Chronic substance abuse can lead to physiological dependence, which means that the body has adapted to the presence of the substance and requires continued use in order to function optimally. When a person is physically dependent upon alcohol or certain drugs, such as opioids or benzodiazepines, stopping the use of these substances can result in the person experiencing unpleasant symptoms of withdrawal. Withdrawal symptoms vary depending on the type of substance involved but, in general, they can be very uncomfortable if not outright painful, as well as occasionally life-threatening.1
Detox programs are designed to help a person safely and comfortably withdraw from alcohol or other drugs on which they have become dependent. Detox should not be confused with comprehensive substance abuse treatment. It is only the first step on a continuum of addiction care, but it is a crucial step that prepares someone to begin on the road to recovery.
There are generally two types of detox—social detox and medical detox. Social detox is an approach for individuals at relatively low risk of experiencing severe or complicated withdrawal; it emphasizes peer and social support. People who do develop complications during withdrawal are usually transferred from a social detox setting to a hospital or other facility able to provide adequately intensive medical intervention.
By contrast, a medical detox program consists of 24-hour monitoring by a team of medical professionals. Medically managed withdrawal typically involves the use of some form of medication for relief of certain acute withdrawal symptoms. This is critically important for someone who is withdrawing from benzodiazepines or alcohol, as abruptly stopping the use of these substances can result in life-threatening seizures. In addition, although withdrawing from opioids is seldom medically dangerous, people in opioid detox are almost always in need of medical intervention to alleviate their very uncomfortable symptoms, such as nausea, vomiting, stomach cramps, fever, chills, and body aches.2
Medical detox can take place in a variety of settings—including but not limited to inpatient or residential facilities. However, the level of care required for detox depends on numerous factors, such as a person’s mental and physical health and social support system, which may be most reasonably determined after a thorough assessment by a substance abuse professional.
Depending on a person’s needs, the possibilities for detox settings include:2
That said, the Substance Abuse and Mental Health Services Administration (SAMSHA) recommends that detox for alcohol and benzodiazepines take place in some type of inpatient, medically monitored setting due to the risk of withdrawal seizures. In addition, although withdrawal from opioids is seldom fatal, the intensity of the highly unpleasant symptoms often requires 24-hour care due to humanitarian concerns.2
Several detox medications are used to manage withdrawal; their administration may vary according to the type of substance a person has been using.
For opioid withdrawal, the most commonly used medications are:2
When a person who is dependent on alcohol stops drinking, it can result in life-threatening seizures, as well as delirium and hallucinations. A medical detox approach may be utilized to manage uncomfortable symptoms, such as tremors and anxiety, as well as prevent dangerous ones, such as seizures. The most commonly used medications for alcohol withdrawal are benzodiazepines, such as diazepam (Valium) and chlordiazepoxide (Librium).2,3,4 Generally, the use of benzodiazepines to treat alcohol withdrawal is fairly limited in an outpatient setting, due to concerns over a person using alcohol when not in treatment, which could have serious medical complications, such as respiratory depression and coma.2
In some cases, anticonvulsant drugs are used in managing alcohol withdrawal, as they are less sedating and present a lower risk for a secondary dependence than with the use of a benzodiazepine. However, anticonvulsants are not always as effective as benzodiazepines at controlling seizures. Therefore, doctors tend to only use anticonvulsants in cases of relatively mild alcohol withdrawal. In some cases, antipsychotic medications, such as Haldol, may be used to treat the withdrawal-induced hallucinations and delirium. That said, these drugs can increase the risk of seizures. As a result, antipsychotics are not used frequently and only under close supervision.4 Although clinical trials have explored the use of various additional medications (e.g. acamprosate, baclofen, and GHB) to assist with alcohol detox, these medications have not been demonstrated to be consistently effective in the research to date.
Similarly to problematic alcohol use, benzodiazepine abuse can result in physical dependence; suddenly quitting these drugs can result in life-threatening seizures, although this is rare. Therefore, treatment protocols commonly call for a gradual reduction in their use over a period of several weeks to several months. Although this can work on an outpatient basis, there is not a great deal of consensus on exactly the best way to taper a person off of benzodiazepines.5 When a person is dependent upon a short-acting benzodiazepine, such as oxazepam or alprazolam, doctors will oftentimes substitute a longer-acting benzodiazepine, typically diazepam, and use it to taper the person off benzodiazepines.6 In rare cases, a doctor may also use phenobarbital to assist with benzodiazepine withdrawal.2
Several popularly abused drugs, such as cocaine, methamphetamine, amphetamines, MDMA (ecstasy), LSD, bath salts, and marijuana have no specifically FDA-approved medications for the management of withdrawal. Detox for these substances emphasizes managing any significantly troublesome withdrawal symptoms as they arise.2 For example, while going through withdrawal from stimulants, such as cocaine or methamphetamine, people commonly experience agitation. Doctors may use diazepam to control these symptoms.6 Over the years there has been some research into the potential for pharmaceutical management of some of these withdrawal syndromes, such as lithium for marijuana withdrawal, however there still remain no FDA-approved medications for such a purpose.6
There are many benefits to undergoing a medical detox. Although people can and do attempt to detox at home, it is not always advisable to do so, especially for certain types of substances. If you struggle with an addiction to certain drugs or alcohol, medical detox can provide:
A medical detox protocol, especially one utilized in an inpatient or residential setting, offers many advantages, including increased comfort during withdrawal and the prevention/management of medical emergencies.
Although medical detox is a great option for managing withdrawal, there are some potential disadvantages, such as:
Nevertheless, when you weigh the advantages and disadvantages, the most important thing to consider is your health and well-being. The pros of medical detox often greatly outweigh the cons, since this intervention can ensure your safety during a distressing and trying time.
There is no way to determine whether or not you or your loved one is in need of medical detox without a thorough evaluation by a doctor or other experienced substance abuse treatment professional. Medical detox is typically recommended, however, for people who:2,6
If you or your loved one is struggling with an addiction to drugs or alcohol, reach out for help. With many different options for medical detox, you can find one to meet your specific needs. There is hope for addiction, and detox is the first step on the road to recovery.