Detox centers are designed to treat withdrawal symptoms that result from the body’s chemical dependencies. Licensed professionals at detox facilities can help recovering addicts manage those harmful (or even fatal) symptoms using a combination of medication, counseling, and closely monitored care.
Professional detox takes place in one of two main settings (inpatient or outpatient) at five different levels of care. Detox services are typically performed in the same rehab center that the user plans on undergoing rehab, but depending on the severity of the withdrawal, they may need to be conducted at an outside facility. Likewise, patients with no immediate plans to undergo continued treatment can utilize stand-alone detox services. Here are the main types of detox services:
Regardless of the service setting or level of care, the purpose of detoxification is to provide safe, comfortable withdrawal from drugs and alcohol and to facilitate the patient’s transition into a full treatment program. To that end, the Substance Abuse and Mental Health Services Association outlines the following three-step process for all licensed detox facilities.
Before detox begins, clinical staff thoroughly evaluate all patients. This process includes questioning them on their history of abuse, testing for the presence of substances in the bloodstream, measuring concentrations to gauge the level of addiction, and screening for other physical and psychological conditions that could be complicated by withdrawal. Once the scope of the patient’s addiction is fully understood, an effective treatment plan can be created.
Once the evaluation is complete and a treatment plan is in place, the patient starts the withdrawal process. During that time, the facility staff utilizes medical and psychological therapies to help the user manage withdrawal symptoms until that person has achieved a physically and mentally stable, substance-free state.
Detox only addresses the physical symptoms of substance abuse, not the factors that lead to it. For patients to maintain their abstinence after detox, it is highly recommended that they enter into an ongoing treatment plan. In the final phase of detox, counselors at stand-alone detox centers help facilitate that transition by mentally preparing patients for rehab, recommending treatment plans and facilities, and helping to make all of the necessary arrangements to get them into a program. Full-service rehab facilities will simply move the patient on to the next phase or rehabilitation (therapy).
For more information about what comes next and the role of detox in the overall process of recovery, read our guide on “The Rehabilitation Process”
The withdrawal symptoms that users experience during stabilization vary by substance and addiction level. Some of the most common include nausea, sweating, elevated blood pressure, anxiety, and irritability. Severe symptoms include tremors, seizures, hallucinations, and suicidal thoughts.
In general, users of depressants such as alcohol and opiate drugs tend to have overly stimulated withdrawal symptoms, while users of stimulants tend to exhibit depressive side effects.
The onset and duration of withdrawal symptoms also vary by substance and addiction severity. The symptoms of some drugs manifest within 24 hours of last use, while others could take days to appear. Likewise, the worst of the symptoms can last as little as three days for some substances and as many as several weeks for others.
For example, opioid withdrawal symptoms typically last 3-5 days, but cocaine has been shown to have psychological withdrawal symptoms that last anywhere from three weeks to three months for those with severe addictions. In general, most recovering users should expect withdrawal symptoms to start within 24-48 hours of cessation and last 3-7 days.
Severe withdrawal symptoms in patients with preexisting conditions (or those with new medical concerns occurring at the same time as detox) could lead to serious illness and even death. For example, if an opioid user has a pre-existing heart problem such as coronary artery disease or heart arrhythmia, the increased pulse and elevated blood pressure associated with withdrawal could lead to stroke or heart attack.
For this reason, it is dangerous for recovering users to attempt detox alone. One key component of the evaluation stage of professional detox is to gather a complete medical history of the patient to adequately prepare for possible complications. Many professional detox facilities have medical staff on hand to manage any unforeseen complications and emergencies, and the staff at non-medical detox facilities are trained to respond appropriately to medical emergencies.
Below is a summary of withdrawal symptoms and potential complications for some of the most commonly abused substances.
|Alcohol||Stimulants (Cocaine, Methamphetamine)||Opioids (Heroin, Painkillers)|
|Onset||24-48 hours||Within 24 hours||8-12 hours|
|Duration||5-7 days||3-4 days (extreme: 3-8 weeks)||3-5 days|
|Possible Medical Complications||
SAMHSA – Treatment Intervention Protocol 45: Detoxification and Substance Abuse Treatment
One of the key reasons for choosing a professional detox facility is because they treat withdrawal symptoms with medication which can reduce or eliminate the unpleasant side effects of detox for a majority of substances. These medications can be administered both at inpatient and outpatient facilities.
Some withdrawal medications have the potential to be habit-forming, which is another reason why detox should be conducted under professional supervision. Otherwise, patients could just be trading one addiction for another. During an evaluation, detox admissions counselors can help patients decide which (if any) medical treatments are most appropriate for them based on the type of substance used, the severity of their addiction, and their commitment to future abstinence.
Below are some common medications used to treat the withdrawal symptoms of the most frequently abused substances. For more information on these (and more) treatment options, read our rehab guides.
|Cocaine||There are currently no medications approved for use in treating stimulant withdrawal, but several are sometimes prescribed to combat some of the psychological symptoms. They include:
SAMHSA – Treatment Intervention Protocol 45: Detoxification and Substance Abuse Treatment
For most people, a professional detox program is the right choice, but there may be some with slight addictions to low-risk substances that are able to safely and successfully self-detox.
Note: Even if you think you aren’t at risk for complications, it’s always wise to consult a medical professional before making the decision to self-detox.
Professional detox facilities employ specially-trained staff and licensed medical professionals. As such, they are well equipped to manage both the physical and psychological symptoms of withdrawal. They provide a safe, supervised place to detox that protects patients against the risk of medical complications. Inpatient facilities also provide a structured environment for those who need an escape from negative personal and societal influences.
Certain medications can reduce or eliminate the negative side effects of drug and alcohol withdrawal. Users who detox alone will have to suffer through that period. Without safe medication to alleviate their discomfort, many may return to their addicted substance to find relief.
Patients who undergo professional detox are more likely to complete the process than those who attempt to detox alone. One study reported a 74% failure rate among opioid users who tried self-detox methods. Another found that 59% of addicts who detoxed alone relapsed within the first 24 hours. According to the latest data from the Substance Abuse and Mental Health Services Association, 67% of all patients who entered a professional detox program in 2015 completed their treatment, which translates to a significantly lower failure rate of only 33%.
Enrolling in a professional detox program requires the patient to take time off work and away from their family. Detoxing in your own home may allow you to continue with some responsibilities, although the symptoms of withdrawal may not allow the addict to safely care for children or perform job duties.
The physician consultations, health screenings, counseling, and medical treatments of a professional detox program all come with a higher price. As such, it can be difficult for those without insurance or sufficient income to cover the cost of treatment.
The following are the three key factors you should research to be sure that whatever facility you’re considering will provide the safest environment and give you the best chance to overcome your addiction:
For more information on these and other considerations, read our full guide, “Choosing the Right Rehab”
The appropriate service setting for detox depends on the substances abused, the level of addition, patient medical history, and other social factors. To detox safely and efficiently, it’s important that you choose the setting most appropriate for your situation. An admissions counselor at any rehab or detox facility can help you decide on the appropriate setting based on a thorough evaluation. In general, the influencing factors are as follows.
There is limited medical monitoring at outpatient facilities. Patients arrive for treatments each day, then leave soon after completion. As such, it is most appropriate for those with mild addictions (and therefore mild withdrawal symptoms) and a low risk for medical complications.
It’s also essential for patients to maintain the detox schedule outlined in their treatment plans. Therefore, outpatient treatment is best for those with reliable transportation and the ability to arrive at the clinic on a daily basis. It is also only recommended for those with a strong social support system and a willingness to follow all treatment recommendations. Because patients are free to come and go from outpatient facilities, there is a greater potential for relapse than if they were monitored 24-hours per day at an inpatient facility.
Intensive outpatient therapy includes hours of extensive medical monitoring after treatments each day. It is best for patients who otherwise qualify for traditional outpatient treatments, but have moderate addictions with more serious withdrawal symptoms and a slightly higher risk for medical complications.
Residential inpatient facilities tend to emphasize non-medical, social detox. Patients are monitored 24-hours a day, but not necessarily by trained medical staff (as they are in some other settings). Some facilities do have licensed clinicians come in to administer appropriate medical treatments during regular business hours, but the rest of the day is dedicated to counseling and peer support. As such, this setting is best for users with moderate to severe addictions who need 24-hour monitoring to avoid relapse but do not have a high risk for medical complications.
Those who would otherwise qualify for residential inpatient treatment but have co-occurring medical or mental conditions that could be complicated by detox are best served in a medically-monitored inpatient facility. They are better equipped to treat both the original condition and the addiction, while also being prepared for a medical emergency should complications arise.
If the patient’s co-occurring medical condition has the potential for immediate, life-threatening complications, it is safest to undergo detox in a hospital inpatient setting. Medically-monitored inpatient treatment typically occurs in a freestanding detox facility. While they are equipped to handle medical emergencies, a hospital has far more resources at its disposal in a worst-case scenario.
|Outpatient||Intensive Outpatient||Residential Inpatient||Medically-Monitored Inpatient||Hospital Inpatient|
|Patients needing medical treatments||✓||✓||✓||✓||✓|
|Substances with severe physical withdrawal symptoms||✕||✕||✕||✓||✓|
|Substances with potential medical complications||✕||✓||✕||✓||✓|
|Patients with co-occurring medical conditions||✕||✕||✕||✓||✓|
|Patients with co-occurring psychological conditions||✕||✕||✕||✓||✓|
|Patients with limited social support||✕||✕||✓||✓||✓|
Detox accounts for a significant portion of your overall rehab expense. Service setting, the length of stay, prescription medications, physician consultations, and medical testing all factor into the cost.
Your budget and the availability of insurance or other means of offsetting the cost may influence your decision about which detox facility to choose. However, further expenses and medical issues may result from choosing a cheap facility that doesn’t provide the resources and treatment that you need.
There are many variables that factor into the cost of detox, but multiple studies have found the average to be around $300 per day for medication-assisted outpatient treatment and $1,000-$1,700 for inpatient. That number can increase or decrease based on the type and amount of medication used and additional services performed, but patients should expect to pay at least that average.
For more information on the cost of treatment, read our full guide, “The Cost of Rehab”
To find the right detox facility in your area – based on these factors and more – you can use our searchable directory that includes thousands of treatment centers nationwide.
The treatment finder tool includes several filters to help you narrow down the perfect option. To find facilities that offer detox services, enter your city and state, select the category “Type of Care,” and select the option for “Detoxification.”
In addition to detox services, the tool also includes options to search facilities by medical treatment approaches, payment options, and insurance acceptance.
Recovery doesn’t truly start until detox ends. For many, detox is performed as the first phase of a rehab program. For patients who undergo stand-alone detox, that period provides the perfect window of opportunity for them to clear their heads and consider further treatment.
Because detox does not solve the emotional, social, psychological, and cognitive issues associated with addiction, it is highly recommended that all patients pursue a long-term treatment plan immediately after discharge. A Johns Hopkins study found that people who committed to continuing treatment after detox were up to 10 times more likely to remain drug-free than people released from detox with no follow-up.
If the detox facility doesn’t perform rehab services themselves, counselors will put patients into contact with an appropriate substance abuse treatment program after detoxification. To find a rehab facility that continues the rehabilitation process for yourself, you can use our directory (above) to find inpatient or outpatient treatment centers that will fit your needs.
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