People who are considering inpatient detox often wonder whether it’s really necessary, and you may be wondering what kind of drug use requires this type of around-the-clock detox treatment. The Substance Abuse and Mental Health Services Administration (SAHMSA) recommends 24-hour detox care for several different substances of abuse. They do so for humanitarian and safety purposes; constant support and monitoring can help mitigate withdrawal symptoms, reduce the risk of complications, and facilitate the management of any issues that may arise. Further, regardless of the drug or drugs abused, anyone who has a severe addiction, a dual diagnosis, or a co-occurring medical condition may want to consider enrolling in an inpatient detox program.
Anyone who is dependent on or addicted to a substance can benefit from inpatient detox. That being said, the concepts of dependence and addiction are somewhat distinct. Dependence develops when your body has adapted to the presence of the drug. People who develop a substance dependence may experience withdrawal symptoms with the abrupt cessation of or reduction in use. Addiction is a chronic condition characterized by compulsive drug use, despite knowing the negative consequences. People who are addicted are nearly always dependent, but dependence doesn’t necessarily imply addiction.1
Withdrawal syndromes can manifest differently depending on what drug a person is dependent on or addicted to. Certain substances have dangerous and potentially fatal withdrawal symptoms, while others have milder, but still unpleasant symptoms. People at risk of severe or life-threatening withdrawal, which is known as “complicated withdrawal,” should be treated in an inpatient detox facility, or other 24-hour setting, such as a hospital, for monitoring and safety considerations.
Substances that often require inpatient or 24-hour detox care include:2
Alcohol is one of the most commonly abused substances worldwide. Should problematic drinking result in the development of significant alcohol dependence, a person attempting to quit or cut back on their drinking may experience what’s known as an acute alcohol withdrawal syndrome.
Alcohol withdrawal can be very hazardous. It can result in symptoms that range in intensity from mild to severe. Alcohol withdrawal symptoms can include:2,4,5
In some cases, a severe form of alcohol withdrawal—known as delirium tremens, or DTs—may develop when drinking stops. DTs can be life-threatening and can include serious symptoms such as:2,5
Other substances associated with severe withdrawal complications like DTs and grand mal seizures include benzodiazepines and other types of sedatives. The clinical course of sedative withdrawal is sometimes worsened by the fact that people who use benzodiazepines also often abuse alcohol.2
Benzodiazepines are often prescribed to treat anxiety and panic disorders. This class of drugs includes brand name medications Xanax, Valium, and Ativan. Other prescription sedatives include barbiturates, such as phenobarbital, and sleep medications, such as Lunesta or Ambien.3
Withdrawal from these medications can result in a number of symptoms resembling those seen during alcohol withdrawal. In the most extreme cases of benzo withdrawal, people can develop delirium and seizures. Seizures are a particular concern because they can develop in the absence of any other withdrawal symptoms.2
Common withdrawal symptoms associated with benzodiazepines and other sedatives include:6
People who are dependent on or addicted to benzodiazepines are often initially prescribed these medications to manage anxiety or panic. Withdrawal can lead to rebound anxiety, meaning those symptoms return, which can be quite distressing and may increase the likelihood that a person continues to use the drug in question.
Unlike alcohol and sedative withdrawal, opioid withdrawal is not usually life-threatening. However, because the experience can be so violently unpleasant and, in some cases, is associated with significant complications, SAHMSA recommends a 24-hour supervised detox treatment or hospitalization for opioid withdrawal.2
Acute opioid withdrawal symptoms include:6
Opioid withdrawal is also associated with some physical and mental health complications. Some of the potentially dangerous complications of opioid withdrawal include:2
Inpatient detox is a multi-step process focused on providing the most comprehensive and supportive withdrawal treatment possible. When you arrive at a detox facility, you will undergo a complete evaluation by a medical or addiction professional. You will receive an assessment of your mental health, physical health, severity of your addiction, risk of complicated withdrawal, and other factors to help determine the appropriate course of action.
You may also need to provide blood or urine samples in order to evaluate for underlying health conditions, and, in some cases, undergo a genetic test, which can provide more information about how your individual makeup will impact the effectiveness of a medication.7 Testing provides your care team with the most information to best treat you and to create an individualized detox treatment plan.
The 3 main steps of the detox process include:8
When applicable, you may receive medications to help alleviate withdrawal symptoms and cravings. Some of the commonly-used medications for withdrawal from specific substances include:2,9
Keep in mind that detox is not a form of treatment but rather the first step in the recovery process. Its goal is to manage the withdrawal process and achieve medical stabilization. In order to create a solid foundation for ongoing sobriety, it is advised to transition into a comprehensive addiction treatment program, which helps to address the underlying issues that lead to substance abuse, helps correct maladaptive behaviors, and fortifies your coping skills.