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Drug and Alcohol Detox Information

detox treatment

Many mind-altering drugs, including alcohol, are associated with severe, uncomfortable, and even life-threatening withdrawal symptoms when a person who has been regularly using the substance(s) suddenly reduces their dose dramatically or stops using completely.1 Due to the physical discomfort and psychological distress that may accompany withdrawal, many people attempting to get sober seek out medical detoxification as the first step on the road to recovery from substance abuse issues.Detoxing can be stressful and sometimes dangerous. Many people relapse when they attempt to withdraw alone, so the value of professional detox can't be overstated.

Do All Addicts Experience Withdrawal?

Not every person actively abusing and addicted to substances will experience withdrawal when they attempt to quit. In fact, addiction and its potential consequences go well beyond merely the emergence of withdrawal symptoms. Addiction is a condition wherein maladaptive substance-related thoughts, feelings, and behavioral changes develop and support continued substance abuse. As a result, drugs and/or alcohol become the main focus in that person’s life, even when they are causing devastating harm to the individual.2 It is not addiction itself but rather physical dependence to a substance that results in withdrawal.

Physical dependence develops from frequent or consistent, long-term use of substances like alcohol, heroin, and cocaine. The use of prescription drugs, such as opioid painkillers and benzodiazepines, may also lead to the development of some amount of physical dependence, even when used according to prescription guidelines.When a patient uses substances—for example, alcohol or sedatives—consistently, certain signaling chemicals in the brain may begin to function abnormally. Though the precise impact on these chemicals will vary by substance, the results of drug or alcohol abuse could be that activity in one neurotransmitter system is abnormally increased, while that in another diminishes.3 As the brain keeps adapting to achieve a new balance in the face of such chemical turmoil, physical dependence sets in. Once a significant level of dependence develops, the brain begins to need the drug to maintain its new normal. At this point, when the drug is discontinued, withdrawal symptoms arise.

Which Drugs Cause Withdrawal?

Although all drugs affect the brain, not all drugs create physical dependence, and without physical dependence, there will be no withdrawal.2 Substances with known withdrawal syndromes include:

  • Alcohol.
  • Opioids, including prescription pain medications and heroin.
  • Sedatives, including medications like barbiturates and benzodiazepines.
  • Stimulants, including cocaine, methamphetamine (crystal meth), and prescription medications for attention-deficit/hyperactivity disorder.
  • Marijuana.

Other substances like hallucinogens are not recognized by the American Psychiatric Association (APA) as having withdrawal syndromes.4 Some drug classes are the subject of disagreement among recognized addiction organizations; inhalant withdrawal, for example, is not recognized by the APA but is recognized by the Substance Abuse and Mental Health Services Administration (SAMHSA).1

What Are Some Common Symptoms?

Withdrawal symptoms are drug-specific. These symptoms can range from minor (e.g., upset stomach) to very serious (such as changes in heart rhythm, breathing difficulties, and even life-threatening seizures) 4

An alcohol-dependent person who stops drinking may experience symptoms such as:4

  • Sweating.
  • Anxiety.
  • Higher heart rate.
  • Nausea and vomiting.
  • Hallucinations.
  • Seizures.

Because other sedating drugs, like benzodiazepines, affect the brain in ways similar to alcohol, they will produce similar withdrawal effects.4

People withdrawing from opioids can experience very intense flu-like symptoms as well as some psychological distress. Symptoms often include:4

  • Anxiety and restlessness.
  • Muscle aches.
  • Runny nose and watery eyes.
  • Sweating.
  • Fever.
  • Nausea, diarrhea, and vomiting.

For someone quitting stimulants, symptoms of withdrawal might include:4

  • Fatigue.
  • Vivid dreams and nightmares.
  • Periods of sleeping a lot or not sleeping at all.
  • Unusually quick or slow body movements.

Cannabis and marijuana withdrawal symptoms include:4

  • Irritability and anger with possible aggression.
  • Worry, nervousness, and anxiety.
  • Poor sleep and troubling dreams.
  • Depression.

Not every person will experience every characteristic symptom of withdrawal, but most people detoxing from a substance associated with a known withdrawal syndrome will experience at least some. In many cases, the best way to manage these symptoms is to get professional treatment, whether inpatient or outpatient.

What Is Detox?

Professional detox is an umbrella term that refers to a group of interventions that medical and addiction treatment professionals use to guide someone through withdrawal symptoms as quickly, comfortably, and safely as possible.1

Professional detox options strive to accomplish this goal in 3 steps:1

  1. After conducting a thorough assessment of the individual’s unique history, symptoms, and goals, treatment staff will place the person in the most appropriate level of care.
  2. Treatment staff provide treatment/support to best stabilize someone in early recovery.
  3. Linkage to other services. Detox is not usually enough for people to remain substance-free long-term.2 To help the patient achieve sustained recovery, professional detox centers should spend the final section of treatment coordinating patient care with another treatment provider.

Detox covers a large range of services, staff options, and treatment locations. Medications are frequently used during detox to prevent or manage withdrawal symptoms, but some detox programs use no medications at all. Called nonmedical, or social detox, these options rely only on the support from a trained staff and a safe environment to help the individual get through withdrawal.1

How Long Will I Be in Detox?

There is no concrete amount of time that all detox programs last. The amount of time you spend in detox may be impacted by:

  • The specific drug or drugs you consume.
  • How long you have been consuming them.
  • The frequency and intensity of use.
  • Previous negative experiences with detox and withdrawal.
  • The presence of other mental or physical health issues.
  • The detox plan devised by the treatment team.

How Long Will My Withdrawal Last?

Different drugs will have different withdrawal timelines. For example:4

  • In the case of alcohol withdrawal, the most serious effects usually occur within 5 days after the final drink.
  • Marijuana withdrawal symptoms may continue for 2 weeks past quitting.
  • Withdrawal from short-acting opioids like heroin and hydrocodone can begin just hours after the last dose, with most symptoms resolving after about a week.
  • Long-acting opioids like methadone may not begin until as many as 4 days after last use and may continue for weeks.

The course of treatment the detox center employs will also have a large impact on the duration of detox. In some situation, providers will recommend quickly ending all substance use and focus their treatment on managing withdrawal symptoms, which leads to a shorter course of detox.1 In other situations, the center will recommend a slow, steady taper from the substance, which can take much longer (e.g., several weeks) to conclude.1

It can be tempting to go for the quickest and seemingly easiest detox, but these options might not always be safe. For example, some centers offer what they claim is easy detox under general anesthesia; however, this method has not been found to be any easier on the patient and is rife with risks.5 It is the goal of the detox center to prescribe the type and duration of treatment that leaves each person with the best chance of recovery, in both the short and long term.

How Much Does It Cost?

The cost of detox can vary widely. Aspects of detox that influence treatment costs include.6

  • The intensity of the program. Detox options that provide a relatively intensive medical approach with 24-hour observation and care will cost more than programs with minimal staff intervention and no medications.
  • The duration of treatment. In general, detox options that last longer are going to be more expensive than options that are shorter.
  • The facility’s location. The most desirable locations, such as beachside detox with a resort feel, will typically be more expensive than other choices.
  • Staff expertise. People with more complex physical health or mental health issues may require care delivered from staff with plenty of experience managing more complicated cases. These services will typically command a higher fee.

Based on averages compiled by American Addiction Centers, detox centers may charge between $600 and $1,000 for each day of treatment.7

Luckily, insurance coverage will often pay for part or all of detox, which can offset a potentially large financial burden. If you already have insurance, be sure to contact your company regarding covered services and locations.

If you lack insurance, don’t let it deter you from treatment. There are plenty of options for free or discounted coverage on the federal, state, or county level. Also, some treatment centers may offer you a discounted fee based on your income.

Can Medications Help?

Yes! Medications are frequently used during detox to improve the chances of success and keep the patient safe and comfortable.2

Many medical detox programs utilize treatment medications that affect the brain similarly as the substances being abused.1 These medications are administered in a controlled manner to increase safety and comfort, decrease the likelihood of immediate relapse, and minimize the risks of complications. In cases of prescription drug abuse, medical detox providers may maintain an individual on their prescription but taper the doses over time. Throughout any medical detox program, certain other supportive medications may be given to augment treatment—providing relief for withdrawal effects such as insomnia, hypertension, etc.1The drugs used may vary by the condition they are treating.

Alcohol Withdrawal Medications

Some medications used in alcohol withdrawal include:1

  • Benzodiazepines and barbiturates. Sedative medications like diazepam and phenobarbital can help to manage withdrawal effects such as anxiety, agitation, and seizures.
  • Anticonvulsants. This class of drugs that includes carbamazepine, can also help to manage severe seizures, if present.
  • Antipsychotics. Drugs like haloperidol can limit agitation, hallucinations, and delusions associated with withdrawal.
  • Other drugs. During alcohol withdrawal, a person may be treated with a variety of medications like clonidine to manage symptoms of hypertension and rapid heart rate.

Opioid Withdrawal Medications

Opioid withdrawal may require medications such as:1

  • Methadone and buprenorphine. As opioids themselves, these medications help to reduce cravings and limit withdrawal symptoms. Methadone and buprenorphine can be tapered every few days or continued in the longer-term to help those in recovery to best maintain abstinence.
  • Clonidine. Used for years as a blood pressure medication, clonidine alleviates certain withdrawal symptoms but won't reduce cravings.
  • Lofexidine hydrochloride. In the same class of drug as clonidine, this newly approved nonopioid medication is specifically intended to ease the opioid withdrawal process.8
  • Other drugs. A variety of over-the-counter and prescription drugs can be used to address sleep, pain, and GI issues caused by opioid withdrawal.

Detox physicians may treat sedative withdrawal with medications as well. Depending on the case, the individual may remain on their current drug with a slow taper or be switched to another longer-acting sedative, such as chlordiazepoxide or clonazepam, to achieve a more predictable course of withdrawal.1 In either case, the tapering process will help minimize the symptoms while reducing the risk of seizures.

Many other substances do not have medications specifically approved to treat their withdrawal syndromes, but researchers are always looking for new options.1

Can I Do It Safely at Home?

Depressed person looking out of a windowAny time someone attempts to detox at home, there is some level of risk. It’s true that some might be able to safely detox at home without the disruption or expense of professional treatment, but others will experience severe physical and mental health symptoms without the support and guidance of addiction professionals. Though the withdrawal syndromes associated with certain drugs are known to be much less serious than others, withdrawal is unpredictable, and it's impossible to know exactly how it will go for you.

Even withdrawal symptoms not generally known to be life-threatening may cause some significant concerns. For example, opioid withdrawal may result in dehydration from vomiting and diarrhea, as well as worsened symptoms of underlying cardiac illness. For those with existing mental health issues, the anxiety and mood issues that often come with withdrawal may make symptoms worse.1

Beyond these risks, the seizures and delirium that may occur during alcohol and sedative withdrawal pose a great physical health risk.4 SAMHSA advises people to not to attempt home detox in the case of alcohol, sedatives, or opioids.1

Cravings may also lead to quick relapse if the person remains at home with easy access to drugs.4

Where Can I Find Help?

Detox procedures are offered in a variety of inpatient/residential and outpatient settings. Inpatient detoxification can be carried out in a hospital, standalone detox center, or another acute care setting in cases of high physical or psychological risk to the patient.1 These options offer 24-hour care and the highest level of treatment and safety.

Outpatient procedures to detoxify the individual are available, but outpatient treatment is usually only recommended in cases of mild dependence with low risk.1 Such outpatient procedures involve prescribing/administering medications or conducting tapers out of a clinic or office where the patient can be regularly monitored through frequent follow-up to minimize the risk of severe symptoms emergence.1 Monitoring is also necessary to ensure that patients comply with their detoxification regimens and do not return to using addictive substances.

For people who require long periods of detox due to extended medication tapers, they may begin treatment in an inpatient setting and then continue the process on an outpatient basis.

Once the initial detox procedure is completed, behavioral therapy and intensive counseling are necessary to help recovering persons progress even further toward full recovery.2 Medical detoxification is only the first step toward breaking the grip of alcohol and drug addiction.

Treatment Center Features

In 2016, Recovery Brands asked patients leaving a rehabilitation center which characteristics they had come to view as valuable to examine when looking at a program. The highest-rated priority was the program's financial options, for example insurance accepted and payment options. After completing treatment, participants rated the facility's offerings the facility's offerings (facility housing, extra activities, room quality, etc.) as much more important than they did prior to entering. Individuals considering programs will want to look at a facility's payment policies as well as clinic offerings to help with their final facility choice.

Changes in Preferences Pre- and Post-Treatment

References

  1. Substance Abuse and Mental Health Services Administration. (2015). Detoxification and Substance Abuse Treatment.
  2. National Institute on Drug Abuse. (2018). Principles of Drug Addiction Treatment: A Research-Based Guide.
  3. Medscape. (2017). Withdrawal Syndromes.
  4. American Psychiatric Association. (2013). Diagnostic and statistical manual of mental disorders (5th ed.). Arlington, VA: American Psychiatric Publishing.
  5. National Institute on Drug Abuse. (2006). Study Finds Withdrawal No Easier With Ultrarapid Opiate Detox.
  6. French, M. T., Popovici, I., & Tapsell, L. (2008). The Economic Costs of Substance Abuse Treatment: Updated Estimates and Cost Bands for Program Assessment and ReimbursementJournal of Substance Abuse Treatment35(4), 462–469.
  7. American Addiction Centers, 2017.
  8. U.S. Food and Drug Administration. (2018). FDA Approves the First Non-Opioid Treatment for Management of Opioid Withdrawal Symptoms in Adults.

 

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