Drug Addiction Detox Guide

Drug addiction is a chronic, progressive disease that causes long-lasting changes in the reward, motivation, and memory centers of the brain and is often marked by periods of remission and relapse.^1,2 These changes in the brain can create strong cravings for the substance and reduce your impulse control. Addiction often leads to negative effects on relationships, employment, and finances, and sometimes precipitates legal issues.¹

A simple way to understand addiction is the ABCDE concept:^1,2

• Abstinence: Addiction makes it difficult to maintain long-term abstinence, with users commonly relapsing after periods of sobriety.
• Behavior: Addiction is marked by an inability to control behavior, leading to poor decision-making or trouble at work, school, or in relationships.
• Cravings: Strong urges to use are another characteristic of addiction, and these often lead to relapse.
• Diminished ability: Addiction can lead users to fail to recognize major issues with behavior or in relationships, which can be caused or exacerbated by addiction.
• Emotions: People with addiction often have difficulty expressing or managing emotions, and using drugs may mask or numb these emotions, making them even more challenging to experience and deal with when not intoxicated.

The continued, and often escalating, drug use that accompanies addiction can greatly increase your chances of overdosing, which can be lethal or have long-lasting negative effects on your physical and mental health.³ Symptoms of a drug overdose can be very different, based on the substance used, and should always be addressed as a medical emergency.³

In 2015, more than 50,000 deaths from drug overdose were recorded in the United States, which is more than double that of the overdose death rate in 2002.⁴ Opioids accounted for nearly 35,000 of these deaths, almost 9,000 were from benzodiazepines, and cocaine overdoses accounted for about 7,000 deaths the same year.⁴ Many of these deaths involved more than one substance, particularly alcohol.⁴

Drug detox is the earliest phase of treatment for most people, but the experience you have when detoxing from a drug varies widely depending on the substance you abuse. Since there is no way to know for sure how you may tolerate your withdrawal symptoms, attending a quality, licensed detox program is the best way to get through it safely. In this setting, medical and psychiatric professionals can provide medications and care to ease the discomfort often associated with the withdrawal process.⁵

You can go through detox in an inpatient or outpatient setting, depending on your needs, the severity of your addiction, and the substance you abuse.⁶ And while a supervised program helps oversee and support the process of clearing the body of drugs, it does not address the issues surrounding the underlying addiction, so long-term substance abuse treatment is usually recommended post-detox.^5,6

What Exactly Happens in Drug Detox Programs?

Most people have many questions about detox—this is completely normal. Reviewing this list of common questions and their answers might help calm some anxiety you may feel about entering detox.

How long does a detox program last?

Depending on the substance used, detox can last from several days to a month. You can stay in a detox program until symptoms are dramatically reduced or have stopped.^2,7

Should I quit cold turkey? What are the dangers?

Again, this depends on the substance or substances being used. Alcohol, benzodiazepines, and some other types of sedating medications can have potentially fatal withdrawal symptoms, so detox from them should never be attempted without professional help. Detoxing from drugs such as opioids or stimulants can be markedly unpleasant and, in some instances, is associated with the development of withdrawal complications, so a supervised detox is often suggested in these cases as well. ^2,6

What are the dangers of withdrawal?

Alcohol tends to carry some of the greatest and potentially deadly withdrawal dangers such as seizures and autonomic instability, which can lead to impaired control of body temperature, heart rate, and blood pressure. Opioid withdrawal creates extremely uncomfortable symptoms such as high blood pressure, abdominal cramps, and bone and muscle pain, which often lead a person to use again to relieve the discomfort. Detoxing from any drugs can also cause or worsen anxiety or depression, so people in detox are frequently monitored for mental health concerns or suicidal thoughts.^2,6

What is PAWS (Post Acute Withdrawal Syndrome)?

PAWS, also known as protracted withdrawal, is when withdrawal symptoms persist after the established timeline for acute withdrawal. Depending on the substance used, PAWS can last for weeks or months after detox, although the severity and intensity of symptoms may vary.⁷

Is rapid detox a viable option?

While the idea of a quick, painless detox sounds appealing, there is very little data to show that this is an effective means of treatment. Its use is highly controversial and can be associated with a variety of health risks.⁸

How do I choose the best detox program?

A good detox program is tailored to meet the specific needs of each person. The best detox programs use methods that have been extensively studied and demonstrated to be safe and effective (otherwise known as evidence-based treatment), create a comfortable environment, and have a basic philosophy that aligns with your values.⁵

Guides to Detoxing from Different Drugs of Abuse

Benzodiazepine Detox Guides

Opioid Detox Guide

An overview of opiate withdrawal, a timeline of symptoms, and the effects of the use of opioids. Various other topics are explored, including the risks of detoxing at home; how opioids affect the brain; information about overdose; how to manage chronic pain without using opioids; the current opioid epidemic in the United States; the risks of combining opioids with other drugs or medications; and how addictive opioids are.

Prescription Stimulants Detox Guide

A detailed description of the various types of prescription stimulants, the withdrawal symptoms associated with these drugs, the general detox timeline, and effects of using prescription stimulants.

Prescription Drugs

The detox process is often different for each prescription drug—some substances have medications available to ease symptoms of withdrawal, while others do not.^5,6 Mixing prescription drugs with other drugs or alcohol can also influence the length of detox, as does your physical and psychiatric makeup.⁶ For more detailed information about the detox process of specific prescription drugs, click on the links below.

Illicit and Other Drugs

Withdrawal from different types of illicit drugs also varies depending on the substance or substances used, how long the detox takes, the type of symptoms that can be experienced, and what medications can be used to manage withdrawal, if there are any. These articles provide detailed information about the detox process of specific illicit drugs.

Synthetic Drugs

The detoxification process for many synthetic street drugs may be unpredictable, since they are often adulterated with other harmful substances. The frequently unknown chemical makeup of these drugs contributes to a withdrawal process that varies widely for each user, especially as new variations of these drugs continue to appear. Additionally, some synthetic drugs are illegal and can have serious legal consequences. These pages discuss in more detail some of the more commonly abused synthetic drugs.

Sources

1. American Society of Addiction Medicine. (2017). Definition of Addiction.
2. American Psychiatric Association. (2013). Diagnostic and Statistical Manual of Mental Disorders (5^th). Arlington, VA: American Psychiatric Publishing.
3. National Council on Alcoholism and Drug Dependence, Inc. (2017). Drug Overdose: A Medical Emergency.
4. National Institute on Drug Abuse. (2017). Overdose Death Rates.
5. National Institute on Drug Abuse. (2012). Principles of Drug Addiction Treatment: A Research-Based Guide (3rd Edition): Types of Treatment Programs.
6. Center for Substance Abuse Treatment. (2006). Detoxification and Substance Abuse Treatment. Treatment Improvement Protocol (TIP) Series, No. 45. HHS Publication No. (SMA) 15-4131, Rockville, MD.
7. Substance Use and Mental Health Services Administration. (2010). Protracted Withdrawal.
8. American Society of Addiction Medicine. (2005). Rapid and Ultra Rapid Opioid Detoxification.