FAQs: Detoxing From Substance Use

When is Detox Required?

Medical detox is absolutely necessary for some patients. Before you decide on a specific course of treatment—and before you discontinue substance use—it’s best to get a medical evaluation. Your primary care doctor should be able to connect you with a qualified professional who can help. Alternatively, some rehab facilities can conduct over-the-phone detox evaluations during your initial call.

These assessments help quantify the risks associated with withdrawal, given your specific health history. But if you have a history of using certain substances, it’s very likely that your doctor will recommend medical detox.

Alcohol

After prolonged and/or heavy alcohol use, you can expect to go through severe withdrawal symptoms.⁴ These symptoms include insomnia, anxiety, and a serious condition called delirium tremens.

Delirium tremens (DT) can be debilitating and even fatal without proper medical care. This condition “typically begins 24 hours or longer following acute cessation of alcohol and is a life-threatening form of alcohol withdrawal² involving sudden & severe changes in the mental and nervous system. These changes can cause severe mental confusion and hallucinations.” DT is often associated with other risk factors, including electrolyte imbalance and head injury.

If you exhibit any of these symptoms, your medical team can prescribe certain medications to help manage alcohol withdrawal.⁵ While benzodiazepines may be helpful, these medications must be taken under close supervision, because they also have the potential to be addictive.

Benzodiazepines

Medications like Valium and Xanax are commonly prescribed for anxiety. According to the National Institute on Drug Abuse, “Although they are highly effective for their intended uses, these medications must be prescribed with caution because [benzodiazepines] can be addictive.”⁶

For patients who misuse or overuse them, benzodiazepine withdrawal⁷ is associated with severe and possibly fatal side effects. During detox, patients with a physiological dependence on these drugs may experience “sleep disturbance, irritability, increased tension and anxiety, panic attacks, hand tremor, sweating, difficulty in concentration, dry retching and nausea, some weight loss, palpitations, headache, muscular pain and stiffness and a host of perceptual changes…seizures and psychotic reactions.” It is absolutely vital that these patients receive medical care during the detox process. In order to manage your withdrawal from benzodiazepines,⁸ your doctors will help you slowly taper down your usage. In some cases, they will also prescribe additional medications to help alleviate some of your symptoms.

Opiates

In the U.S., we are currently experiencing an opioid crisis.⁹ Abuse of these drugs, which may be prescribed or illicit substances, is extremely common. Some of the more commonly misused opioids¹⁰ include oxycodone, hydrocodone, morphine, methadone, fentanyl, and heroin.

Since they’re often prescribed for physical pain, it can be especially difficult to distinguish between addiction and proper use of these drugs. If you have a prescription for painkillers, it’s extremely important to take them only as directed, and to stay in close communication with your medical team and your personal support network about your relationship with opiates.

Opiate withdrawal can be lethal¹¹ in the short term, partly due to potentially severe gastrointestinal side effects. And in the long term, former opiate users may be at risk of developing post-acute withdrawal syndrome¹² (PAWS). With this condition, patients may experience irritability, depression, obsessive-compulsive behaviors, anxiety, and an increased sensitivity to stress.

After stopping narcotic use, most people progress through three clearly defined stages of opioid withdrawal,¹³ as follows:

• Early Stage: Symptoms begin at the expected time of the first missed dose. Patients may experience cravings, anxiety, an intense preoccupation with opioid use, and flu-like physical symptoms.
• Peak Stage: Starting 1-2 days after the cessation of drug use, cravings reach their highest intensity. During this stage, you may also exhibit more severe gastrointestinal symptoms (such as nausea and vomiting), increased heart rate and blood pressure, sweating, and insomnia.
• Late Stage: In most cases, these symptoms will begin to decrease within 7 days of your last dose. Physical withdrawal symptoms disappear, and psychological symptoms decrease.

At every stage of this process, it’s common—and often necessary—for doctors to prescribe nonaddictive medications, intended to alleviate your most severe symptoms. You may even be prescribed other narcotics, such as methadone.¹⁴ These prescriptions should only be taken as directed, under the close supervision of a medical team.

What Types of Detox Treatment are Available?

Depending on which substances you’re detoxing from, you may be eligible for various types of treatment. In most cases, though, detox programs provide some combination of psychotherapy, non-addictive prescriptions, and medical monitoring. If you have any co-occurring medical conditions, or you’re detoxing from alcohol, benzodiazepines, or opiates, inpatient detox is highly recommended.

Detox in a Hospital Setting

In a hospital environment, your providers will likely focus on managing the physical symptoms of withdrawal. You can expect 24-hour care, with a team of doctors and nurses monitoring your vital signs. This setting is ideal for patients with additional diagnoses, and especially chronic illnesses. Because substance misuse may have an impact on your use of other prescriptions, it’s important to get medical support during this transitional period.

Hospitals may or may not be able to provide the same level of psychological care as other facilities. If you have a co-occurring mental health diagnosis, one of the following detox settings might be a better fit.

Medical Detox Centers

Some treatment centers focus entirely on medical detox. These centers provide similar services to both rehabs and hospitals. You’ll be monitored by a team of doctors and nurses, and also have regular sessions with a psychotherapist. You may also work with other healing professionals, such as a nutritionist or even a massage therapist.

Most medical detox programs last for 1-2 weeks. Some also require that patients make plans for longer-term care before entering treatment. For example, you may need to enroll in a residential rehab program that will begin as soon as you complete detox. Other medical detox centers may help patients plan for aftercare during their stay.

Residential Rehab

Some residential rehabs allow patients to detox on-site. If you’d like to go through detox and longer-term treatment at the same facility, talk to your admissions team to learn more about your options.

Inpatient detox is absolutely necessary for some patients, and is highly recommended for most. However, it’s not accessible for everyone. Fortunately, you can still begin recovery while living at home.

Detoxing at Home

At-home detox may be appropriate for some clients. You can consider this option if you have a strong personal support network, you’re exhibiting only mild withdrawal symptoms. It’s also essential that you make a plan to obtain emergency medical care if your symptoms worsen.

No matter where you plan to detox, make sure you consult with a doctor before you discontinue substance use. Even if you decide to go through withdrawal at home, with little professional support, their advice can help you plan for your own safety. Detoxing at home is almost never safe for patients recovering from alcohol, benzodiazepine, or opioid misuse.

If this option is appropriate for you, there are some noteworthy benefits to outpatient detox.¹⁵ Specifically, you may “​​retain greater freedom, continue to work and maintain day-to-day activities with fewer disruptions, and incur fewer treatment costs” compared to those who receive inpatient treatment.

How Much Does Detox Cost?

The cost of detox varies widely from one facility to another and is influenced by factors like facility type and the level of clinical care you receive. Detoxing from certain substances involves more intensive clinical services, which plays into final costs.

Low-cost detox programs are available. They’re usually offered at state-funded rehabs and some may even be free, though you’ll have to meet certain criteria to be eligible for most of these. In general, outpatient detox programs are more affordable than inpatient programs. On the low end, a private outpatient detox program can start at $250 per day.

A 30-day program at a private rehab center can cost less than $10,000 to over $75,000. In comparison to outpatient detox programs, these centers often offer additional therapeutic services on top of around-the-clock care during the initial stages of detox.

Many facilities accept insurance, including Medicaid. Make sure you check with your insurance provider, and your treatment provider’s admissions team, to see what portion of your costs can be covered by insurance.

What Happens After I Detox?

Recovery is a lifelong process, and detox is just the first step. It’s important to set realistic expectations, and understand that completing detox doesn’t mean you’ll be “fixed.”

After detox, many patients benefit from entering a longer-term treatment program. There are numerous ways to approach this. For example, you might attend residential rehab, or you might start an intensive outpatient program (IOP). Some patients join support groups, such as Alcoholics Anonymous¹⁶ or SMART Recovery.¹⁷

These long-term groups and programs serve many purposes. For example, they might help you improve your physical and mental health, or heal your interpersonal relationships. But even with the right support, you’ll continue to face challenges. It’s normal to have cravings long after you successfully complete detox. Effective treatment doesn’t take away your triggers; instead, it helps you navigate them in a healthy way.
If you’re ready to take the next step toward recovery, you can browse medical detox centers here.

Reviewed by Rajnandini Rathod

1. Kelly, J. F., Saitz, R., & Wakeman, S. (2016). Language, substance use disorders, and policy: The need to reach consensus on an “addiction-ary.” Alcoholism Treatment Quarterly, 34(1), 116–123. https://doi.org/10.1080/07347324.2016.1113103 [↩]
2. » detox. (n.d.). Retrieved from https://www.recoveryanswers.org/resource/alcohol-and-drug-detox/ [↩] [↩]
3. Information, N. C. for B., Pike, U. S. N. L. of M. 8600 R., MD, B., & Usa, 20894. (2006). 4 physical detoxification services for withdrawal from specific substances. Substance Abuse and Mental Health Services Administration (US). https://www.ncbi.nlm.nih.gov/books/NBK64116/ [↩]
4. Alcohol withdrawal. (2019, April 22). Harvard Health. https://www.health.harvard.edu/a_to_z/alcohol-withdrawal-a-to-z [↩]
5. Grover, S., & Ghosh, A. (2018). Delirium tremens: Assessment and management. Journal of Clinical and Experimental Hepatology, 8(4), 460–470. https://doi.org/10.1016/j.jceh.2018.04.012 [↩]
6. https://plus.google.com/+NIDANIH. (2012, April 19). Well-known mechanism underlies benzodiazepines’ addictive properties. https://archives.drugabuse.gov/news-events/nida-notes/2012/04/well-known-mechanism-underlies-benzodiazepines-addictive-properties [↩]
7. Pétursson, H. (1994). The benzodiazepine withdrawal syndrome. Addiction (Abingdon, England), 89(11), 1455–1459. https://doi.org/10.1111/j.1360-0443.1994.tb03743.x [↩]
8. Information, N. C. for B., Pike, U. S. N. L. of M. 8600 R., MD, B., & Usa, 20894. (2009). Withdrawal management. World Health Organization. https://www.ncbi.nlm.nih.gov/books/NBK310652/ [↩]
9. Division (DCD), D. C. (2018, May 8). Opioid crisis statistics [Text]. HHS.Gov. https://www.hhs.gov/opioids/about-the-epidemic/opioid-crisis-statistics/index.html [↩]
10. Opioid basics | cdc’s response to the opioid overdose epidemic | cdc. (2022, March 17). https://www.cdc.gov/opioids/basics/index.html [↩]
11. Yes, people can die from opiate withdrawal | NDARC – National Drug and Alcohol Research Centre. (n.d.). Retrieved from https://ndarc.med.unsw.edu.au/resources/yes-people-can-die-opiate-withdrawal [↩]
12. Post-acute withdrawal syndrome (Paws) | semel institute for neuroscience and human behavior. (n.d.). Retrieved March 25, 2022, from https://www.semel.ucla.edu/dual-diagnosis-program/News_and_Resources/PAWS [↩]
13. Opioid withdrawal timeline: Symptoms, stages, recovery, and more. (2021, March 31). https://www.medicalnewstoday.com/articles/opioid-withdrawal-timeline [↩]
14. Methadone. (n.d.). Retrieved from https://www.samhsa.gov/medication-assisted-treatment/medications-counseling-related-conditions/methadone [↩]
15. Hayashida, M. (1998). An overview of outpatient and inpatient detoxification. Alcohol Health and Research World, 22(1), 44–46. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6761814/ [↩]
16. Have a problem with alcohol? There is a solution. | Alcoholics Anonymous. (n.d.). Retrieved March 25, 2022, from https://www.aa.org/ [↩]
17. Self-Help Addiction Recovery Program. | Smart Recovery. Retrieved from https://www.smartrecovery.org/ [↩]