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Inpatient Detox Guide

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What is Detoxification?

Detoxification, or detox for short, is the process through which the body rids itself of the toxic influence of any drugs or alcohol to which it has grown dependent. While detox is not a substitute for more comprehensive substance rehabilitation, it often the first step of such treatment.1

Detox has the potential to be uncomfortable and even extremely dangerous. Don’t go through detox alone. Call 1-888-509-8965 Who Answers? today and let our admissions navigator help you find the treatment you need to go through detox and beyond as you work toward recovery.

Medical detox is meant to help manage the acute and potentially dangerous withdrawal effects associated with suddenly quitting drugs and/or alcohol.1,2 Medical detox protocols may involve the use of specific medications to manage withdrawal symptoms, safely stabilizing the patient and increasing comfort throughout the process.3,4

In 2017, 19.7 million people, aged 12 and older, met the diagnostic criteria for a substance use disorder.5 Research shows that addiction treatment can improve your health and productivity, yet despite this potential for an enhanced quality of life, only 1 in 10 people receive substance abuse treatment.6

Apprehensions about an unpleasant withdrawal experience may deter people from seeking treatment, but that is where inpatient detox can make a difference.


What is Inpatient Detox?

Inpatient detox centers provide a safe place for people to go through withdrawal, the symptoms of which can be quite unpleasant for certain types of substances. Medical complications sometimes arise during detox, which makes the 24/7 supervision provided by the treatment team in an inpatient center a good option for those at risk.

Inpatient settings may facilitate close patient monitoring throughout detox as well as provide medical intervention, when necessary, to ensure that patients remain as comfortable and safe as possible during withdrawal.


What to Expect at an Inpatient Detox

Hospitals provide you with intense care during detox, which is often best for people who have a long-standing opioid addiction or other medical conditions that may require intervention.Drug and alcohol detox treatment centers specialize in helping you comfortably wean off a substance; programs vary in terms of location, length, and intensity. Someone with a less-severe addiction may be able to go through detox on an outpatient basis, but people with severe addictions or with addictions to specific substances (including alcohol and opioids) may be advised to consider an inpatient facility.

A typical detox process for severe substance abuse begins with 3 to 7 days of medically managed detoxification, which takes place in an inpatient facility.6 Depending on which withdrawal symptoms you have or the substance to which you’re addicted, doctors may prescribe specific medications to help alleviate any discomfort and to help control cravings.

You may undergo inpatient detox treatment in various settings, including a hospital or clinic that is staffed by physicians, nurses, and other clinicians on the treatment team who can address serious medical complications, should they arise.

Other inpatient programs, sometimes referred to as social detox facilities, emphasize peer or social support throughout early recovery for those whose withdrawal needs may not require intensive, round-the-clock care.4,6 Given this relative lack of medical oversight, you should be cleared by a medical doctor before you begin such a social detox program to ensure its appropriateness and safety for your health.

No matter the precise level of care, most programs will have set rules and regulations for your time there. For example, some centers may give you complete access to cell phones and computers, while others may limit such use. In these cases, cell phone use may be restricted during the first few days of treatment, but you may be offered a landline to keep in touch with family and friends. Often, things such as razors and other sharp objects are confiscated, then handed out at specific times and retrieved (such as before and after a shower) to reduce the opportunity for self-harm. Safety and a singular focus on your health are the primary concerns for your time in detox.


What It’s Like Going Through Detox & Withdrawal

Going through withdrawal isn’t easy, but it is a necessary first step toward recovery since longer-term rehabilitation efforts (a 30- or 60-day treatment program, for example) require patients to first have completed detox and be medically stable. Detox center staff strive to keep you as comfortable as possible during this time, all the while assessing for any withdrawal complications and monitoring your recovery progress.

The length and intensity of your withdrawal depends on several different factors, including the type of substance you abuse and how long you have been abusing it. Some substances have more significant withdrawal symptoms than others, such as alcohol, which can be dangerous and even life-threatening.

Some of the drugs people commonly detox from and their corresponding withdrawal symptoms include:7-9

Detoxing from opioids (prescription or heroin):

  • Muscle pain.
  • Agitation/anxiety.
  • Stomach pain/cramping.
  • Diarrhea.
  • Nausea and vomiting.
  • Insomnia.
  • Sweating.
  • Cramping.

Detoxing from alcohol:

  • Anxiety.
  • Depression.
  • Irritability.
  • Fatigue.
  • Nightmares.
  • Nausea and vomiting.
  • Tremors.
  • Delirium tremens.
  • Seizures.

Detoxing from cocaine:

  • Depressed mood.
  • Agitation.
  • Restlessness.
  • General discomfort.
  • Fatigue.
  • Nightmares.

Common Detox Medications

Medical staff at inpatient detox centers can prescribe medications to manage these symptoms and to reduce the risk of complications or immediate relapse. Commonly used detox medications include:2,10-15

  • Methadone: A long-acting opioid that minimizes opioid withdrawal and reduces cravings. When taken as directed, methadone should not produce a pronounced, euphoric high like the drug you may have been abusing and can be tapered down once you have been stabilized.
  • Buprenorphine: As a treatment medication, buprenorphine is distinct from methadone in that it is a partial opioid receptor agonist. As such, it helps to manage your symptoms and decrease drug cravings, but it has a ceiling to its opioid effects, meaning it is less likely to result in the euphoria or pronounced sedation associated with heroin or misused prescription painkillers.
  • Suboxone: This drug combines buprenorphine with naloxone (an opioid antagonist) to minimize the abuse potential of the treatment drug itself—such as by attempting to dissolve and inject it.
  • Benzodiazepines: A class of sedative drugs often prescribed to treat anxiety, restlessness, insomnia, and seizures, they are often used in the management of acute alcohol withdrawal.
  • Anticonvulsants: Though benzodiazepines are more commonly used for this purpose, anticonvulsant medications may be used during alcohol detox for the management of withdrawal symptoms, including seizures.
  • Antipsychotics: Sometimes used to manage withdrawal-associated delirium, delusions, hallucinations, and agitation, they must be administered cautiously since, in some cases, they may increase the risk of seizure in alcohol-dependent patients.

Different Types of Inpatient Detox Centers


Your choice of facilities depends on several factors, including cost, location, and insurance coverage. Various centers offer a range of different treatments and amenities, so you should ask about what is available at the ones you’re considering before making your final choice.

  • Hospital: A hospital setting may provide the most intensive medical supervision possible during detox. In this setting, you will be monitored by a medical team at all times, providing a safe recovery environment for people with long-standing or otherwise severe addictions, for those at risk for experiencing withdrawal complications, or for people with other significant medical problems.
  • Standalone medical detox programs: These programs are staffed by a medical team to provide 24-hour support and, when applicable, treatment medications to make you more comfortable. You live at the facility for the duration of your detox, after which you may immediately enter a 30-, 60-, or 90-day addiction treatment program. Many programs at this level of care are equipped to handle medical complications and mental health problems, so they are good for people with significantly severe physical substance dependence and co-occurring medical issues as well.
  • Detox at the start of treatment: Many comprehensive rehabilitation centers have a detox wing or otherwise incorporate a detox phase at the start of ongoing treatment. In-house detox programs provide for medical supervision during the detox period and, at detox completion, facilitate the transfer into long-term treatment on the same campus.
  • Peer support detox: Not all treatment programs offer medical detox. In some instances, these programs conduct what is known as social detox, which means you are supported by peers and counselors rather than medical professionals, and no medications are used during the process. These programs may be best suited for people who are medically stable and at little risk for complications. Social detox settings may be inappropriate for those with significant alcohol, sedative, or opioid dependence. Before considering this option, thoroughly vet the program and ensure it meets all the necessary requirements for a competent and qualified detox center and that they may appropriately escalate the level of care, should it be necessary.

How to Choose the Best Option for You

Your choice of detox facility depends on a number of factors. Think about your unique needs and goals for treatment as well as:

  • Location: You may want to be near your family or the workplace, or you may want to travel to a vacation-like setting (e.g., the beach or countryside) where you can continue long-term addiction treatment away from everyday triggers that may cause you to relapse.
  • Specialized populations: These are good options if it’s important to you to surround yourself with a specific group of people who you identify with more closely, such as gender-specific, LGBT, or faith-specific.
  • The drug: Some detox programs may be tailored toward the management of specific substance addictions. For instance, some detox facilities may have more experience with or be better equipped to manage potentially complicated acute withdrawal syndromes, such as those associated with alcohol and opioids.
  • The long-term plan: Many detox facilities are located within a larger addiction treatment center. An immediate transition to addiction treatment after detox significantly improves your chance of long-term recovery.
  • The treatment: Some centers offer medications, 24-hour medical monitoring, social support, counseling, and mental health treatment: Choose one that best addresses your specific needs and wants.
  • Insurance: Cost is a major factor in choosing any treatment—many centers accept insurance, including private insurance and Medicaid. Reach out to your insurance company to find out if a particular treatment is covered.
  • Out-of-pocket cost: If you don’t have insurance or your plan only covers part of the cost, then it is important to find out what you will owe and learn about any payment options an inpatient program offers, such as sliding scales or payment plans.
  • Extra costs: Different inpatient facilities offer different amenities, some of which charge extra for room and board, food, or luxury amenities. Also, consider the cost of travel for you and your family if the facility is not local.

Sources

  1. National Institute on Drug Abuse. (2018). Principles of Drug Addiction Treatment: A Research-Based Guide (Third Edition): Types of Treatment Programs.
  2. National Institute on Drug Abuse. (2019). DrugFacts: Treatment Approaches for Drug Addiction.
  3. Zhu, H., Wu, L. (2018). National trends and characteristics of inpatient detoxification for drug use disorders in the United States. BMC Public Health, 18(1073).
  4. Substance Abuse and Mental Health Services Administration. (2015). TIP 45: Detoxification and Substance Abuse Treatment.
  5. Substance Abuse and Mental Health Services Administration. (2018). Key Substance Use and Mental Health Indicators in the United States: Results from the 2017 National Survey on Drug Use and Health.
  6. U.S. Department of Health and Human Services (HHS), Office of the Surgeon General. (2016). Facing Addiction in America: The Surgeon General’s Report on Alcohol, Drugs, and Health.
  7. U.S. National Library of Medicine. (2018). MedlinePlus: Opiate and opioid withdrawal.
  8. U.S. National Library of Medicine. (2019). MedlinePlus: Alcohol withdrawal.
  9. U.S. National Library of Medicine. (2019). MedlinePlus: Cocaine withdrawal.
  10. U.S. National Library of Medicine. (2019). MedlinePlus: Methadone.
  11. National Institute on Drug Abuse. (2018). Principles of Drug Addiction Treatment: A Research-Based Guide (Third Edition): Opioid Addiction.
  12. U.S. National Library of Medicine. (2019). Buprenorphine Sublingual and Buccal (opioid dependence).
  13. Hammond, C.J., Niciu, M.J., Drew, S., Arias, A.J. (2015). Anticonvulsants for the Treatment of Alcohol Withdrawal Syndrome and Alcohol Use Disorders. CNS Drugs, 29(4), 293-311.
  14. Zullino, D.F., Khazaal, Y., Hattenschwiler, J., Borgeat, F., Besson, J. (2004). Anticonvulsant drugs in the treatment of substance withdrawal. Drugs Today (Barc), 40(7), 603-619.
  15. Chokhawala, K., Stevens, L. (2020). Antipsychotic Medications. StatPearls Publishing.

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