs is incredibly difficult to do alone. For many people who struggle with drug addiction or alcoholism, professional treatment and therapy provides them the best chance of success.
- Substance Abuse and Mental Health Services Administration. (2006). TIP 45: Detoxification and Substance Abuse Treatment.
- National Institute on Drug Abuse. (2018). Drugs, Brains, and Behavior: The Science of Addiction: Drug Misuse and Addiction.
- National Institute on Drug Abuse. (2018). Principles of Drug Addiction Treatment: A Research-Based Guide (Third Edition): Principles of Effective Treatment.
- Miller, S. C., Fiellin, D. A., Rosenthal, R. N., & Saitz, R. (2019). The ASAM Principles of Addiction Medicine, Sixth Edition. Philadelphia: Wolters Kluwer.
- American Addiction Centers. (2017).
- U.S. Department of Health and Human Services (HHS), Office of the Surgeon General. (2016). Facing Addiction in America: The Surgeon General’s Report on Alcohol, Drugs, and Health.Chapter 4.
- National Institute on Drug Abuse. (2016). Understanding Drug Abuse and Addiction: What Science Says: 8: Medical detoxification.
- National Institute on Drug Abuse. (2019). DrugFacts: Treatment Approaches for Drug Addiction.
- National Institute on Drug Abuse. (2018). Principles of Drug Addiction Treatment: A Research-Based Guide (Third Edition): Alcohol Addiction.