Addiction can be conceptualized as an inability to abstain from substance use despite the potential impairment of emotional responses, deficits in behavioral functioning, and interpersonal relationship problems that it may cause. According to the Substance Abuse and Mental Health Services Administration (SAMHSA), approximately 23.5 million individuals over the age of 12 needed treatment for a substance addiction in 2009. However, despite this staggering number, only 11.2% of individuals actually received the treatment services they needed.1 For many people struggling with substance use, detox represents a critical, transitional state bridging active addiction to a sustained state of abstinence or reduced use. Every detox program is different so it’s important to seek professional guidance when choosing a program that best suits your needs.
Outpatient detoxification typically last 3-14 days, depending on the specific type(s), frequency, and intensity of substance use taking place prior to detox.2 While costs vary, many publicly funded programs and insurance policies can assist individuals in receiving the detox support they need.
Outpatient detox settings include the following:
The main goals for outpatient detox include minimizing withdrawal symptoms, reducing mental and physical complications, and providing a safe opportunity to explore, achieve, and maintain long-term abstinence.3
Individuals with relatively less severe substance use disorders and low risk of complicated withdrawal symptoms may be referred to outpatient detox.2 Within these supportive settings, trained clinical staff routinely monitor and assess behavior, symptoms, and drug cravings. If the individual seems unfit for the outpatient setting, they will typically receive referrals or transfers to higher levels of care. This referral aims to protect the individual’s safety and reduce the likelihood of relapse.
On the other hand, individuals experiencing the following are typically not suitable or recommended for outpatient detox:
Histories of chronic relapse or unsuccessful outpatient detox episodes typically mandate a higher level of care. Furthermore, individuals with dual diagnoses and serious medical conditions often require close monitoring and supervision, specifically if taking DEA-scheduled medications. Outpatient care will not be able to provide the necessary safety resources these individuals likely need.
Similar to outpatient detox, inpatient detox typically lasts between 5-14 days depending on drug type, severity, and frequency of use.2 Unlike outpatient detox centers, inpatient care entails around-the-clock supervision, support, monitoring, and assessment within a residential environment. Inpatient care provides frequent interaction with wraparound treatment teams (often including psychiatrist, nurse, therapist, case manager, and support staff).
Inpatient detox settings include:
Those with relatively more severe addictions and chronic relapse histories are typically recommended for inpatient detox. Furthermore, those who have concurrent mental illnesses, such as psychotic, anxiety, or mood disorders, typically benefit from this level of care. Detox timelines vary depending on individual needs, frequency and dose of substance use, and concurrent health conditions. Psychosis, suicidal ideation, or physiological concerns, such as extreme dehydration, malnutrition, or head injury, may affect these timelines.
Inpatient or residential settings might not be the right fit for everyone. The following groups might receive adequate treatment from an outpatient program:
Medical detox refers to detox performed under close medical supervision. In some cases, such as severe alcohol or benzodiazepine withdrawal, detoxing without medical support can be fatal. Furthermore, medications can help ease the withdrawal process and reduce some of the discomfort and pain.2 The medical detox timeline can vary greatly depending on whether a person is receiving medication-assisted treatment, is following a tapering schedule, or experiences adverse reactions to medications.
Medication depends on each individual’s needs. Some take medications solely during the detox stage, while others incorporate them as part of an overall maintenance plan for their recovery.
According to the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5), the acute withdrawal syndrome specific to each substance type presents with its own unique symptoms, side effects, and timelines.4 Here is a brief outline of what to expect for the most commonly abused substances:
Opioid (heroin, Oxycontin, oxycodone, hydrocodone, Dilaudid, Percocet, fentanyl) withdrawal symptoms include:4,7
Opioid withdrawal symptoms can be highly uncomfortable, and many detox centers offer medication-assisted treatment (MAT), which allows for safe stabilization and decreased physical and mental distress. According to SAMHSA, the following medications are approved to manage opioid withdrawal:3
In terms of MAT, the individual will either adhere to a maintenance plan for long-term recovery or will follow an appropriate tapering schedule once stabilized.
Alcohol detox symptoms include:4
Alcohol withdrawal symptoms can occur as soon as 8 hours after the last drink, though symptoms generally peak within 24-72 hours and resolve within 5-7 days.4 Detox medications, such as benzodiazepines, may be prescribed to reduce unpleasant symptoms and to minimize the risk of seizures and agitation.3
The sudden discontinuation of alcohol abuse can be fatal due to the risk of seizures. As a result, severe alcohol detox without medical supervision is not recommended.
Benzodiazepine (Xanax, Klonopin, Valium, Ativan) symptoms of withdrawal include:4,5
The benzodiazepine withdrawal timeline largely depends on the half-life of the sedative. Drugs, such as lorazepam, oxazepam, and temazepam, produce detox symptoms within 6-8 hours of the most recent dose, peak on the second day, and dissipate within 4-5 days. Conversely, benzodiazepines with longer half-lives, such as diazepam, produce symptoms about a week after last use. Symptoms tend to peak in the second week and resolve within the third or fourth week.4 For polydrug users (i.e. those who use other substances), this detox timeline may take even longer.5
As with alcohol withdrawal, significantly severe cases of benzodiazepine dependence should be addressed with medically supervised detox. A closely monitored tapering schedule and judiciously administered sedative medications may preclude more severe risks such as seizures.
Stimulant (Adderall, cocaine, crack, methamphetamine) detox symptoms include:4
The detox timeline will differ depending on the half-life of the stimulant and mode of administration. Withdrawal symptoms typically emerge within several hours to a few days after the last dose.4
Statistically, many individuals relapse after treatment, with one study indicating that 27% of the participants relapsed the day after discharge, 59% after one week, 65% after one month, and 90% within one year.6
One of the most concerning issues for relapse after detox is the potential risk for overdose. Recent statistics indicate that approximately 100 people die each day from a drug overdose.7 When an individual stops using drugs (even if just for a few days), their tolerance to the drug decreases. Therefore, if they relapse and take the same amount of the substance as before, they are at risk of overdosing.
Other potential post-relapse outcomes, such as a quick progression to heavy drug use, the ongoing risks of medical and mental health issues, financial hardship, and interpersonal problems become renewed concerns. This, coupled with potential feelings of hopelessness, fear, or shame, can send the relapsed user into an even more dangerous and deep spiral.6
For these reasons, going back to detox is usually the prescribed course of action. Detox will medically assist the individual with monitoring and safety. If the person is acutely psychotic or feeling actively suicidal, they may be referred to a higher level of hospitalized care for increased supervision and stabilization.
It should also be noted that serious mental health issues can also impact the detox timeline. For example, such rapid change can cause symptoms to feel heightened during detox. Certain withdrawal symptoms, called protracted withdrawal, may persist once acute withdrawal is resolved. These symptoms may last for several weeks to months after withdrawal.11
These symptoms can include the following:11
Typically, aftercare in the form of extended treatment (inpatient or outpatient), support groups (Alcoholics Anonymous or Narcotics Anonymous), and individual or group psychotherapy yields positive results for those struggling with substance addiction.9, 10
Detoxing alone can be incredibly dangerous and even fatal. If you or a loved one is struggling with addiction, remember that safe help is always available. Please reach out to an addiction support specialist to find the treatment you need today.