Detox: The First Step Toward Recovery
- Drug and alcohol treatment often begins with detox, which is the process of allowing any toxins to leave the body while managing withdrawal symptoms.
- Detox can be done on an inpatient or outpatient basis. It usually includes 3 stages: evaluation, stabilization and transitioning to treatment.
- Medically supervised detox is strongly recommended for alcohol, opiate or benzodiazepine withdrawal, which can be fatal.
- Detoxing “cold turkey” can have severe and life-threatening consequences.
- Detox is not actually treatment. After you complete detox, you should consider entering a rehabilitation program.
What Is Detox?
Detoxification (detox) is the process of eliminating all traces of drugs and/or alcohol from the body, while managing the symptoms of withdrawal. While it is an important initial hurdle to overcome, detox alone is NOT treatment.
Why Is It Necessary?
Continued use of certain drugs or alcohol can lead to your body becoming physically dependent on the substance. Abruptly quitting certain substances can lead to a withdrawal syndrome that can prove, in some cases, to be life-threatening.
A detox program can help:
- Ease the discomfort of withdrawal.
- Help with any serious medical situations that may arise.
- Offer the smoothest path for someone to traverse this difficult period of time immediately following the discontinuation of drugs or alcohol.
A successful detox period can lower the risks of continued drug use or the temptation to relapse to prevent a painful withdrawal.
How Safe Is Detox?
Detox can be a dangerous and life-threatening process. Because of the severity of risks associated with detox, it is critical that you seek medical and professional help prior to starting treatment.
Which Drugs Require Detoxification?
Several drugs require medically supervised detoxification “without any exceptions.” Withdrawal from these substances can cause you to become dangerously agitated or experience potentially life-threatening seizures/convulsions.
These drugs include:
- Benzodiazepines – such as Ativan, Valium and Xanax.
There is some evidence that the non-benzodiazepine sedative hypnotics such as Ambien and Lunesta also warrant a strictly monitored detox period.2
Detox Strongly Recommended
- Opiates – including illicit drugs such as heroin.
- Prescription opioids – such as hydrocodone and oxycodone, as well as their brand formulations including Lortab, Vicodin, Norco, OxyContin and Percocet.
- Stimulants – including cocaine, methamphetamine and prescription medications such as Adderall and Ritalin.
Withdrawal from the above substances does not constitute a medical emergency. But the extremely unpleasant physical effects of the withdrawal can cause some people to relapse.
Detox for Specific Drugs
Learn more about the detox process for commonly abused drugs, including:
Quitting ‘Cold Turkey’
Trying to quit cold turkey (without medical intervention) can cause severe and life-threatening risks – particularly for those experiencing acute alcohol, barbiturate or benzodiazepine withdrawal.
- Needlessly uncomfortable withdrawal.
- Increased risk of relapse.
- Increased risk of overdose from relapse due to lowered tolerance to the drug.
- Death (frequently in the setting of uncontrolled seizure and convulsion).
What Is The Process Like?
Detox consists of 3 essential steps: evaluation, stabilization and transitioning to treatment.
Drug or alcohol detoxification consists of 3 essential steps, according to the Substance Abuse and Mental Health Services Administration.1
During evaluation, treatment providers gather information about you to help with treatment planning. This includes:
- Blood tests.
- Screening for co-occurring conditions (mental and physical).
- A comprehensive assessment of your medical and psychological status.
- Assessment of your social situation.
- Risk assessment for withdrawal severity and need for medical supervision.
Stabilization is the medical and psychosocial processes of helping you through acute intoxication and withdrawal. This step often includes:
- Medication to ease withdrawal symptoms.
- Proper diet and nutrition (e.g., vitamin B).
- Familiarizing you with what to expect in treatment and recovery.
- Including your friends and family when appropriate and with release of confidentiality.
Transitioning Into Treatment
This step involves preparing you to enter substance abuse treatment. Staff will encourage you to follow through with a treatment program and aftercare. Many programs can help you transition into their treatment program or give you information on programs you can attend.
Alternative and Holistic Detox Treatments
Many drug or alcohol detox programs typically include pharmaceutically managed drug detox. Alternative and holistic programs combine more nontraditional therapies, which include but are not limited to:
- Yoga and meditation
- Healthy nutrition
- Creative arts therapies
Often these programs are residential treatment facilities. Some of these centers include:
During rapid detox – also known in clinical studies as anesthesia-assisted detoxification – you are placed under anesthesia while going through withdrawal symptoms.
This process is advertised as a virtually painless detox method, where addicts can basically “sleep through withdrawal.” People supposedly detox within hours as opposed to several days or even weeks.
Rapid detox was designed to speed up the detoxification process. However, this process is widely criticized. According to the Centers for Disease Control and Prevention (CDC), rapid detox programs have been shown to have “substantial risks, including a risk for death, and little to no evidence to support its use.”
Which Medications Are Used?
- Barbiturates: (previously used but, largely replaced with benzodiazepines today).
- Benzodiazepines: Diazepam (Valium).
- Lorzapam (Ativan)
- Chlordiazepoxide (Librium)
- Clonidine – an antihypertensive medication effective in minimizing some but not all of the unpleasant symptoms of opiate/opioid withdrawal.
- Buprenorphine – an opiate drug itself, but with mixed agonist/antagonist activity at the mu opioid receptor; frequently used for detox and opiate replacement.
- Naloxone – a complete opioid receptor antagonist used in emergency overdose situations and combined with other substances (such as buprenorphine) to lower risk of overdose if misused.
- Naltrexone – useful in opiate recovery (and alcohol, for that matter) due to its ability to blunt some of the rewarding effects of these substances.
- Methadone – another opiate replacement medication; longer-acting than many other opiates, making it safer to dose and potentially easier to taper off of.
- Desipramine (Norpramin): is an antidepressant used for major withdrawal symptoms.
- Benzodiazepine sedatives have also been used to manage methamphetamine and cocaine withdrawal.
Where Do You Go for Detox?
Detox can happen in a variety of settings and locations. These settings can be broken into two types: inpatient and outpatient.
Inpatient detox is more common and includes:
- Residential rehab treatment facilities.
- Dual-diagnosis treatment facilities (treating co-occurring mental health problems).
- Medical detox centers.
- Other detox centers.
- Holistic/alternative treatment centers.
- Studies have shown inpatient to be the most effective treatment method.
- It offers the most support and quality of care with staff available 24/7.
- You’re more closely monitored and treated for other medical conditions.
- You’re removed from your environment, reducing triggers and barriers that increase likelihood of relapse.
- You receive continued care after the detox program (often at the same location).
- It’s more expensive.
- There’s less flexibility with your schedule, since you live at the treatment center for the duration of inpatient services.
Outpatient detox includes:
- Outpatient detox clinics (typically you come into the clinic daily to get medication or visit your doctor’s office monthly to obtain a prescription).
You should enroll in an outpatient addiction treatment program at the same time as an outpatient detox clinic to address cravings and allow for additional support.
- It’s cheaper.
- There’s more flexibility with your schedule.
- You may face a higher risk of relapse.
- You’ll continue to be exposed to same environment, increasing the likelihood of triggers and easy access to the substance.
- It is more difficult to safely manage the period of acute substance detox on an outpatient basis.
- There’s less continuity of care.
How Long Does It Take?
The duration of detox varies greatly and is dependent on several factors including the substance, dosage and length of time the drug was abused.
But detox usually ranges from a few days to a couple weeks (with the exception of benzodiazepines).
How Much Does it Cost?
Cost of detox depends on factors such as:
- Type of detox.
- Inpatient vs. outpatient.
- Private or publically funded facility.
- Medication (pharmacotherapy).
Payment options for detox include:
- Insurance (Call our helpline at 1-888-892-1840Who Answers? to make sure the program accepts your insurance).
- Out-of-pocket (check with treatment centers, as many offer payment plans).
- Sliding scale (some addiction treatment facilities often have sliding scale fees, meaning the cost varies depending on your ability to pay).
- Government assistance (only available in states where detox is considered a medical need).
- Financing (loans, credit cards, selling assets, borrowing from friends and family).
What Happens After Detox?
Options for treatment following detox include:
While not mandatory, it is strongly recommended that you enter treatment immediately after detoxing.
Most detox centers provide information and resources to help you transition to treatment facilities. Often, inpatient drug and alcohol treatment centers incorporate an initial period of structured detox into their program design. This design creates a more seamless transition from detox to ongoing treatment.
Treatment after detox can range from inpatient treatment to various outpatient programs and support groups.
Treatment may include more than one of these options, and you can move from more intense treatment options to a less intensive program throughout your recovery.
Where to Find a Detox Treatment Program
. Miller, N., & Kipnis, S. (2006). Overview, Essential Concepts, and Definitions in Detoxification. In Detoxification and substance abuse treatment: A treatment improvement protocol. Rockville, MD: U.S. Dept. of Health and Human Services, Public Health Service, Substance Abuse and Mental Health Services Administration, Center for Substance Abuse Treatment
. Javadi, S., Hajiali, F., & Asl, M. (2014). Zolpidem Dependency and Withdrawal Seizure: A Case Report Study. Iranian Red Crescent Medical Journal Iran Red Crescent Med J.
Amato, L., Minozzi, S., Davoli, M., & Vecchi, S. (2011). Psychosocial and pharmacological treatments versus pharmacological treatments for opioid detoxification. Cochrane Database of Systematic Reviews Reviews.
Bellamy, J. (2015, August 20). Anesthesia-Assisted Rapid Opioid Detox. Science-Based Medicine. Retrieved August 30, 2015, from https://www.sciencebasedmedicine.org/anesthesia-assisted-rapid-opioid-detox/
Day, E., Ison, J., & Strang, J. (2005). Inpatient versus other settings for detoxification for opioid dependence. Cochrane Database of Systematic Reviews Reviews.
Deaths and Severe Adverse Events Associated with Anesthesia-Assisted Rapid Opioid Detoxification – New York City, 2012. (2013, September 27). Retrieved August 29, 2015
Marsch, L., Bickel, W., Badger, G., Stothart, M., Quesnel, K., Stanger, C., & Brooklyn, J. (2005). Comparison of Pharmacological Treatments for Opioid-Dependent Adolescents. Arch Gen Psychiatry Archives of General Psychiatry, 1157-1157.
Medication-Assisted Treatment for Opioid Addiction in Opioid Treatment Programs: A Treatment Improvement Protocol TIP 43. (n.d.). PsycEXTRA Dataset. Retrieved September 1, 2015, from http://www.ncbi.nlm.nih.gov/books/NBK64158/
Miller, N., & Kipnis, S. (2006). Detoxification and substance abuse treatment: A treatment improvement protocol. Rockville, MD: U.S. Dept. of Health and Human Services, Public Health Service, Substance Abuse and Mental Health Services Administration, Center for Substance Abuse Treatment.
Minozzi, S., Amato, L., & Davoli, M. (2009). Detoxification treatments for opiate dependent adolescents. Cochrane Database of Systematic Reviews Reviews. Retrieved August 28, 2015.
Safari, F., Mottaghi, K., Malek, S., & Salimi, A. (2010). Effect of Ultra-Rapid Opiate Detoxification on Withdrawal Syndrome. Journal of Addictive Diseases, 449-454.
Whitten, L. (2014). Study Finds Withdrawal No Easier With Ultrarapid Opiate Detox. PsycEXTRA Dataset. Retrieved August 29, 2015, from http://www.drugabuse.gov/news-events/nida-notes/2006/10/study-finds-withdrawal-no-easier-ultrarapid-opiate-detox