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Outpatient Detox Guide: What Is Outpatient Treatment?

doctor talks with male patient about what to expectWhen you want to quit using drugs or alcohol but need to keep working or maintain your typical routine as much as possible, an outpatient detox program may be the right choice for you.

Outpatient detox facilities allow you to visit the center for detox services and return home at night. With fewer disruptions of day-to-day routines, they provide a similar level of safety and efficacy as inpatient detoxification and are often relatively more affordable.1

In 2015, an estimated 21.7 million Americans (1 in 12) over the age of 12 needed treatment for drug or alcohol abuse, but only about 2.3 million received it.2 According to an annual census, there are more than 6,000 programs in the United States that offer intensive outpatient services, some of which may offer detox options to those who do not meet admissions criteria for inpatient treatment.3 So if you’re considering an outpatient detox program, read on to learn more about how they work and what you can expect.

What to Expect

In a typical outpatient program, the clinical team develops a detox plan to meet your specific needs. Your care team may consist of nurses, doctors, counselors, and therapists who consider multiple aspects of your health and substance use to create a personalized detox plan for you, taking into account your:

  • Mental health.
  • Physical health.
  • Substances used.
  • Severity of addiction.
  • Relationships.
  • Gender.
  • Age.

If you have enough stability in your home life (reliable housing, transportation, and a strong support system), outpatient detox can be a safe and effective treatment option.

General timelines for common drug and alcohol detox programs include:4

  • Alcohol: Depending on the severity of physical dependence, alcohol withdrawal can be dangerous and require medical supervision. Alcohol detox should only take place in an outpatient setting after a medical professional has determined it is safe to do so.  Alcohol withdrawal symptoms usually occur within 6 to 24 hours after the last drink. Symptoms can peak within 36 to 72 hours, and people may feel the effects for 2 to 10 days.
  • Benzodiazepines: Like alcohol, acute benzodiazepine withdrawal presents serious risks and would require similar medical clearance before it would ever take place in an outpatient detox setting. Withdrawal from short-acting benzos such as alprazolam (Xanax) typically starts 1 to 2 days after the last dose and continues for 2 to 4 weeks or longer. Withdrawal from longer-acting benzos such as diazepam (Valium) can begin between 2 and 7 days after the last dose and may continue for 2 to 8 weeks.
  • Opioids: Detoxing from opioids can be extremely uncomfortable, but does not carry the same health risks as benzodiazepine or alcohol withdrawal. The onset of withdrawal symptoms for short-acting opioids such as heroin typically occur within 8 to 24 hours after the last use and can last 4 to 10 days. Long-acting opioids are associated with withdrawal symptoms that arise within 12 to 48 hours after the last use and last for 10 to 20 days.
  • Stimulants: Stimulant withdrawal effects may be seen within 24 hours of last use, with some of the effects lasting for 3 to 5 days.
  • Marijuana: Marijuana withdrawal is generally mild; symptoms typically start between 1 to 3 days after the last use, peak between days 2 and 6, and last between 1 and 2 weeks.

Depending on the facility, your outpatient detox center is likely to have policies concerning:

  • Whether someone can come with you to appointments.
  • Cell phone use.
  • Computer use.
  • Pets.

If any of these things are of particular importance to you, ask about them prior to beginning your detox program.

What It’s Like Going Through Withdrawal

woman suffering from withdrawal cover her face with her hands

Going through detox has its ups and downs, so it’s important to keep your end goal in mind as you work through uncomfortable symptoms. At the end of detox, your body will be cleared of all harmful substances and, with a clean mind and body, you can begin to move forward in treatment.

Depending on your drug of choice, withdrawal signs and symptoms vary greatly, but these are some general examples of what to expect while detoxing from each drug:4

  • Alcohol: During detox, you may experience nausea and vomiting, so it is recommended that you replace these fluids by drinking a lot of water. Should withdrawal be significantly difficult to bear, you may be prescribed medication to manage the discomfort your symptoms cause. (If your symptoms worsen, you will be referred to inpatient detox care for more comprehensive treatment.) Other relatively mild withdrawal symptoms may include:
    • Mild tremors (e.g., shaky hands).
    • Elevated heart rate and blood pressure.
    • Mild anxiety.
    • Insomnia.
    • Nausea.
    • Vomiting.
    • Dehydration.
  • Benzodiazepines: After you have been medically cleared for outpatient detox, you will likely undergo a slow, gradual tapering of the drug. In some cases, you may be given a longer-acting sedative, such as diazepam (Valium) or chlordiazepoxide (Librium), instead of your previously taken benzodiazepine medication. This could facilitate the tapering process and minimize potential withdrawal symptoms, such as:
    • Muscle tension/muscle aches.
    • Poor concentration and memory.
    • Anxiety.
    • Irritability.
    • Insomnia.
    • Restlessness.
  • Opioids: You may be administered a Short Opioid Withdrawal Scale (SOWS), 1 to 2 times daily, to ensure that your symptoms are being managed. Depending on your condition, you may be given medications such as buprenorphine or methadone to reduce cravings and withdrawal symptoms, which may include:
    • Muscle cramps.
    • Sweating.
    • Watery discharge from eyes.
    • Nausea.
    • Anxiety.
    • Insomnia.
    • Vomiting.
    • Hot and cold flashes.
    • Diarrhea.
  • Stimulants: Detox staff will monitor you for depression and anxiety during withdrawal, and if you exhibit severe psychiatric symptoms, you will be referred to a hospital for more intensive care. During stimulant detox, you are advised to drink a lot of water and take vitamins B and C. Symptoms of withdrawal may include:
    • Muscle aches.
    • Agitation and irritability.
    • Increased sleeping and appetite.
    • Depression.
  • Marijuana: During detox, you may be observed for symptoms of dissociation or anxiety since they may need medication to treat. Other symptoms of withdrawal can include:
    • Restlessness.
    • Poor appetite.
    • Feelings of fear and dissociation.
    • Tremor.
    • Irritability.
    • Vivid dreams.
    • Disturbed sleep.
    • Night sweats.

Different Kinds of Outpatient Centers

If you have enough stability in your home life (reliable housing, transportation, and a strong support system), outpatient detox can be a safe and effective treatment option. And, if cost is a concern, outpatient offers a less-expensive and less time-consuming alternative to inpatient detox.

Outpatient detox can take place in a number of different settings, including:

  • Outpatient clinics.
  • Doctor’s offices.
  • Substance abuse treatment centers.

While there are advantages to detoxing in an outpatient setting, there are a number of drawbacks to consider. Outpatient detox is associated with an increased risk of relapse, given the easy access to alcohol and other substances once you leave the treatment setting each day. Additionally, you may simply decide not to keep a detox appointment and stop treatment before you’ve fully detoxed. One study found that after being randomly assigned to either inpatient or outpatient detoxification, there was a higher completion rate for those who received treatment in the inpatient facilities. However, this higher completion rate is not a measure for long-term sobriety.1

Outpatient detoxification is not appropriate for everyone. For example, detoxing in an outpatient facility may not be a good fit if you:1

  • Are an alcoholic at risk for seizures or delirium tremens.
  • Are significantly physically dependent on benzodiazepines or another sedative drug and at risk for severe or complicated withdrawal.
  • Are an alcoholic with pancreatitis, gastrointestinal bleeding, or cirrhosis.
  • Are suicidal or homicidal.
  • Are experiencing problems with your family or job.
  • Are not able to travel every day to the treatment facility.

How to Choose One

Choosing a detox center from the hundreds of available options can be overwhelming, but the more you can zero in on what you need in a facility, the easier it will be to find one that you feel comfortable with.

Depending on what is important to you, factors to consider could include:

  • Programs that specialize in specific drugs: Some programs offer specialized programs for people who are going through withdrawal from the same type of drug. For example, in light of the opioid epidemic, many programs now specialize in providing support to people battling an opioid addiction.
  • Cater to certain populations: Your identity might be largely influenced by your culture, gender, or faith. In this case, looking for a program that specializes in providing faith-based services, women-only programming, or treatment that is tailored to members of the LGBT population, may benefit your long-term treatment goals. When you feel comfortable in your treatment program, you are more likely to stay engaged in care and experience better treatment outcomes.
  • Location: Your environment can largely influence your overall well-being, and if you know that you will feel more relaxed and at ease in a mountain, desert, or ocean setting, you may seek out these locations. Keep in mind that detox programs located in desirable locations often cost more than those in other settings.
  • Take your insurance: If you have insurance, check with your provider before entering a program. Sometimes, insurance companies will not cover the full cost of detox, but they may be able to partially cover costs. You can avoid surprises or financial problems by asking what the cost breakdown will be and finding out about other payment options.

Sources

  1. Hayashida, M. (1998). An Overview of Outpatient and Inpatient Detoxification. Alcohol Health and Research World22, 44­–46.
  2. Substance Abuse and Mental Health Services Administration. (2015). Key Substance Use and Mental Health Indicators in the United States: Results from the 2015 National Survey on Drug Use and Health.
  3. McCarty, D., Braude, L., Lyman, D. R., Dougherty, R. H., Daniels, A. S., Ghose, S. S., & Delphin-Rittmon, M. E. (2014). Substance Abuse Intensive Outpatient Programs: Assessing the Evidence. Psychiatric Services (Washington, D.C.)65(6), 718–726.
  4. World Health Organization. (2009). Clinical Guidelines for Withdrawal Management and Treatment of Drug Dependence in Closed Settings. 4, Withdrawal Management.
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