Apprehensions about an unpleasant withdrawal experience may be a factor deterring more people from seeking treatment, since to some degree (and with some substances more than others) it is an inevitable occurrence at the beginning of detoxification.
Inpatient detox centers provide a safe place for people to go through withdrawal, the symptoms of which can be quite unpleasant. Medical complications sometimes arise during detox, which makes the 24/7-hour supervision provided by medical professionals in an inpatient center a good option for those at higher risk.
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.1 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 receive inpatient detox treatment in various settings, including a hospital or clinic that is staffed by physicians, nurses, nurse practitioners, and physician assistants who can handle serious medical complications, should they arise. Other inpatient programs, sometimes referred to as social detox facilities, rely greatly on peer support as opposed to medical supervision.1 Given this lack of professional supervision, you should be cleared by a medical doctor before you begin such a program to ensure its appropriateness and safety for your health.
Most programs 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 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 common drugs people detox from and their corresponding withdrawal symptoms include:2,3,4
Methadone: A long-acting opioid that is taken once a day to treat the symptoms of opioid withdrawal. When taken as directed, methadone will not produce a pronounced, euphoric high like the drug you may have been abusing, and can be tapered down once you have been stabilized.
Suboxone: This drug combines buprenorphine with naloxone to reduce the chance of a dangerous overdose.
Benzodiazepines: A class of sedative drugs often prescribed to treat anxiety, restlessness, insomnia, and seizures, they are indispensable in the management of acute alcohol withdrawal, and similarly used in a variety of types of sedative detox.
Anticonvulsants: Though benzodiazepines are more commonly used for this purpose, anticonvulsant medications may be used during alcohol detox to prevent seizures.
Antipsychotics: Used to treat delirium, delusions, hallucinations, and agitation, they must be administered cautiously since they can increase the risk of seizure in alcoholic patients.
Anti-nausea medicine: Prescribed to decrease nausea and vomiting during detox.
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.
Some of your options include:5
Hospital: A hospital offers the most intensive medical supervision possible during detox. In this setting, you will be monitored by doctors and nurses at all times, which is the best option 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.
Medically supervised detox: These programs are staffed by medical professionals who provide 24-hour support and provide medications to make you more comfortable and to reduce your cravings. 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. Most of these programs are equipped to handle medical complications and mental health problems, so they are good for people with severe addictions and medical issues as well.
Detox wing: Many comprehensive addiction treatment 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 are best 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.
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 exclusively treat certain drug 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.
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. Chapter 4.
Mayo Clinic Staff. (2016). Opioid and Opiate Withdrawal.
Mayo Clinic Staff. (2017). Alcohol Withdrawal.
Mayo Clinic Staff. (2015). Cocaine Withdrawal.
Substance Abuse and Mental Health Services Administration Center for Substance Abuse Treatment. (2006). Quick Guide for Clinicians. Based on TIP 45: Detoxification and Substance Abuse Treatment. Rockville, MD: Center for Substance Abuse Treatment.