- PrintArticle Summary
- Dependence, Withdrawal, and Detox
- What Happens During Detox?
- Benefits of Professional Detox
- Inpatient Detoxification Program Options
- Which Treatment Features Are Most Important?
- Insurance and How to Pay
While determination and self-sufficiency can be admirable traits, some people may overestimate the likelihood of there being a quick, easy way to conquer their addictions at home without professional assistance. They may believe professional addiction treatment is too inconvenient or too expensive. Some others may be reluctant to admit they need help. In reality, however, addiction is a disease that many struggle to overcome in the absence of treatment.
All professional addiction treatments help move people towards recovery, but many people, especially those new to recovery, benefit greatly from inpatient detoxification. And some may require it to avoid certain life-threatening hazards associated with withdrawal from specific substances. Inpatient detoxification is an intensive form of professional treatment focused on applying a set of strategies and interventions that make the early hours and days of recovery as safe and comfortable as possible.1
Dependence, Withdrawal, and Detox
Substances of abuse, including prescription medications, can change the way your brain operates and often lead to the development of tolerance and dependence with continued use.2
Drugs and alcohol alter certain brain processes in various ways, producing intoxicating effects in the short-term.3 With time and consistent use, these changes upset the normal balance the brain works so hard to maintain.
As the brain adapts to continued substance use, you can develop:3
- Tolerance—the need to use a substance more frequently to produce the desired effects – needing 10 beers instead of 5 to feel intoxicated, for example.
- Dependence—the physiological state in which the drug is needed to maintain the new normal and stave off withdrawal.
Drug and alcohol dependence is problematic on many levels. As dependence develops, the brain works to establish a new balance as it adapts to a particular substance of abuse. When that substance is no longer available in the same amounts or at all, this new balance is severely disrupted.3 As a result, the dependent individual may experience the onset of withdrawal symptoms that can range from minor to very dangerous.1Withdrawal symptoms are drug-specific—the symptoms experienced after quitting heroin, for example, will be different from the symptoms experienced by someone attempting to stop drinking.2 Not all drugs are associated with problematic withdrawal symptoms but some, like alcohol, sedatives, and opioids, can be especially distressing and could even present a medical emergency.1 It’s true that many people will not experience medical or mental health emergencies during detox, but it is sometimes difficult to predict who will. 1
Do not put your physical or psychological health in danger. Seek out professional detox treatment if you have been abusing alcohol or other drugs for an extended period.
What Happens During Detox?
The main objectives of alcohol and drug detoxification are to reduce the severity of withdrawal symptoms and ease the detoxing person into a substance-free state. All detox treatments will focus on 3 stages of care:1
- Linking to additional services.
During the evaluation stage, the professional will assess all important aspects of your physical, emotional, and social health, with special attention paid to: 1
- The specific drug or drugs used.
- The amount, frequency, and duration of the substance abuse.
- Any previous issues with withdrawal symptoms or withdrawal complications.
- Physical conditions, illness, and diseases affecting your health.
- Current or past mental health concerns.
- How much support you have.
- Any concerning stressors.
The treatment phase focuses on implementing a plan to safely withdraw based on the information gained during the evaluation. In some instances, such as those involving prescription benzodiazepine abuse, a doctor might gradually reduce the dose of the drug in question over time. In other cases, such as with heroin or alcohol detox, additional medications will be used to stabilize a person in acute withdrawal. 1
Sometimes, a substance will not be tapered but rather stopped abruptly, with detox treatment aimed at treating, rather than preventing, the withdrawal symptoms.1
The administration of medications is not always a part of detox treatment, but it is very common. About 80% of detox treatments feature at least one medication used to alleviate withdrawal symptoms or help prevent relapse.4
The final stage of detox treatment, linkage to other services, is just as important as assessment and treatment, because detoxification, by itself, is rarely sufficient to maintain long-lasting sobriety. 2 To make sure you get the full spectrum of care you need, the detox treatment providers will recommend and refer you to another level of treatment to maintain and continue your path toward recovery. 1
Benefits of Professional Detox
Entering a professional detox program offers both short-term and long-term benefits. In the short term, detox under the care of medical and addiction professionals helps ensure your health and safety. When your withdrawal symptoms present, the treatment team closely monitors your condition and deals with any issues as they arise.1
Certain medical complications can compromise your health and cause enough discomfort to compel you to relapse, so the staff at these programs may administer medications to help mitigate these problems and increase your comfort.1 Some physical health problems that may arise during alcohol and drug detox include:1
- Dehydration and electrolyte imbalance due to diarrhea and vomiting.
- Choking on or breathing in vomit, leading to blocked airways or risk of pneumonia.
- Cardiovascular issues, including changes in blood pressure and heart rate.
- High fevers that could indicate an infection somewhere in the body.
For someone detoxing alone, these issues can lead to serious problems and may even endanger their life. But in the medically supervised environment of an inpatient detox, they can be addressed immediately.1
Some people withdrawing from drugs and alcohol not only have to suffer through physical symptoms but may also experience potentially debilitating mental health issues including depression, anger, aggression, or even suicidal or homicidal thoughts. 1 Others may endanger themselves or people around them when hallucinations or delusions distort their reality and trigger high levels of distress. 1
Common to most withdrawal syndromes is a strong desire to get and use more of the substance. Called cravings, these compulsions to use drugs can lead to relapse, overdose, and a restarted cycle of addiction and dependence.5
Fortunately, detox programs are well-suited to address mental health concerns as well. By prescribing supportive medications, if indicated, and providing therapeutic and emotional support, a person’s mental health issues may be simultaneously managed alongside their physical health. The staff at the program should also know the best place to refer a patient suffering from specific symptoms in the event that they need further evaluation.
In the long-term, detox helps set the stage for lasting recovery. Alcoholics and drug-dependent people who do not go through the detoxification process are more likely to relapse after some period of sobriety.4
Detox and rehab programs employ principles of care that treat the entire person, not only their problems with addiction and dependence. Care can address and increase access to education, employment, housing, and relationships. 2 During treatment, staff may help you build a partnership with those close to you so that they may better understand addiction and learn how to respond and support you appropriately. 1 It is difficult to stay sober without the support of those you love, and when you involve them in your recovery, you may be more likely to stay clean for longer.
Inpatient detox programs will also help you create a plan for your treatment once your body is stable enough to move onto the next phase. You might believe that detox is all you need, but while it does offer an invaluable foundation for recovery, it is rarely considered enough to fully address a person’s addiction. A multitude of factors contribute to and perpetuate drug abuse, and these can be worked through in a longer-term treatment program.2
Inpatient Detoxification Program Options
Detoxification can take place in two general treatment settings, inpatient detox and outpatient detox, with smaller subcategories in each group. Overall, inpatient detoxification programs are more intensive than outpatient treatment programs. During inpatient, the person resides inside the treatment facility, and the whole detoxification process is completed within the center.1 Outpatient programs allow you to leave and sleep in your own home at night. Outpatient detox may not be an appropriate treatment setting for managing withdrawal from certain substances where dangerous symptoms can arise at any time or for people who feel unable to avoid relapse in their home environment.
Unlike outpatient centers, an inpatient facility provides continuous support for its patients while separating them from environmental and social stimuli that may hinder their recovery. Patients are monitored carefully and supported appropriately with a professional team.
Some people may be deterred by the potential cost of inpatient detoxification as compared to outpatient options. However, money should not stand in the way of a safe and progressive recovery.
There are 3 separate levels of care within the category of inpatient detox: 1
- Medically managed detox.
- Medically monitored detox.
- Social detox.
An inpatient detox program can range in time from several days to several weeks, depending on the patient's history and their drug(s) of abuse.5
Medically Managed Detox
Of the three, medically managed detox is able to provide most intense level of care. This form of detox includes medical supervision and treatment in an acute care setting with access to physician services, when needed. 1 In addition to physician access, a staff of registered nurses and other substance abuse treatment professionals will be present to provide ongoing observation and intervention.
With the access to physical and mental health experts in an acute care setting, medically managed detox is a great option for someone with significant physical and/or psychological issues or who might be at greater risk of experiencing severe or complicated withdrawal.1
Medically Monitored Detox
The primary difference between medically managed and medically monitored detox is the setting. Rather than being an acute care environment, medically managed detox occurs in a freestanding detox center. 1 These still offer treatment from physicians, nurses, and other trained staff members but may not be as well equipped to effectively manage severe physical or psychological symptoms of withdrawal. 1
Medically monitored detox centers will be a good option for people who still require some medical intervention without the full intensity of medically managed detox. Someone with successful past detoxes, mild physical complications, and no history of significant mental health issues will do well here.
Like other inpatient detox settings, social detox provides a substance-free environment with 24/7 supervision and support. 1 However, these programs won’t utilize much, if any, medication, choosing instead to emphasize the guidance and support of caring clinicians.
Social detox is a great fit for people withdrawing from substances such as stimulants that pose a relatively low risk of severe withdrawal symptoms. 1 These centers can also help to stabilize the patient's mental state after a period of severe intoxication where aggression or suicidal thoughts may emerge. 1
Which Treatment Features Are Most Important?
In 2016, Recovery Brands asked those leaving a rehab center what aspects to take into account when considering a program. The top consideration was the center's monetary policies, like insurance accepted, financial support, and payment options.
People entering treatment may want to examine a program's financial practices as well as the clinic's offerings to inform their final treatment decision.
If you’re considering treatment, you may want to examine a program's financial practices as well as the clinic's offerings to inform your final treatment decision.
Insurance and How to Pay
Whatever you do, do not let the cost of substance detox scare you away from the care you need.
The most intense addiction treatments are usually the most expensive, and medically managed detox will usually be among the priciest of treatment programs.1 However, the treatment intensity is only one variable affecting cost. Addiction treatments may also vary greatly based on:6
- The location of treatment. Options with picturesque scenery, privacy, or convenient access will generally be more expensive than others.
- The duration of treatment. Shorter programs may cost less than longer forms of treatment regardless of intensity.
- Range of services offered. A program with an array of complementary treatments like yoga, art/music therapy, and equine therapy will be more expensive than ones with standard treatments.
- Types of conditions treated. If a program is highly specialized in treating a certain population such as individuals with dual diagnoses, the fees could increase.
Whatever you do, do not let the cost of substance detox scare you away from the care you need. Programs may seem expensive, but there are many options to make the treatment that may save your life more affordable.
If you have insurance, start by calling the number on the back of your card for information about covered programs. Depending on your plan, your detox treatment may be fully or partially covered by your insurance. Your insurance provider will link you to in-network facilities to discuss their fees and your coverage.
If you don’t have insurance, consider acquiring coverage by:
- Exploring insurance provided by the county or state in which you live. Options usually exist for people with low incomes or certain mental/ physical health conditions.
- Search the online health insurance marketplace for plans that fit your financial situation and medical needs.
If you’re uninsured, don’t assume that treatment isn’t an option for you. Many people utilize alternative methods to afford their care, including:
- Loans. By securing a loan from a bank or even a personal connection, you can attend treatment now and pay back to the money over time in digestible payments.
- Crowdfunding. Many websites can make setting up a page, collecting money from your social network, and transferring it to your detox center simple and streamlined.
- Financing and sliding scales. Some detox facilities may offer flexible payment schedules that begin after treatment concludes. Others may offer free or deeply discounted care based on need, income, and level of commitment. Be sure to inquire with the center how they work with clients on payment.
To locate treatment today, you can visit SAMHSA’s directory of drug and alcohol abuse treatment facilities or call for help at 1-888-935-1318 Who Answers? now to speak to someone at any time of day or night.
- Substance Abuse and Mental Health Services Administration. (2015). Detoxification and Substance Abuse Treatment.
- National Institute on Drug Abuse. (2018). Principles of Drug Addiction Treatment: A Research-Based Guide.
- Medscape. (2016). Withdrawal Syndromes.
- National Institute on Drug Abuse. (2018). DrugFacts: Treatment Approaches for Drug Addiction.
- American Psychiatric Association. (2013). Diagnostic and statistical manual of mental disorders (5th ed.). Arlington, VA: American Psychiatric Publishing.
- French, M. T., Popovici, I., & Tapsell, L. (2008). The Economic Costs of Substance Abuse Treatment: Updated Estimates and Cost Bands for Program Assessment and Reimbursement. Journal of Substance Abuse Treatment, 35(4), 462–469.