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Inpatient Detox: Frequently Asked Questions

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If you or someone you know struggles with an addiction, you may have some questions and concerns about entering a detox program. Inpatient detox is a highly-structured type of detox that can help ensure your safety and comfort throughout the withdrawal process.

What is Inpatient Detox?

What a detox program entails.Inpatient detox takes place in a residential setting, which means that you live at a facility specifically devoted to helping people withdraw from drugs. Staff members provide 24/7 supervision, monitoring, and care to help you remain safe and comfortable during the withdrawal phase. The goal of detox is to help you obtain a medically stable, drug-free state. Once stabilized, it is best to transition to a formal addiction treatment program and continue on your path to recovery.

Inpatient detox is appropriate for anyone who is struggling with a substance abuse problem, but it is especially beneficial for those addicted to opioids, alcohol, or sedatives, due to potentially dangerous withdrawal symptoms, such as seizures.1

The two main inpatient detoxification settings include:1

  • Medical detox: You live at an inpatient detox facility and receive around-the-clock medical supervision and treatment. You may receive medications to ease withdrawal symptoms, as well as manage other potential co-occurring mental or physical health conditions.
  • Social detox: You live in a residence with others who are detoxing. While there, you rely primarily on interpersonal and emotional support as opposed to medication and medical supervision. However, some programs do have access to medical interventions, if necessary.

How Does it Differ From Outpatient Programs?

Seeking advice about detoxification.Inpatient detox involves living at a detox facility for a specified period of time, while outpatient detox involves frequent visits to an outpatient center for care and monitoring.2

People receiving outpatient detox, which is less intensive than inpatient, still live at home while receiving detox services.2

Inpatient detox provides highly structured care, which makes it an ideal setting for:

  • People with severe addictions.
  • People without a strong support network.
  • People with suicidal thoughts or behaviors.
  • People with co-occurring mental or physical conditions.
  • People who have experienced a previous complicated withdrawal.

According to the Substance Abuse and Mental Health Services Administration (SAMHSA), inpatient detox services include “24-hour supervision, observation, and support for [people] who are intoxicated or experiencing withdrawal.”1 Conversely, people enrolled in an outpatient detox program receive anywhere from a couple hours per week to several hours per day of treatment, depending on the specific outpatient program.2

What is the First Step?

Choosing the right treatment option for you.An intake evaluation is the first step in the detox process. You receive an evaluation from specialized substance abuse and mental health professionals to gather the following information:1,3

  • Overall physical and mental health
  • The presence of any co-occurring psychiatric conditions, such as depression or panic disorder
  • Patterns of substance abuse
  • Previous history of detox
  • Cultural considerations
  • A toxicology screening
  • Demographics, such as age, residence, family structure, etc.
  • Risk of violence or suicide
  • Other medical factors that require immediate attention (especially a risk of seizures)
  • Financial situation
  • Availability of transportation

This information is used to create a comprehensive detox plan, as well as to help determine the appropriate level of placement in a rehabilitation program once detox is complete.

Who Benefits from this Treatment?

Difference between inpatient and outpatient rehab.Anyone struggling with a substance addiction can benefit from inpatient medical detox, but SAMHSA strongly advises inpatient medical detox for people who meet certain criteria, such as:1

  • Those who may have an increased risk of complicated withdrawal or life-threatening symptoms, such as seizures.
  • Those who have a history of prior withdrawals.
  • Those who are addicted to alcohol, sedatives, or opioids.
  • Those with co-occurring mental health disorders.
  • Those with physical health problems.
  • People who have a risk of suicidal thoughts or behaviors.

Inpatient detox will help you stay safe and help address complications that can come up during withdrawal.

What Medications Are Used?

Depending on the substance you are addicted to, you may be given different medications to help you throughout the withdrawal process. Specific substance withdrawal syndromes and the medications used to treat them include:5

  • Alcohol withdrawal: Benzodiazepines, such as diazepam, lorazepam, oxazepam, or chlordiazepoxide are used to prevent or manage certain alcohol withdrawal symptoms and treat any serious complications, such as delirium tremens. Barbiturates, like phenobarbital, are prescribed in limited cases to manage alcohol withdrawal symptoms. Anticonvulsants, like carbamazepine, can help treat seizures. Antipsychotics, such as haloperidol, may reduce or prevent severe agitation and psychotic symptoms such as delusions and hallucinations.
  • Opioid withdrawal: Methadone and buprenorphine, which are opioid medications, reduce withdrawal symptoms and cravings. Clonidine (as well as the recently-approved medication lofexidine) can also be used as an adjunct medication to manage some autonomic arousal symptoms, such as increased blood pressure. Additional medications are prescribed as necessary, depending on your symptoms. This can include drugs like sleep aids for insomnia or laxatives for constipation.
  • Sedative withdrawal: In many cases, the current benzo or sedative is gradually tapered off, which can help either prevent or minimize withdrawal symptoms. Sometimes, longer-acting agents will be substituted for shorter-acting ones (e.g., Xanax) prior to initiating a taper. Phenobarbital may be used in limited cases, but as with alcohol withdrawal, barbiturates are rarely used because of safety considerations. Anticonvulsants, like carbamazepine, may be used to manage otherwise uncontrolled seizures.

What does medicated detox feel like?No medications are FDA-approved to specifically treat withdrawal from other commonly-abused drugs, such as marijuana, stimulants, ecstasy, hallucinogens, or inhalants.

However, you may still receive supportive medications to help manage symptoms that can arise during detox; for example, you may be treated with antidepressants for depression.5  

Does Insurance Cover Detox?

If you have private insurance, there’s a good chance that you will receive at least partial, if not full, coverage for detox. However, your coverage largely depends on your insurance plan. Calling your insurance company is the best way to find out what your plan covers.

If you have Medicaid or Medicare, you may also be covered for detox, but not all settings may be covered. Therefore, you should check with your plan administrator to determine exactly what’s covered and what your out-of-pocket costs might be.1

How Much Does a Program Cost?

Cost of addiction treatment.Due to the intensity of the program and the services offered, such as room and board and 24/7 care, inpatient detox is likely to cost more than outpatient detox. Several factors affect the cost of inpatient detox treatment, such as: 2

  • Amenities and services offered, e.g. luxury detox might resemble a 5-star resort and offer spa-like treatments, while “bare bones” facilities will offer few or no extra amenities.
  • Location.
  • Length of your stay.
  • Your insurance coverage.

The overall cost of detox can vary greatly, but according to American Addiction Centers (AAC), the average cost of inpatient detox for a 7-day minimum stay is $600 to $1,000 per day, which means one week of detox may cost anywhere from $4,200 to $7,000.6

People who don’t have insurance or cannot realistically afford treatment costs may be eligible for payment through an income-based sliding scale, scholarship, grant, or payment plan, although the availability of these benefits depends on the specific detox center.

What to Expect from Different Approaches

How treatment tailored to your needs ensures your recovery.Medical inpatient detox programs employ a wide range of professionals, including physicians, nurses, addiction counselors, social workers, psychologists, and other support staff.1 A social detox will probably not have medical professionals on-site, but they do have therapists and counselors. Social detox programs will provide access to medical care in case of emergencies, such as through clinics and emergency departments, or will transfer a person to a medical facility if necessary.1

The philosophies of inpatient programs can vary widely, so some programs may offer access to other qualified professionals as well. For instance, a program that has a holistic approach (meaning a focus on the mind-body-spirit) may offer meditation, yoga, acupuncture, or nutritional counseling, so this means that professionals who offer these services are usually available in addition to standard detox staff.

Do I Need Rehab After Detox?

Importance of getting help tailored to your needs.It’s important to note that detox is not a substitute for addiction treatment because it does not address the underlying issues that initially caused or contributed to your drug abuse. Once detox is complete, you should transition to a professional substance abuse treatment program that meets your specific needs, or, if the inpatient detox took place within a treatment program, then you may remain at that facility for continued rehabilitation.

Drug rehab can help you obtain and maintain sobriety. Rehab provides many benefits, such as addressing maladaptive behaviors that may lead to relapse, teaching healthy coping skills, helping you develop better ways of handling stress, and modifying your attitude about substance use.7

Rehabs offer a wide range of therapies to accomplish these goals. Some of the key therapies used include:7

  • Cognitive-behavioral therapy: This form of treatment is designed to help you identify unhealthy behaviors and thoughts and replace them with more adaptive and healthy ones.
  • Contingency management: Rehabs that use this type of treatment offer rewards and incentives to help you maintain motivation to remain in the program and stay clean. For example, you may receive a voucher for a movie if you have a clean drug screen.
  • Motivational enhancement therapy: This form of treatment is designed to help increase your internal motivation for change and commitment to staying in treatment.
  • Family therapy: This form of treatment improves communication between family members and also helps to heal damage cause by drug abuse.

As with detox facilities, rehabs also vary in terms of treatment philosophy (such as 12-step, non-12-step, or holistic), services and amenities offered, and staffing. Once you complete detox, staff at your detox center will help you find and enter the best rehab for your specific needs.

Sources

  1. 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.
  2. Hayashida, M. (1998). An Overview of Inpatient and Outpatient Detoxification. Alcohol Health & Research World, 22(1), 44-6.
  3. 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.
  4. American Psychiatric Association. (2013). Diagnostic and statistical manual of mental disorders (5th ed.). Arlington, VA: American Psychiatric Publishing.
  5. 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.
  6. American Addiction Centers. (2017).
  7. National Institute on Drug Abuse. (2014). Drugs, Brains, and Behavior: The Science of Addiction: Treatment and Recovery.

 

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