Drug Detox Programs

Detoxification (detox) is often the first step of recovery. However, detoxing on your own can be dangerous because of the uncomfortable withdrawal symptoms, some of which can be potentially life-threatening. Drug detox programs can occur in several settings, including hospitals, free-standing detox facilities, outpatient programs, and more.

In this article:

• What is Drug Detox?
• Drug Detox Settings
• Which Drug Detox Program Should You Choose?
• Which Drugs Require Medical Detox?
• Transitioning to Substance Abuse Treatment After Detox

What is Drug Detox?

The term detox is a general term that can mean two different things. The first meaning refers to ridding your body of a drug or alcohol; this doesn’t necessarily involve professional oversight. The second meaning refers to professional detox, which involves several interventions aimed at achieving a substance-free, medically stable state.

The Detox Process

If you develop a physiological dependence on a substance, your body essentially needs it to function. If you stop using the drug abruptly or “quit cold turkey,” as it is often known, your body struggles to function without the drug.

This phenomenon is called withdrawal or detox and involves uncomfortable, painful, and sometimes dangerous symptoms. Withdrawal symptoms vary between substances. However, some drug withdrawal symptoms can include:¹

• Sweating
• Body aches
• Vomiting
• Seizures
• Delirium
• Anxiety
• Drug cravings
• Flu-like symptoms
• Bone and muscle pain

Drug Detox Programs

There are two main types of drug detox programs: medical detox and social detox or nonmedical detox. Medical detox involves medical supervision, monitoring, and care to manage your drug withdrawal symptoms and cravings and keep you safe. If applicable, you may receive withdrawal medications to alleviate your symptoms. The medical team may also provide nutritional support if you are experiencing nutrient imbalance.² A medical detox setting may be beneficial for those addicted to alcohol, benzodiazepines, and opioids since withdrawal from these substances can be extremely distressing and even dangerous.

Conversely, social detox does not offer medical detox and instead relies on peer support to help aid you during detox. This type of setting may be appropriate for a mild addiction or an addiction to a drug that doesn’t tend to cause severe withdrawal symptoms, such as a prescription stimulant.

The services and interventions typically offered at medical drug detox programs include:³

• Counseling: Before the start of detox, you participate in a few counseling sessions to mentally prepare for the process and learn what to expect.
• Supportive medical care: In addition to medical care that creates safer detox, these programs also provide any other medical care you need. This may include treatment for a medical or mental health condition you might have.
• Medications: Medications are a central part of detox treatment. Providers administer medications to reduce withdrawal symptoms, wean your body off the effects of the substance, and treat any other medical or mental health conditions.
• Case management: Case management services connect you with any resources or programs you need. Examples include housing or a substance use treatment program to join after detox.

Thus, medical detox programs provide comprehensive care that involves not only helping you detox safely but also attending to other health needs you may have.

Drug Detox Settings

There are different types of settings in which drug detox can happen. The one that is the best fit for you depends on your situation and needs.

Physician’s Office

This is the least intensive level of care and may only be appropriate for a mild addiction or for someone who developed a dependence after taking a medication as prescribed (such as prescription painkillers after surgery). You regularly visit with your provider in their office for supervision and for drug tapering or medication management. Depending on your needs, this might also include extended monitoring, which means that nurses monitor you over a few hours during prescheduled appointments.

Urgent Care or Emergency Department

This level of care may be a good fit for you if you are experiencing severe withdrawal symptoms. This setting initiates the detox process and then the medical team links you to longer-term comprehensive medical detox programs or treatment programs for your substance use disorder.

Acute Care Inpatient Settings

Acute care can happen in various types of settings, including acute care hospitals, acute care addiction treatment units in general hospitals, acute care psychiatric hospitals, or chemical dependency specialty hospitals. This detox setting is appropriate for severe withdrawal symptoms since they provide intensive inpatient care and medical monitoring and supervision.

Substance Use Treatment or Mental Health Facility

Sometimes addiction treatment or psychiatric facilities offer medical detox services within their programs, which can be a beneficial way to jumpstart your recovery. You’ll receive 24/7 observation and support while you detox, and a physician is available 24 hours by phone.

Intensive Outpatient and Partial Hospitalization Programs

These outpatient detox options offer structured services onsite for several hours per day. Though similar to a physician’s office, these programs have multidisciplinary teams to meet all patient needs, including physicians, nurses, addiction counselors, psychologists, psychiatrists, and case managers. Detox sessions are regularly scheduled and delivered under set protocols. They are a good option for someone who needs more oversight than a doctor’s office but may not require the intensiveness of an inpatient detox program.

Which Drug Detox Program Should You Choose?

The various detox settings can be placed in one of two broad categories: inpatient or outpatient. Determining the best one for you depends on the severity of your withdrawal symptoms, if you have additional medical or psychiatric conditions, and if you can take yourself to a clinic on an outpatient basis.

Inpatient Detox

When in doubt, inpatient detox is the safest option. This is because you are closely monitored by staff who can respond to your medical needs right away.³

Inpatient detox will especially be a fit for you if you have:³

• A history of severe withdrawal that was accompanied by seizures or delirium
• Suicidal ideation
• Co-occurring psychiatric conditions
• Co-occurring medical conditions such as diabetes or hypertension

Outpatient Detox

The main advantage of outpatient detox is that it can accommodate someone who has to work or attend to other responsibilities while in treatment. It is also an effective treatment for most cases of mild to moderate alcohol use disorder.⁴

Outpatient detox would be a fit for you if you:³

• Can attend a clinic or doctor’s office daily
• Do not have a history of withdrawal seizures or delirium
• Are able and willing to follow treatment recommendations
• Do not have other mental health or medical conditions
• Have a supportive person who can help you

In addition, detox should occur in a doctor’s office only if you have become dependent on a drug that you originally started taking as a prescription for medical reasons. Otherwise, a more intensive setting is needed for drug detox, such as a mental health or substance use treatment facility, intensive outpatient program, or a partial hospitalization program. This way, you can also get counseling and education to also help address underlying reasons for substance use.⁵

Which Drugs Require Medical Detox?

Medical detox may be necessary if you are detoxing from alcohol, benzodiazepines, barbiturates, or opioids like heroin or prescription painkillers. This is because withdrawal from alcohol and sedatives can be potentially life-threatening due to seizures. While opioid withdrawal isn’t typically dangerous, it can be extremely distressing and painful.

Alcohol

Severe alcohol use disorder can come with dangerous consequences in addition to seizures or delirium. These include unregulated body temperature, pulse, and blood pressure, and all can be fatal. Additional complications can include liver failure, gastrointestinal bleeding, infections, and impaired brain functioning.³

Benzodiazepines and Barbiturates

Like alcohol, benzodiazepines and barbiturates have depressant effects on the brain. As a result, the behavioral and physiological effects are like those of alcohol. Most individuals who misuse these types of substances may also be misusing alcohol. This combination increases the risk of overdose and can lead to more severe withdrawal.³

Opioids

Opioid withdrawal symptoms are not typically medically dangerous. However, they can be intensely uncomfortable. In addition, medical complications can develop because of symptoms and need to be quickly treated. For instance, extreme vomiting or diarrhea can lead to dehydration or electrolyte imbalance. While oral fluids can help, some individuals may require fluids to be administered intravenously.³

Further, if you have an underlying heart condition, it could be exacerbated by withdrawal symptoms like fast pulse and high blood pressure. Also, those with anxiety disorders can experience very intense anxiety during opioid withdrawal. Lastly, medical conditions like chronic pain are also worsened by opioid withdrawal.³

Given the dangers and complications of misuse of these substances, 24/7 monitoring and care are needed. This also allows medical professionals to treat existing medical and mental health conditions.

Transitioning to Substance Abuse Treatment After Detox

Detox is usually the first step toward recovery from a substance use disorder (SUD). This is because issues that led to the SUD still need to be addressed after detox, such as trauma or difficult childhood experiences. Otherwise, there is a high risk for relapse when emotional pain resurfaces or stressors occur, and you do not have healthy coping skills to deal with them.⁶

Therefore, it may be helpful to transition to an addiction treatment program after completing detox. While in a treatment program, you learn coping and relapse prevention skills. The different types of services that treatment programs offer can include:⁷

• Individual therapy: Here you can gain insights about your use or work toward healing deeper pain that contributes to your use.
• Group therapy: Here you can get interpersonal support from others with similar struggles. You can also learn and share coping strategies.
• Educational classes on drugs and alcohol: In these classes, you learn how substances affect your body and mind.
• Family therapy: Here your family can heal from the consequences of substance use, learn and practice communication skills, and learn boundary setting.
• Case management services: Case management services connect you with resources, such as vocational rehabilitation or ongoing therapy, after you complete the treatment program.

Although very important, drug detox is just the first step on the continuum of addiction care. Substance abuse treatment is a process that involves addressing your psychological and behavioral issues as well.

For help with locating drug detox or treatment programs, please call 800-996-6135(Who Answers?) to start your recovery journey.

Resources

1. American Psychiatric Association. (2013). Substance-related and addictive disorders. Diagnostic and Statistical Manual of Mental Disorders. American Psychiatric Publishing.
2. Das, K.D. (2020). Detoxification of drug and substance abuse. In P. Erkekoglu & T. Ogawa (Eds.), Medical toxicology.
3. Substance Abuse and Mental Health Services Administration. (n.d.). Detoxification and substance abuse treatment.
4. Allan, C., Smith, I., & Mellin, M. (2000). Detoxification from alcohol: A comparison of home detoxification and hospital-based day patient care. Alcohol and Alcoholism, 35(1), 66-69.
5. Witkiewitz, K., Bowen, S., & Donovan, D. M. (2011). Moderating effects of a craving intervention on the relation between negative mood and heavy drinking following treatment for alcohol dependence. Journal of Consulting and Clinical Psychology, 79(1), 54–63.
6. Melemis, S.M. (2015). Relapse prevention and the five rules of recovery. Yale Journal of Biology and Medicine, 88(3), 325-332.
7. National Institutes of Health. (2018). Types of treatment programs.