You’ve been struggling with drugs or alcohol for some time now. You’re exhausted. Your health may be suffering. You’ve hurt your family and friends by using drugs or alcohol. You know you need to make a change, but you aren’t sure where to find help.

Detoxing from a drug can be difficult. Maybe you tried quitting on your own but found the withdrawal symptoms too overwhelming. You tried to remain strong, but the drug got the better of you.

A drug detox line can be a valuable resource in finally getting clean. By making a simple call, you have access to information and resources to help you achieve your goal of sobriety.

What is Drug and Alcohol Detox?

Detox (or detoxification) refers to the process by which a person addicted to alcohol or drugs (including prescription drugs) is withdrawn from the substance(s) of abuse. 1

Detoxification is a natural process in the healthy human body. The liver performs detox every day to eliminate toxins and waste from the body. In the context of addiction, detox is the process of allowing the body to remove illicit drugs and alcohol.

People who have been using an addictive substance for a long time can experience a variety of physical and psychological symptoms (these are called withdrawal symptoms) if they stop or reduce drug or alcohol use abruptly. Withdrawal can be unpleasant, even life-threatening or fatal. One of the reasons addicts continue using drugs is because of the development of distressing withdrawal symptoms. The goal of detox is to enable people to withdraw from drugs and alcohol comfortably and safely. To this end, healthcare providers use several medications to manage symptoms during detox. They also have various other techniques at their disposal to keep drug and alcohol users comfortable during detox while the illicit substances leave their bodies.

Detox is a period of physiologic adjustment during which the body acclimatizes to the absence of drugs and alcohol. It is also the period during which a recovering addict makes the psychological readjustment necessary to prepare for long-term recovery.

Detox is not a treatment for drug or alcohol abuse. Rather, it is a method of managing symptoms of withdrawal in the short-term. Detoxification is usually the first step in a comprehensive treatment strategy for substance use disorders. The goal of detox is to substantially reduce or stop a person’s use of illicit drugs and alcohol. 2

General Principles of Detoxification

There are specific detox protocols for various drugs and alcohol. However, there are some general principles of detox that apply to all addictive substances.3

  • Detox alone is rarely sufficient to treat alcohol and drug dependence. Detoxification needs to be followed by appropriate addiction treatment, such as behavioral therapy and medication management.
  • There are established safety and efficacy protocols for detox from various drugs. These protocols should be used in clinical practice during medication regimens and other detoxification treatments. If healthcare providers use any investigative or experimental drugs or procedures during detox, the patient should be advised of the same.
  • Successful detox requires preventing access to drugs and alcohol as much as possible. Moreover, people who are addicted to drugs and alcohol cannot be relied upon to take prescription medications as directed. There is always a risk of prescription drug abuse during detox, so staff at detox facilities should administer medications under supervision.
  • Detoxification is not a one-size-fits-all treatment. Detox should be individualized to each patient. For example, if a person initiates detox during a personal crisis, it may be preferable to stabilize the patient with medications before initiating drug withdrawal.
  • Detoxification can be achieved by substituting a long-acting drug with a short-acting one. For example, during alcohol detox, patients may be prescribed Valium (diazepam) or Librium (chlordiazepoxide) which are metabolized slowly and provide a controlled neuro-adaptation and gradual decline in blood levels.
  • Clinicians can assess the various risk factors for a complicated or intense detox, such as the severity of drug use, the duration of addiction, etc., but there is no way to accurately predict the intensity of withdrawal symptoms during detox.
  • Besides the management of physical symptoms, psychological support is extremely important in reducing a patient’s distress during detox.
  • Following detox, patients should start participating in other addiction treatments as soon as possible, including support groups, individual counseling, and group therapy.

What Happens During Detox?

Detoxification is individualized to each patient’s needs, but in most cases, there are three basic steps:

Intake Evaluation: The medical team evaluates the alcohol or drug abuser with a complete history of substance abuse, past medical history, and physical exam. Blood tests and other investigations are ordered to check which drugs are in the patient’s system. This helps in treatment planning.

Withdrawal: The next step is the patient’s withdrawal from drugs and alcohol. At this stage of the detox process, the recovering addict is stabilized with medications and withdrawal symptoms are managed. Also, the patient receives psychological support to overcome drug cravings.

Preparation for Recovery: The final step in detox is preparing the patient for an addiction treatment program. This stage involves making the patient aware of what to expect in the coming weeks and months as well as offering advice on relapse prevention strategies after detox.

Goals of Detoxification

Detox is typically the first phase of substance abuse treatment. It involves both physical and psychological readjustment by the recovering addict. The immediate goals of detox are:

Safety: The first goal of detox is to ensure safe withdrawal from alcohol and drugs. In other words, detox enables former drug users to become drug-free without medical complications. Unsupervised cessation of drinking or quitting drugs “cold turkey” can lead to life-threatening withdrawal symptoms. Detox makes withdrawal symptoms safe and tolerable through the use of medications. Inpatient detox is preferred in terms of safety as outpatients may have continued access to street drugs. The interaction between prescription medications and illicit substances can result in a drug overdose.

Dignity: The second goal of detox is to provide addiction treatment in a supportive environment with qualified staff who are culturally sensitive. Confidentiality is assured and the staff ensures withdrawal from drugs and alcohol is humane and protects the patient’s dignity.

Preparation: The third goal of detox is to prepare the patient for subsequent treatment for alcohol or drug dependence. Detoxification offers an opportunity to learn about various treatment options and become motivated to get clean.

How Long Does Detox Take?

The length of detox depends on various patient-specific factors, such as:

  • The type of drug the person is addicted to
  • The duration of the addiction
  • The frequency of drug use
  • The amount of the drug used at one time
  • The method of drug use (injecting, snorting, smoking, swallowing)
  • The person’s unique genetic makeup
  • Co-occurring health conditions
  • Co-occurring mental illness
  • Family history

There are various ways to define how long a person is in detox. One method is to calculate the detoxification period as the period during which the person receives detox medications. Another method is to measure the duration of withdrawal symptoms. Based on the typical duration of withdrawal symptoms, detox from various drugs and alcohol lasts for: 4

  • Short-acting opioids (heroin): 4-10 days
  • Long-acting opioids (methadone): 10-20 days
  • Short-acting benzodiazepines (Xanax): 2-4 weeks
  • Long-acting benzodiazepines (Valium): 2-8 weeks
  • Stimulants (methamphetamine, amphetamine, cocaine): 3-5 days
  • Alcohol: 2-10 days
  • Inhalants: 2 days to 2 weeks
  • Marijuana: 1-2 weeks

Side Effects of Drug and Alcohol Detox

Alcohol and drug detoxification is a challenging period in addiction recovery when the risk of relapse is highest. Moreover, withdrawal symptoms can lead to potentially life-threatening medical complications during detox. Some of the common side effects of detoxification include:5

  • Restlessness, agitation, irritability, anxiety
  • Lack of appetite, nausea, vomiting
  • Elevated heart rate and blood pressure
  • Tremors (shakiness)
  • Insomnia, sleep disturbances, nightmares, intense dreams
  • Poor memory, poor concentration, impaired judgment
  • Sensitivity to light, sound, and touch
  • Hallucinations, delusions
  • Seizures
  • Delirium (disoriented to time, person, and place with a fluctuating level of consciousness)

Benefits of Medically-Supervised Detox

During a medically-supervised drug and alcohol detox, healthcare providers use a wide range of medications to treat the physical and psychological symptoms of withdrawal.

For instance, benzodiazepines (Valium, Librium, Ativan) are commonly used during alcohol detox to prevent agitation, seizures, and delirium.6 Various symptoms like anxiety, nausea, insomnia, and muscle aches are treated with appropriate prescription medications. Also, recovering addicts are given vitamin supplementation and aggressive hydration to maximize support to the body.

Close monitoring during a medically-supervised detoxification program for alcohol and drugs has several advantages, including:7

  • Improved patient safety
  • Better compliance with treatment
  • Lack of access to drugs and alcohol during detox

The success of a detox program has far-reaching effects. In combination with subsequent addiction treatment, detox helps to reduce criminal activity in substance users, improves their ability to become and remain employed, and is associated with better outcomes in pregnant women with substance use disorders.

Social Detox

Social detoxification refers to short-term, non-medical addiction treatment for individuals with substance abuse issues. Social detox programs typically consist of a room, board, and psychological support during what is essentially a “cold turkey” detox.

The scope and approach of different social detox programs can vary greatly. Some programs offer nursing and medical supervision onsite while others provide access to medical care through local emergency departments and urgent care centers.

To ensure the safety of recovering addicts, a social detox program should, at the very minimum, supervise the administration of medications prescribed by healthcare professionals, monitor vital signs, and provide medical surveillance.

The consensus among addiction treatment professionals is that medically-supervised detox is preferable to social detox. This is based on the observation that intensive 24-hour care provided during inpatient detoxification ensures the highest safety and the greatest chances of successfully coming off drugs and alcohol.

However, for some individuals, such as homeless people or people with no health insurance, social detoxification is the only viable option and is preferable to completely unsupervised detox on the streets, for example. Moreover, many social detox centers have extensive experience and provide high-quality supervision and care to their clients.8

Rapid and Ultra-Rapid Detox for Opioid Addiction

A new type of detoxification called rapid or ultra-rapid detox has emerged in recent years as an innovative approach to withdrawal from opioid drugs. The American Society of Addiction Medicine refers to this as opioid antagonist detoxification under sedation or anesthesia.

The goal of ultra-rapid detox is to reduce the duration of the detoxification process to 6-8 hours. This is achieved by rapidly transitioning the patient to naltrexone shortly after the patient’s last opioid drug use. Naltrexone is an opioid antagonist and reduces cravings by blocking the pleasurable effects produced by opioid drugs. To blunt the physical discomfort caused by drug withdrawal, ultra-rapid detoxifications are performed under general anesthesia or deep sedation.9

The biggest advantage of an ultra-rapid detox is that it is associated with a high detox completion rate and successful induction into naltrexone maintenance. However, there are ethical conflicts regarding the use of general anesthesia. Also, no studies have demonstrated that ultra-rapid detox leads to superior outcomes in the long-term compared to standard detox beyond the immediate detox period. Moreover, rapid detox is expensive and is not usually covered by insurance.

Nonetheless, certain patients, such as those who have been unable to abstain from opioid abuse despite methadone maintenance, may benefit from rapid detox. Also, opioid addicts who do not have the time to go through the usual extended detoxification process due to work commitments may be candidates for this type of detox. It is worth noting that rapid detox is not safe in polysubstance abusers who have concurrent dependence on alcohol, stimulants, or benzodiazepines along with opioids since these other substances can complicate the rapid detox. Rapid detox is also contraindicated in pregnant women, individuals with heart disease, chronic kidney disease, and liver disease.

Dangers of Detoxing at Home

Due to the cost of treatment for substance use disorders and the lack of access to such programs, many drug users and alcoholics attempt to detox at home without professional help. Such detoxification has the advantage of protecting the user against the social stigma of addiction. While detoxing at home, a former drug user does not have to disclose their addiction to anyone. However, quitting drugs and alcohol cold turkey at home is not recommended as it can be dangerous. This is especially true after prolonged and heavy alcohol abuse or in people with severe drug addiction.

Various complications can occur during detox. For instance, severe vomiting and diarrhea can lead to dehydration and elevation in blood sodium levels, which in turn can cause heart failure. 10In a supervised setting, healthcare providers monitor the patient continuously and manage the withdrawal symptoms before they get out of hand, making the detox safer and more comfortable for the patient.

Another risk associated with unsupervised home detox is that former users may still have access to drugs or alcohol. Drug cravings during the withdrawal process can lead to a relapse or drug overdose.

For individuals who cannot or do not want to undergo inpatient detoxification, there are many outpatient detox programs where medical supervision is available to manage mild withdrawal symptoms. 11

Medications Used During Alcohol and Drug Detox

Healthcare providers manage withdrawal symptoms during drug and alcohol detox with various FDA-approved medications. In particular, detox from opioid drugs and alcohol can be successfully managed with medications. Medications used during detox act in various ways.

Certain medications produce unpleasant side effects in the presence of an intoxicating substance. For example, a medication called Antabuse (disulfiram) causes highly unpleasant symptoms like nausea, vomiting, flushing, and a racing heart when a person drinks alcohol. This medication works by discouraging alcohol use in recovering alcoholics by inducing a fear of the distressing symptoms. 12

Other medications like Campral (acamprosate) decrease cravings for alcohol and reduce distress during detox by balancing the levels of neurotransmitters (chemicals) in the brain. 13

A drug called naltrexone (Vivitrol) is used during detox from opioid drugs and alcohol. It reduces alcohol and opioid cravings by blocking receptors in the brain that produce the pleasurable effects of these substances. When the receptors are blocked by naltrexone, the recovering addict no longer associates these alcohol and opioid drugs with pleasurable feelings, leading to reduced drug and alcohol use. 14

Some medications mimic the effects of harmful drugs. These medications are used to relieve physical symptoms and reduce cravings during detox. For example, methadone is an opioid drug that is used to treat heroin addiction. It attaches to the same receptors in the brain as heroin and blocks the effect of heroin. However, since methadone is longer-acting, it does not produce a “high.” Methadone maintenance is used to help recovering heroin addicts overcome drug cravings. 15 It is worth noting that since methadone is itself an opioid, methadone maintenance treatment carries a risk of addiction.

Another medication called Subutex (buprenorphine) has a similar mechanism of action as methadone but has a lower risk of addiction. Buprenorphine is used in combination with naloxone (Suboxone) to treat opioid dependence. During detox from opioid drugs, it reduces withdrawal symptoms and helps reduce and stop drug use. 16

Healthcare providers use a variety of medications to manage withdrawal symptoms during detox. For example, anti-epileptic drugs like Tegretol (carbamazepine) may be used for the treatment of seizures (convulsions) and anti-hypertensive medications (beta-blockers) may be used to treat high blood pressure.

Detox During Pregnancy

Pregnant women have every incentive to quit drugs and alcohol for the sake of their unborn child. However, quitting drugs and alcohol cold turkey during pregnancy can be dangerous and may lead to severe fetal distress, preterm labor, and fetal demise. As such, medical supervision is necessary for detox during pregnancy.

The recommendations for the management of pregnant patients with opioid dependence are to avoid detox during pregnancy. However, studies have shown that pregnant patients can be successfully detoxified from opiates without harming the fetus.17 Ultimately, every patient has to be evaluated on an individual basis to assess whether detox is safe during pregnancy.

Risk Factors for Complicated Detox

Some people experience more severe symptoms during detox than others. A few of the risk factors that increase the chances of a complicated detox are listed below:18

  • Age: Older people have more difficult detoxification.
  • Prior detoxifications: Numerous previous attempts at drug withdrawal increase the risk of a complicated detox.
  • Medical conditions: Coexisting health problems can complicate detox.
  • Prior history of seizures or delirium: Patients with seizures or delirium during previous detoxifications are more likely to have complicated withdrawal from drugs and alcohol.
  • Severity of addiction: Individuals with longstanding or heavy drug and alcohol use have more severe symptoms during detox.
  • Polydrug abuse: Simultaneous use of multiple drugs and/or alcohol can make detox more difficult.
  • Psychiatric illness: Co-occurring mental health problems can complicate detox.

However, this doesn’t mean that people with these risk factors cannot quit drugs and alcohol. Even the most severe detox symptoms can be managed with medications and various other techniques.

Coping with Detox

Detox from drugs and alcohol is one of the most challenging periods of addiction recovery. The presence of distressing withdrawal symptoms and severe cravings can lead to relapse. However, there are many things recovering addicts can do to maximize their chances of successful detox.

Nutrition and Hydration. Eating a well-balanced, healthy diet, and hydrating aggressively can help support the body’s natural detoxification abilities as well as counteract some of the common symptoms during detox like nausea, vomiting, and excessive sweating.

Exercise and Meditation: Experts recommend mild to moderate physical activity during detox, if possible. Gentle exercise techniques like yoga in combination with relaxation or meditation techniques can boost mood, reduce anxiety, and help control drug cravings.

Sleep: People going through detox often experience sleep difficulties, such as insomnia. However, it is critical to get adequate rest through the practice of good sleep hygiene. If maintaining a regular sleep schedule does not help, healthcare providers may be able to prescribe sleep aids.

Symptom Management: Detox is associated with various physical and psychological symptoms, for example, nausea, anxiety, etc. Healthcare providers can prescribe medications to manage these symptoms during detoxification.

Social Support: The support of family and friends plays an important role in helping drug users and alcoholics go through detox.

Life After Detox: Recovering from Addiction

Detoxification is the first step in the road to recovery. By itself, detox can help get rid of drugs and alcohol from the body but cannot ensure a successful long-term recovery. People who are struggling to overcome drug or alcohol addiction must understand the importance of detoxification along with the need for psychological therapy to ensure lasting sobriety. There are a variety of programs available to recovering addicts who have successfully completed detox.

Detox Hotline: What to Expect

The decision to finally get help for your drug or alcohol addiction is a brave step in securing a better future for you and your family. While many people are scared or apprehensive about getting help, they are ultimately glad they made the call.

You could call a detox helpline toll free. In many cases, these hotlines are available any time of the day or night. Even if you have some questions or are seeking advice for a loved one, a detox hotline can be helpful.

Some people put off calling a drug and alcohol detox hotline because they aren’t sure what to say. Be assured, you could talk about anything when making the call. If you don’t know what to say, that’s okay. The empathetic hotline staff will help guide the conversation so you could get the information you need.

Some topics commonly addressed during a detox hotline call:

  • Your drug history
  • How drugs have affected you or your family
  • Tips for talking to a loved one about drug use and detoxing
  • Signs and symptoms of addiction or drug dependence
  • Specific information about detoxing from a drug or alcohol
  • What the withdrawal symptoms will be like and how long they will last
  • Ways to medically manage your detox
  • Treatment options for a successful detox
  • Specific resources you can access immediately to get the help you need

You’ve been through a lot. There may even be some things you’re embarrassed about. Sometimes this keeps people from calling a detox and treatment hotline. You shouldn’t be embarrassed. In fact, be proud you’re finally seeking help. Hotline staff won’t belittle you or make you feel bad. They may be the most empathetic, knowledgeable people you could turn to during this difficult time.

Today is the day you can finally start a drug free life. Take the step by calling a drug detox hotline now.

Last updated: September 3, 2020

References

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  2. Institute of Medicine (US) Committee for the Substance Abuse Coverage Study; Gerstein DR, Harwood HJ, editors. Treating Drug Problems: Volume 1: A Study of the Evolution, Effectiveness, and Financing of Public and Private Drug Treatment Systems. Washington (DC): National Academies Press (US); 1990. 4, Defining the Goals of Treatment.Available from: https://www.ncbi.nlm.nih.gov/books/NBK235499/
  3. Center for Substance Abuse Treatment. Detoxification from Alcohol and Other Drugs. Rockville (MD): Substance Abuse and Mental Health Services Administration (US); 1995. (Treatment Improvement Protocol (TIP) Series, No. 19.) Chapter 3—Clinical Detoxification Protocols.Available from: https://www.ncbi.nlm.nih.gov/books/NBK64513/
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  6. Sachdeva A, Choudhary M, Chandra M. Alcohol Withdrawal Syndrome: Benzodiazepines and Beyond. J Clin Diagn Res. 2015;9(9):VE01-VE07. doi:10.7860/JCDR/2015/13407.6538
  7. Substance Abuse and Mental Health Services Administration (SAMHSA). Medication and Counseling Treatment. No date. Available online. https://www.samhsa.gov/medication-assisted-treatment/treatment#medications-used-in-mat Accessed August 30, 2020.
  8. Center for Substance Abuse Treatment. Detoxification and Substance Abuse Treatment. Rockville (MD): Substance Abuse and Mental Health Services Administration (US); 2006. (Treatment Improvement Protocol (TIP) Series, No. 45.) 4 Physical Detoxification Services for Withdrawal from Specific Substances.Available from: https://www.ncbi.nlm.nih.gov/books/NBK64116/
  9. Singh J, Basu D. Ultra-Rapid Opioid Detoxification: Current Status and Controversies. J Postgrad Med [serial online] 2004 [cited 2020 Aug 30];50:227-32. Available from: http://www.jpgmonline.com/text.asp?2004/50/3/227/12584
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  13. Witkiewitz K, Saville K, Hamreus K. Acamprosate for treatment of alcohol dependence: mechanisms, efficacy, and clinical utility. Ther Clin Risk Manag. 2012;8:45-53. doi:10.2147/TCRM.S23184
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