The Basics of Detox

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.

Types of Detox Services

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:

  • Outpatient: This level of care typically occurs in a physician’s office or freestanding medical center. Patients arrive for scheduled appointments each day, receive treatment, then return home immediately after.
  • Intensive Outpatient: This level of care typically occurs in a physician’s office or hospital setting. Similar to traditional outpatient detox, patients arrive each day for scheduled treatments. Licensed nurses then monitor them for several hours after to ensure there are no side effects that require further medical care.
  • Residential Inpatient: This level of care typically occurs in a non-medical, social detoxification setting, such as a traditional rehab center. Patients live at the facility through the entire detox period. Residential inpatient treatment typically places more focus on peer and social support than medical treatments.
  • Medically-Monitored Inpatient: This level of care typically occurs in free-standing detoxification centers. It is similar to residential inpatient therapy but places a higher emphasis on medical treatments. As such, the facility is staffed by licensed medical professionals who monitor patients 24 hours per day.
  • Hospital Inpatient: As the name implies, this level of care occurs in general or psychiatric hospitals. It provides intensive, medically-managed detoxification with 24-hour supervision for patients with potential medical complications from severe withdrawal symptoms.

The Drug Detox Process

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.

Step #1: Evaluation

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.

Step #2: Stabilization

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.

Step #3: Fostering Entry into Drug Treatment

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

Withdrawal Symptoms from Detox

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.

Withdrawal symptoms can last a few days or several weeks

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.

Possible medical complications from withdrawal make it dangerous to detox alone

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.

Common Withdrawal Symptoms

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
Mild Symptoms
  • Anxiety
  • Decreased appetite
  • Insomnia
  • Irritability
  • Restlessness
  • Anxiety
  • Depression
  • Drug craving
  • Fatigue
  • Hypersomnia
  • Increased appetite
  • Insomnia
  • Irritability
  • Paranoia
  • Poor concentration
  • Slowing of activity
  • Elevated body temperature
  • Increased blood pressure
  • Increased pulse
  • Increased respiratory rate
  • Insomnia
  • Muscle spasms
  • Runny nose
  • Sweating
Severe Symptoms
  • Amnesia
  • Dysregulation of body temperature and pulse
  • Elevated heart rate
  • Hallucinations
  • Impaired memory
  • Increased blood pressure
  • Increased sensitivity to stimuli
  • Nausea
  • Poor concentration
  • Tremors
  • Vomiting
  • Severe depression
  • Suicidal thoughts
  • Abdominal cramps
  • Anxiety
  • Bone and muscle pain
  • Diarrhea
  • Nausea
  • Vomiting
Possible Medical Complications
  • Cardiomyopathy
  • Encephalopathy
  • Gastrointestinal bleeding
  • Hepatic failure
  • Hypoglycemia
  • Infections
  • Pancreatitis
  • Seizures
  • Bleeding in or around the brain
  • Cardiac rhythm disturbances
  • Seizures
  • Vulnerability to arrhythmia
  • Vulnerability to myocardial infarction
  • Dehydration
  • Electrolyte imbalance

SAMHSA – Treatment Intervention Protocol 45: Detoxification and Substance Abuse Treatment

Medications Used During Detox

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.

Withdrawal medications should only be used under supervision

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.

Common Medications Used to Treat Drug and Alcohol Withdrawal Symptoms
Substance Medication
  • Benzodiazepines: Tranquilizers used to slow down the central nervous system to reduce the convulsions associated with detox, prevent seizures, and to address psychological withdrawal symptoms. Includes diazepam (Valium), chlordiazepoxide (Librium), lorazepam (Ativan), and oxazepam (Serax).
  • Carbamazepine (Tegretol): Anticonvulsant used to control tremors.
  • Methadone: Long-acting opioid drug used to eliminate withdrawal symptoms by activating the same opioid receptors as heroin and prescription pain medications, but without the euphoric effect.
  • Buprenorphine (Subutex): Similar to methadone, activated opioid receptors to reduce cravings and eliminate withdrawal symptoms without euphoric effect.
  • Suboxone: A combination of buprenorphine and naloxone used to activate opioid receptors. The naloxone helps prevent dependence on the buprenorphine.
  • Clonidine (Catapres): A blood pressure medication commonly used to reduce the autonomic symptoms of withdrawal including sweating, runny nose, restlessness, and anxiety. Does not reduce cravings. Is most effective when combined with other treatments.
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:

  • Desipramine (Norpramin): Antidepressant used to combat severe depression and suicidal thoughts.
  • Benzodiazepines: Tranquilizers used to combat anxiety, hypersomnia, and irritability.
  • Topiramate (Topamax): Anticonvulsant used to ease agitation during by reducing activity in the central nervous system.
  • Amantadine: Antidyskinetic drug (typically used to treat Parkinson’s disease) which has shown promise reducing withdrawal symptoms and drug cravings during detox.

SAMHSA – Treatment Intervention Protocol 45: Detoxification and Substance Abuse Treatment

Pros and Cons of Professional Detox Programs

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 provides safe, structured withdrawal

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.

Medication administered in professional detox can help to reduce withdrawal symptoms

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.

Professional detox has higher success rates than self-detox

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%.


Professional detox programs are inconvenient for many people

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 cost of professional detox can be prohibitive for some

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.

How to Choose a Detox Program

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:

  • Staff Credentials: A quality center should have at least one licensed medical practitioner on-hand, as well as a licensed counselor to address the psychological aspects of detox.
  • Treatment Options: Some rehabs do not believe in using medication to treat withdrawal symptoms. If you think you can benefit from medical-assisted withdrawal, it’s important to choose a facility that is willing and able to administer those treatments. Likewise, if you want a holistic approach to detox or a service that emphasizes a social support model, it’s important to choose one with that specialty.
  • Case Management: Facilities that employ case managers are better equipped to help you succeed against addiction than those without them. Case managers assist patients in accessing the resources they need to recover from addiction, which includes assessing the patient’s needs, planning care, linking the patient to the appropriate social resources, monitoring treatment progress, advocating for the patient to outside agencies, and facilitating the transition to therapy after detox.

For more information on these and other considerations, read our full guide, “Choosing the Right Rehab

Decide on a Service Setting

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.

Outpatient treatment is best for mild addictions with low risk for complications

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 is best for moderate addictions with harmful withdrawal symptoms

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 is best for moderate to severe addictions with low 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.

Medically-Monitored Inpatient is best for co-occurring medical and psychological conditions

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.

Hospital Inpatient is best for co-occurring conditions with the potential for fatal complications

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.

Overview of Service Settings
Outpatient Intensive Outpatient Residential Inpatient Medically-Monitored Inpatient Hospital Inpatient
Moderate addictions
Severe addictions
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

Consider the Cost

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.

The average cost of medication-assisted detox is between $300 and $1,700 per day

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

Find a Detox Facility Near You

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.

What Happens After Detox

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.

Patients are encouraged to transition immediately to a traditional rehab program

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.

Use our directory to find a rehab center to provide further treatment

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.

Disclaimer: The information contained on is for informational and educational purposes only and should not be relied upon for any medical or diagnostic purpose. The information on should not be used for the treatment of any condition or symptom. None of the material or information provided on is not intended to serve as a substitute for consultation, diagnosis, and/or treatment from a qualified healthcare provider.