For every person who chooses to undertake the journey to recovery, the specifics of treatment, including the period of intense detox that occurs in the first weeks after cessation of drug and alcohol use, will vary widely. Some of the factors that can impact a person’s experience in drug detox specifically include:
- Drug of choice
- Daily dose of drug of choice at the time of cessation of use
- Other drugs of abuse used frequently
- Other drugs taken regularly for medical or mental health treatment
- Co-occurring mental health disorders or symptoms
- Underlying medical issues
- A person’s biology and metabolism
Managing acute mental health symptoms as well as the physical withdrawal symptoms that often characterize drug and alcohol detox is often the primary focus for clients in the first weeks of recovery. Medical care and monitoring are provided to ensure the safety of the client during this process as well as to increase comfort and, in some cases, assist the client in stabilizing rapidly while also helping to avoid relapse. It may be helpful to take advantage of the pharmacological options available in recovery, but that will depend upon all the factors listed above and whether or not there is a medication that is appropriate in a client’s individual circumstance. As detox is winding down, the client will be prepared to transition into the intensive therapeutic treatment necessary to grab a firm hold of a new life in recovery.
It’s important to note that:
- Physical dependence upon a medication is not the same thing as a drug addiction that requires medical detox. It is possible for people to develop physical dependence when they build a tolerance to their medication. If suddenly without that medication, those people would likely experience physical withdrawal symptoms that vary depending upon the medication and dose. A doctor can assist with a tapering process to minimize the discomfort in this situation. Addiction, however, is defined by psychological withdrawal symptoms as well as physical withdrawal symptoms, and a person living with addiction may be unable to avoid using the drug of choice without medical care due to the nature of the addiction disorder – a situation that defines about 16 million Americans addicted to prescription drugs alone each year.
- Alcohol is a drug and can cause significant withdrawal symptoms among those struggling with alcoholism – symptoms that can be treated with professional alcohol detox. The National Institute on Alcohol Abuse and Alcoholism (NIAAA) reports that an estimated 88,000 Americans die each year of alcohol-related issues due to an inability to connect with alcohol detox and addiction treatment in time.
- Mind-altering drugs that are legal can also cause addiction that is defined by physical and mental withdrawal symptoms. Marijuana, certain prescription medications (e.g., stimulants, sedatives, and painkillers), alcohol, and synthetic drugs are all addictive, and those who are addicted to these drugs will benefit from professional detox and treatment.
- It is not just opiate drugs that cause significant withdrawal symptoms. Stimulant drugs, too, can trigger intense psychological withdrawal symptoms and cravings long after the acute physical issues associated with cessation of drug use in addiction have ceased. For example, some studies show that long-term use of methamphetamine can contribute to an alteration of the brain’s structure and thus the ability of the person to avoid compulsive use of the drug. Professional detox and long-term therapeutic treatment are recommended to help prevent relapse. Medication may be appropriate in some cases.
- If psychological withdrawal symptoms are an issue, it may be necessary to follow use of addictive prescription drugs with detox and treatment. The classifications of drugs most commonly associated with addiction include opiate medications, including hydrocodone (e.g., Vicodin, Lortab) and oxycodone (e.g., OxyContin, Percocet), stimulant drugs like amphetamine (e.g., Adderall) or methylphenidate (e.g., Ritalin), and benzodiazepines that can include sleep medications (e.g., Ambien, Lunesta), barbiturates, (e.g., Nembutal), and anti-anxiety medications (e.g., Ativan, Xanax).
- There are numerous rumors that circulate about what works and what doesn’t in drug detox and recovery. Beware of those who offer any kind of a quick fix or magic pill for addressing withdrawal symptoms, especially ultra rapid opiate detox, as these methods can be dangerous as well as ineffective and a waste of time and money.
- Co-occurring mental health disorders and their symptoms can have a significant impact on the detox experience. For clients who are living with both an addiction and a mental illness or mental health symptoms, it is important to choose a treatment program that can effectively address both issues simultaneously.
- Though the cost of drug detox and addiction treatment can be high, recent changes in legislation concerning healthcare coverage require that all insurance providers cover the cost of detox and addiction treatment, including it as one of 10 elements of essential health benefits.
How Do Home Self-Detox and Medically Assisted Detox Programs Compare?
Medically assisted detox programs have the resources to provide clients with everything they need to navigate the initial phase of treatment for drug and alcohol addiction safely and stabilize in recovery. There are different styles of detox – for example, some are inpatient and some are outpatient – that offer a different range of services from very basic medical care to a deeply comprehensive and layered treatment program that leads into long-term therapeutic treatment. The type and style of detox that will be most appropriate will depend upon the client’s personal circumstance, history with addiction treatment, co-occurring mental health disorders, and goals for recovery. Often, however, a medically assisted detox program will offer the following services:
- Medical treatment and monitoring: Not everyone will be in need of acute medical care upon entering a medical detox program, but those who are will have access to the treatment they need to stabilize physically and mentally. An initial medical assessment and evaluation may occur in any case to identify any underlying medical need. If medication or acute care is necessary, appropriate medical care and monitoring will follow throughout the treatment process.
- Counselor and peer support: Therapeutic support often begins during the detox process and slowly builds to take up more and more of the treatment schedule as the client works through the initial withdrawal symptoms and feels well enough to focus in personal therapy sessions, group therapy, support groups, and more.
- Periodic check-ins: Throughout the course of detox, there will be check-ins with a medical doctor as well as therapeutic professionals to ensure that the client is getting the support necessary to continue the healing process on all fronts.
- Referral or start of treatment: Detox services do not encompass the sum total of treatment services necessary to overcome addiction. When detox is complete, intensive therapeutic treatment should begin. Some detox programs are integrated into a comprehensive rehabilitation program while others will end with referrals to appropriate therapeutic services.
Comparatively, at-home detox attempts offer none of the above. When those who wish to stop using their drug of choice try at-home detox, they are gambling that they will not experience any significant medical issues that require immediate medical intervention and that they will be able to avoid relapse. These are both risky assumptions given the unpredictable nature of addiction and the harsh impact that chronic abuse of drugs and alcohol can have on the brain and body. Even with the best of intentions and armed with as much knowledge as possible about what to expect, the urge to relapse and manage the uncomfortable withdrawal symptoms can be powerful and ultimately endanger the person’s health, often resulting in overdose.
No matter what the drug of choice, medical care and treatment starting with a medically assisted detox program are recommended when addiction is the issue.
What Is a Typical Detox Program Timeline?
The length of time spent experiencing withdrawal symptoms as well as the specific treatment options that will be most effective during detox will vary based on the details of the client’s experience, including drug of choice and all the issues listed above. In general, however, individuals can expect the following timeline to define their experience in drug detox:
- Intake and evaluation: For clients embarking on an outpatient detox program, the initial meeting will focus on getting a complete medical and psychological history, undergoing a physical, and taking any tests and evaluations that are indicated by the information gathered. Any paperwork related to admission to the program that needs to be taken care of will be completed at this time. The same process is likely for clients who enter an inpatient program, but intake in this case will often also include a tour of the facility and a bag check as well.
- Acute medical care: In some cases, immediately upon entering treatment, the client requires acute medical care. It’s not uncommon for someone to be in the midst of crisis or experiencing a serious mental health episode that precipitates entry into detox. In these cases, stabilization is the first step followed by the intake process described above. In the event that the evaluation at intake reveals an acute medical issue, treatment will be provided.
- Detox and treatment: Depending upon the needs of the client, a personalized detox plan is created that provides treatment for physical and psychological withdrawal symptoms and aids in the prevention of relapse. If a co-occurring medical or mental health disorder was identified during the evaluation process, then treatment for this issue will be included and launched as well.
- Treatment plan: Following detox, it’s important to create a uniquely personalized treatment plan for therapeutic treatment and continued detox that promotes health and wellness as well as ongoing mental health treatment and medical care if necessary. Therapeutic support for the first year or more of recovery plays an essential role in assisting a client in creating a new life in sobriety.
Do all drugs cause withdrawal symptoms?
Addiction is in part defined by the psychological and physical withdrawal symptoms that occur when the person abruptly stops using the drug of choice. Though not all drugs trigger long-term and intense physical withdrawal symptoms, all cause psychological withdrawal symptoms, including cravings and a strong impulse to relapse and use the drug of choice. It’s not uncommon for someone in detox from any substance of abuse to additionally experience other withdrawal symptoms, including:
- Disrupted sleep patterns
- Disrupted eating patterns
Most drugs of abuse, however, trigger intensive physical withdrawal symptoms as well as psychological withdrawal and even those who enter detox citing the same drug of choice will have an exceedingly different experience during detox. For example, alcohol withdrawal symptoms can be mild for some but life-threatening for others. In general, withdrawal symptoms begin within a few hours of taking the last drink, peak in the first few days, and then continue for weeks on end. In addition to the issues above, they may include:
- Clammy skin
- Rapid heart rate
- Nausea and vomiting
- Mood swings
Most clients in detox for alcohol abuse will experience some variation of the symptoms above at different levels of intensity, but the most severe cases are called delirium tremens and may be defined by the above as well as:
- Agitated and erratic behavior
- Severe confusion
The range of possible withdrawal symptoms and the unpredictable level of severity experienced by each individual are some of the reasons why professional medical detox is recommended.
Can medication help?
Just as all aspects of addiction treatment should be determined based on the needs of the individual, so too should the choice regarding use of medication be based on the client’s individual circumstances. Not all drugs of abuse have a corresponding pharmacological option that will improve the detox experience. Even if a medication is available that can help to mitigate cravings or address other aspects of detox, it is not necessarily appropriate in all cases.
In some cases, a medication-assisted detox that uses a medication may be used to treat the withdrawal symptoms related to detox and help the person to slowly taper down a high-dose addiction while under medical supervision. For example, benzodiazepines may be a positive choice to treat those who are experiencing severe alcohol withdrawal symptoms, and methadone and Suboxone are both often used to help people manage withdrawal symptoms associated with heroin detox. Though both are addictive medications, a slowly lowered dose may diminish the discomfort experienced during detox, which in turn can contribute to a lower risk of relapse as well as a lesser risk of medical complications. Coupled with long-term intensive therapeutic intervention, these options can be exceedingly effective, especially in treating those who have been living with a long-term addiction disorder.
Depending upon the drug of choice and the type of medication chosen during detox, medications may serve any of the following purposes:
- Cut down on cravings
- Create a negative physical consequence (e.g., vomiting) if the person uses the drug in question
- Cut down on severity or length of detox period
- Treat a specific withdrawal symptom
- Cut back on the risk of certain medical issues that may develop
- Improve the ability of the individual to begin therapeutic treatment
It cannot be emphasized enough, however, that there is no magic pill that will make detox easy if withdrawal symptoms are a significant issue. There are, however, a number of medications that may be helpful in easing the severity of these symptoms and empowering the individual to more quickly begin therapeutic treatment.
Can you die from withdrawal symptoms?
Withdrawal symptoms can be severe, and in some cases, with high-dose addictions to alcohol or benzodiazepines, for example, it is possible to experience medical complications that result in death. This risk is increased if there are underlying medical disorders that have gone undiagnosed and untreated during active addiction or if the person relapses during an attempted detox. The risk is diminished when emergency medical care is on standby and the person enrolls in detox at a medically assisted detox program that provides 24-hour supervision and monitoring.
What is ‘cold turkey’ detox?
Cold turkey detox is a term used to describe the process of abrupt cessation of use of all drugs and alcohol with no medical assistance of any kind. It is often a choice made by people who would like to get through detox as rapidly as possible since no long-term medications are used that may prolong the experience.
The use of non-addictive medications to help address specific symptoms (e.g., sleep aids for the purposes of treating insomnia or over-the-counter painkillers for bone and muscle pain or headaches) may help to make the person more comfortable in cold turkey detox.
Is there medical supervision during detox?
When a client enrolls in a professional drug detox program, medical supervision will be provided from the first day to the last. Medical care is a necessary part of the detox process even if physical withdrawal symptoms are not significant, to ensure the safety of the client at all times. Clients may expect:
- Acute medical care for the purposes of stabilization, if necessary
- Medical evaluation at the onset of detox
- Pharmacological treatment for withdrawal symptoms, relapse prevention, and/or co-occurring mental health symptoms
- Medical monitoring to ensure correct dosage and medication
- Immediate care in the event of medical emergency
How long do withdrawal symptoms last?
The length of time that withdrawal symptoms last in detox will vary based on a number of different factors. In most cases, they begin within a few hours of the last dose or drink, and then increase in type and severity until they peak and then slowly fade over the following weeks, though in some cases, psychological withdrawal symptoms can last for months or return every few months.
Factors that have an impact on how long withdrawal symptoms last include:
- Main drug of addiction: The primary drug of choice, or the substance abused daily that triggers withdrawal symptoms, will dictate the type of withdrawal symptoms experienced. For example, someone who struggles with an opiate addiction may have different withdrawal symptoms than someone who is detoxing from marijuana. How long symptoms will last is often heavily dependent upon the drug of addiction.
- Dosage: The dose of the drug of choice that is used each day is pertinent, as well. Those with low-dose addictions may struggle with withdrawal symptoms for less time than someone with a high-dose addiction – sometimes, but not always, depending upon the other factors.
- Other drugs of addiction: When other substances of abuse are used frequently enough to trigger withdrawal symptoms as well, it can lengthen the time spent in detox or otherwise impact the person’s experience with withdrawal symptoms in general. For example, if the primary drug of choice is heroin, but the person often used the drug with speed, then withdrawal symptoms associated with both substances may be an issue.
- Length of time spent living with an active addiction: Someone who began using drugs during the teen years and used them daily through adulthood may have a harder time breaking the habit of using these substances than someone who has had a much shorter experience with active addiction. The brain changes structure due to chronic use of drugs and alcohol, and the longer someone uses a substance, the longer it may take to address those changes, acquire new habits, and learn how to function in sobriety despite changes that cannot be reversed.
- Physiology: A person’s metabolism, weight and age, tolerance for the drug of choice, any other drugs taken routinely, as well as the unique chemical makeup of the person and how the brain responds to drug use – and to being without drugs – are uniquely individual. All else being equal, a person’s physiology can change the type and severity of withdrawal symptoms as well as the length of detox.
- Co-occurring mental health disorders or symptoms: Co-occurring mental health issues can significantly impact the ability to avoid relapse especially during the detox period when cravings are often at their strongest. It is often necessary to stabilize with medication initially in detox to help decrease levels of agitation, depression, anxiety, and other mental health symptoms that can make the process more difficult than it would be otherwise. In some cases, depending upon the nature of the mental health disorder, the related symptoms can serve to lengthen the time spent in detox and/or the time spent struggling with psychological withdrawal symptoms. For example, people who originally began taking benzodiazepines to treat anxiety and developed an addiction may find that they experience “rebound anxiety” when they stop taking the medication during detox, an issue that can impact the length of detox as the person works to get that issue under control in addition to managing withdrawal symptoms.
- Use of medications: Medications may address specific withdrawal symptoms, the overall detox experience, or co-occurring mental health symptoms. Monitoring and follow-up care will help to ensure that the person is taking the right dose of the right medications and safety is prioritized. However, the use of long-term maintenance medications will lengthen the detox period for as long as the medications are used. Until the person is completely free of all drugs associated with addiction, including maintenance meds, they are considered to still be actively in detox.
It’s also important to note that while the focus may be primarily on the physical withdrawal symptoms experienced during the first weeks of detox, the psychological withdrawal symptoms can linger for months. In the case of some drugs, too, cravings can resurface after almost a year or more of sobriety; thus, a state of continued detox and awareness through ongoing connection with treatment is recommended.
What happens after detox?
Detox is just the first part of a comprehensive treatment program for addiction. After detox, clients have the opportunity to learn how to make lifestyle and behavior changes that will increase their ability to remain drug-free for the long-term. Through intensive cognitive and behavioral therapeutic interventions, the client has the chance to explore underlying assumptions and perceptions that may be contributing to the impulse to use drugs and alcohol, and make adjustments where necessary. Additionally, alternative and holistic healing options provide stress management assistance and techniques that can help to manage overall stress levels and provide coping mechanisms that can be applied in tough moments.
A well-rounded treatment plan will utilize a unique combination of traditional, alternative, and holistic treatment options according to the needs of the individual. Like the treatment choices made in detox, the determination of which therapies will be useful should be based on:
- Whether or not the person is living with co-occurring mental health disorders or symptoms
- The person’s history with drug addiction treatment efforts
- The person’s goals for recovery and beyond
- Specific issues faced in sobriety (e.g., legal issues, employment needs, family difficulties, etc.)
Not only should therapy take place during the addiction treatment period immediately following detox, but the therapeutic interventions that most resonate with each client should be continued in aftercare as well, as the person begins the process of transitioning into an independent life in recovery. Though the specific therapies chosen will vary from person to person according to need, some positive options may include:
- Personal therapy: One-on-one meetings with a personal therapist are the cornerstone of an effective treatment program. Here, the client can discuss any acute issues as they arise, privately address any difficult issues that may have occurred before or during addiction and begin the healing process, and discuss the overall direction taken in treatment.
- Support groups: Meeting regularly with peers in recovery under the direction of a therapist can provide all participants with the benefit of interacting with each other with the added advantage of direction provided by the therapist. The group may focus on a different topic in recovery each week or work on one aspect that impacts all of the people in the group (e.g., chronic illness, legal problems, parenting issues, a specific mental health issue like depression or anxiety, etc.). Therapy can offer a range of coping skills as well as the opportunity to discuss where or not those coping mechanisms are actionable and working for each individual.
- 12-Step meetings: Alcoholics Anonymous (AA) and Narcotics Anonymous work within the 12-Step structure, which has been proven to be a benefit to clients in a treatment program and out in the community after treatment. Creating a community of support, using the 12 Steps to address difficulties as they arise, and having the structure of regular meeting attendance can all prove to be powerful parts of recovery as well as aid in the transition from inpatient or intensive outpatient treatment to independent living in recovery.
- Alternative therapies: The list of possible alternative therapies that can be an effective part of treatment is long and varied. For some, a therapy option that makes use of non-verbal tools (e.g., painting, cooking, dancing, etc.) is an excellent way to explore past experiences that are too difficult to discuss out loud. For others, a therapy option that introduces individuals to new skills and new people in a fun environment is an excellent therapeutic tool to build relationships and confidence (e.g., sports therapies, outdoor therapies, adventure therapies, etc.). Mixing and matching therapies, and trying new avenues of treatment, can augment growth in recovery on all fronts.
- Holistic treatments: Stress very often plays a role in relapse in recovery. Little things add up and, over time, the stress can trigger the compulsion to use drugs or alcohol to escape those uncomfortable feelings. Holistic treatments can serve to lower overall levels of stress in everyday life as well as help to shift perspectives so that different events and situations are no longer perceived as stressful. This can help to manage relapse and improve quality of life as well.
The specifics of what an individual needs to safely and effectively navigate detox and addiction treatment is very personal. It is recommended that all who begin the detox process do so with medical care and supervision through a professional substance abuse and addiction treatment program.