If you or someone you care about is struggling with an addiction, you may be curious to learn more about detox and how it can help. Detox is often the first step in the recovery process. Entering a formal detox program can help you or your loved one start on the path to sobriety and begin a healthier, drug-free life.
What is the Purpose of Detox?
Although detox is usually the first part of a comprehensive recovery plan, it is not a substitute for substance abuse treatment. Rather, it is a professional intervention designed to manage acute intoxication and drug withdrawal symptoms. The goal of detox is to help a person achieve a medically stable, drug-free state and subsequently enter and complete some form of addiction treatment.1
Furthermore, detox can help a person avoid potentially life-threatening complications that might arise during acute withdrawal.2
The detox process involves the following 3 components:1
- Evaluation: During your admission screening, you undergo a comprehensive assessment, which includes blood testing to measure the amounts of substances in your bloodstream, as well as an examination of your physical and mental health. This process helps determine the best course of action during detox and the appropriate treatment setting.
- Stabilization: During this time, you undergo the actual detoxification process. You receive support, monitoring, and care throughout withdrawal so that you can remain as safe and comfortable as possible while the harmful substance or substances are eliminated from your system.
- Fostering entry into treatment: You will be strongly encouraged to enter a formal substance abuse treatment program to continue your recovery journey and learn the skills you’ll need to remain clean and sober.
Throughout detox, trained staff members will provide close monitoring and compassionate care as you progress through withdrawal.
What Types of Programs Exist?
There are 2 main types of detox: medical detox and social detox.
Medical detox is an intervention that uses different medications to help ease withdrawal symptoms and minimize complication risks so you remain safe and comfortable while you detox. Medical staff, such as physicians and nurses, are on hand to administer medications and manage any complications to arise. They provide you with around-the-clock monitoring and medical supervision during this distressing time.1
The Substance Abuse and Mental Health Services Administration (SAMHSA) recommends medical detox for those addicted to alcohol or sedatives, such as benzodiazepines or barbiturates, because the withdrawal syndromes associated with these substances can be potentially fatal, due to seizures. Additionally, SAMHSA advises medical detox for opioid withdrawal due to humanitarian reasons, as withdrawal from these substances can be quite painful and distressing.1
Social detox is a nonmedical form of detox, although some programs may be able to provide supportive medications, if needed. Social detox programs can vary largely in what the program actually entails, but the main feature of social detox is that you reside at a detox facility and receive emotional and psychological support from staff members. This type of detox is a short-term intervention mainly intended for people who are not at risk of severe or complicated withdrawal, have not undergone multiple withdrawals in the past, and do not have any co-occurring conditions.1
There are different types of detox programs that offer a wide range of amenities and services. More affordable options usually offer standard services. People with a larger budget might choose a luxury detox center, which offers upscale amenities resembling those found in a 5-star resort. Or, if you are a business executive or professional who doesn’t want to take time away from work, you might choose an executive detox center, where work demands can still be met as you undergo detox.
What Settings are Available?
Detox can take place in 5 main settings, namely:1,2
- Ambulatory Detoxification Without Extended Onsite Monitoring: This outpatient form of detox includes options, such as a physician’s office or home health care agency. Your family doctor might be the first contact you have when dealing with a substance abuse disorder, thus some people choose to undergo detox with their primary care provider. Your physician will need to accommodate frequent visits, especially during the acute stages of withdrawal.
- Ambulatory Detoxification With Extended Onsite Monitoring: This is a form of outpatient detox that includes close monitoring and supervision. It may occur in an outpatient facility, such as a day hospital program. During your visits, qualified nurses and other staff members will monitor you to ensure your comfort and safety throughout the withdrawal process. While you will be required to visit the facility on a regular basis, you are able to return home every evening.
- Clinically Managed Residential Detoxification: This is usually a residential social detox/nonmedical program. You live in a social detox or nonmedical setting and rely on the support of peers and staff members to help you through withdrawal. The facility offers “minimally intensive” monitoring and management by clinical staff; in other words, if there is an emergency or medical need, professional staff will be called upon to assist. This form of detox is geared toward people with withdrawal complications warranting 24/7 support, but are necessarily at risk of experiencing dangerous withdrawal symptoms.
- Medically Monitored Inpatient Detoxification: This involves inpatient detox at a freestanding clinic. You receive medication and 24/7 monitoring and supervision by medical staff.
- Medically Managed Intensive Inpatient Detoxification: In this type of detox program, you reside in the inpatient psychiatric wing of a hospital or in an actual hospital. Here, you receive medication and 24/7 supervision and monitoring by medical staff.
Is it Necessary?
The best way to determine whether or not you need detox is to have an evaluation conducted by a medical professional. In fact, it has been estimated that nearly 50% of all people who visit a primary care provider have experienced problems related to substance use. Your doctor can evaluate your substance abuse, mental and physical health, risks of complicated withdrawal, social situation, past detox experiences, suicide risk, and other factors. You will receive a referral to a detox facility once your doctor has conducted an assessment and determined whether detox is appropriate for your needs.1
Whether or not a physician referral is given, anyone struggling with a substance addiction may benefit from formal detox services.
The Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-V) provides criteria for a substance use disorder/addiction, which include:3
- Taking the drug in larger amounts or for longer times than originally intended.
- Failing to reduce or stop use, despite a desire to do so.
- Spending a great deal of time obtaining, using, and recovering from the effects of the drug.
- Experiencing cravings to use the drug.
- Continuing drug use regardless of failure to meet responsibilities at home, school, or work.
- Continuing substance use despite significant interpersonal or social problems that are a result of drug abuse.
- Giving up important recreational, social, or occupational activities because of drug use.
- Using the drug in physically hazardous situations, e.g. driving or operating machinery.
- Continuing drug use despite physical or psychological problems caused or exacerbated by use.
- Developing tolerance, meaning that you need more of the drug to achieve previous effects.
- Experiencing withdrawal symptoms when you abruptly stop or dramatically reduce use. These vary from drug to drug, but they usually cause significant discomfort, pain, or disruption to your daily life, such as symptoms of insomnia, depression, or anxiety.
If you meet 2 or more of the abovementioned criteria at any point within the past 12 months, you may have a substance use disorder and will likely benefit from the assistance of a detox program.3
How Long Does it Last?
The length of most detox programs varies depending on specific factors, but they will usually last between several days and a few weeks.1
Some of the factors that can influence the length of detox include:3,4
- The specific substance(s) you are addicted to; different substances have different withdrawal time frames and symptoms.
- The usual method of administration, e.g. smoking or injecting the drug.
- The amount of the drug you regularly used.
- The length of time you abused the drug.
- Individual factors, such as age, genetics, mental health, and physical health.
If you attend a detox program that uses withdrawal medications, such as methadone or Suboxone for opioid addiction, or benzodiazepines for alcohol addiction, you may have a longer detoxification period than someone who quits without the benefit of medication. Withdrawal medications need to be slowly tapered off so your body can adjust to their absence, as some of these medications are associated with their own withdrawal symptoms with sudden discontinuation. Additionally, people with an addiction to drugs, such as opioids, often continue taking methadone or Suboxone beyond the initial detox phase to help maintain their recovery progress.6
What Medications are Used?
The medications that are used during detox vary depending on the specific substance you are withdrawing from. Some of the withdrawal syndromes and associated withdrawal medications include:6
- Alcohol withdrawal:
- Benzodiazepines, such as diazepam, lorazepam, oxazepam, or chlordiazepoxide, are used to alleviate alcohol withdrawal symptoms and prevent or treat serious symptoms, such as delirium tremens and grand mal seizures.
- Barbiturates, such as phenobarbital. Although used to manage alcohol withdrawal for about a century, it is no longer the favored medication for alcohol detox treatment, due to addictive potential, complications, and potential for overdose.
- Anticonvulsants, such as carbamazepine, can be used to prevent or manage intractable seizures.
- Antipsychotics, such as haloperidol, help control agitation, hallucinations, and other psychotic symptoms.
- Opioid withdrawal:
- Methadone and buprenorphine are used to prevent or minimize opioid withdrawal symptoms. People may often take these medications for an extended maintenance period to help them avoid relapse.
- Clonidine may be used off-label to manage autonomic arousal symptoms, such as high blood pressure and rapid pulse.
- Supportive adjunct medications to treat other symptoms, such as sleep aids for insomnia or antidepressants for depression.
- Benzodiazepine and other sedatives withdrawal:
- Gradual tapering of the medication is a method used during the withdrawal process; it helps to prevent withdrawal symptoms and keeps you safe as you slowly withdraw from the drug.
- Similar to alcohol withdrawal, phenobarbital can be used to manage benzodiazepine withdrawal syndrome This drug is rarely used anymore, though, due to safety concerns, but it is used in certain cases to ease withdrawal symptoms.
- Anticonvulsants, such as carbamazepine, which can prevent or treat seizures.
There are no medications currently approved by the Food and Drug Administration (FDA) to treat withdrawal from other commonly abused drugs, such as marijuana, cocaine, crystal meth, hallucinogens, ecstasy, bath salts, and synthetic cannabinoids, although people may be given supportive medications to treat co-occurring symptoms, such trazodone, for sleep difficulties.6
How Much Does a Program Cost?
The cost of detox can vary based on a variety of factors, but detox itself may be relatively less expensive than a full complement of substance abuse treatment (though completion of both may be strongly recommended).
Some of the factors that can influence cost include:
- Detox setting, such as inpatient or outpatient.
- Insurance coverage.
- Amenities and services.
- Program length.
The average cost of inpatient detox for a minimum of 7 days is between $600–1,000 per day, which means that the total cost can range from $4,200 to $7,000, although some program costs may fall outside of this range.7
If you have insurance, there is a good chance that your carrier may provide full coverage for detox. If they don’t offer full coverage, you may at least receive partial coverage. You should call your insurance company to check your benefits and learn more about your specific plan.
People without insurance also have options that can help with some of the financial considerations. Some detox programs offer income-based sliding scale fees, payment plans, grants, or scholarships for those who are unable to afford treatment costs. Some programs even provide detox or treatment at no charge for those who can’t reasonably afford to pay.8
Can I Detox On My Own?
It is generally not advisable to detox on your own. While it is possible, there are dangers associated with unsupervised detox, depending on the specific substance. For example, the most severe consequences are associated with withdrawal from alcohol or sedatives, like benzodiazepines or barbiturates, because there is a risk of delirium tremens or grand mal seizures.1
Further, although not inherently life-threatening, opioid withdrawal can lead to some medical complications, such as electrolyte imbalances caused by severe vomiting or diarrhea, the worsening of cardiac problems, and lowered tolerance, which can lead to overdose if the individual relapses.1
Additionally, the dangers of detoxing on your own can be exacerbated by several scenarios, such as:1
- Having a history of severe or complicated withdrawal, particularly if you have had successively worsening withdrawal episodes.
- Having co-occurring mental or physical health conditions that can worsen during withdrawal.
- Having inadequate social support, which puts you at a higher risk of relapse.
- Risk of suicide, which can be higher if you suffer from mental illness or abuse multiple substances.
What Happens After Detox?
Remember that detox is not a replacement for professional addiction treatment because it doesn’t address the issues that led to your substance abuse in the first place. Once you complete detox, your detox team will assist you in transferring to the best substance abuse treatment program for your needs. Rehab provides several benefits to help you stay on the path to clean and sober living, such as helping you build sober social skills, addressing underlying mental health problems, and teaching coping skills to help you avoid relapse triggers.
Some of the ways in which rehab accomplishes these goals is through specific types of therapy. These therapies can vary based on treatment setting, amenities and services offered, philosophy of the treatment center, and staffing. However, some of the common types of therapy include:9
- Cognitive-behavioral therapy (CBT): This therapy helps you identify and replace maladaptive and dysfunctional thought and behavior patterns with healthier ones.
- Contingency management: This therapy relies on positive reinforcement, such as specific goal-based rewards and vouchers, to help you stay motivated and on track.
- Motivational Enhancement Therapy: This therapy promotes rapid and intrinsic motivation to stop drug abuse and to help you enter a treatment program.
- Family therapy: Used especially among younger people in recovery, family therapy helps address any underlying issues in family dynamics and relationships that may have led or contributed to drug abuse.
- Center for Substance Abuse Treatment. (2015). Detoxification and Substance Abuse Treatment: A Treatment Improvement Protocol (TIP 45). Rockville, MD: Substance Abuse and Mental Health Services Administration.
- Center for Substance Abuse Treatment. (2006). Detoxification and Substance Abuse Treatment. Treatment Improvement Protocol (TIP) Series, No. 45. 1. Overview, Essential Concepts, and Definitions in Detoxification. Rockville, MD: Substance Abuse and Mental Health Services Administration.
- American Psychiatric Association. (2013). Diagnostic and Statistical Manual of Mental Disorders (5th ed.). Arlington, VA: American Psychiatric Publishing.
- National Institute on Drug Abuse. (2017). Frequently Asked Questions.
- Knott.L. (2015). Methadone Replacement for Heroin.
- Center for Substance Abuse Treatment. (2006). Detoxification and Substance Abuse Treatment. Treatment Improvement Protocol (TIP) Series, No. 45. 4. Physical Detoxification Services for Withdrawal From Specific Substances. Rockville, MD: Substance Abuse and Mental Health Services Administration.
- American Addiction Centers. (2017).
- Center for Behavioral Health Statistics and Quality. (2013). 2013 State Profile — United States National Survey of Substance Abuse Treatment Services (N-SSATS).
- National Institute on Drug Abuse. (2014). Drugs, Brains, and Behavior: The Science of Addiction: Treatment and Recovery.