Drug And Alcohol Detox: What To Expect

The choice to begin recovery from alcohol or drug abuse is a life-changing one. For all of the positives that this choice can bring, it can also be daunting.

Learning what to be prepared for can alleviate some of the fear about beginning addiction treatment and give you or your loved one insight into the process of embarking on the recovery journey.

For some people, the first step following a drug or alcohol abuse assessment is detoxification.

What Is Detoxification In Substance Abuse Care?

Detoxification can be defined as a period where a person abstains from drug or alcohol use so that the substance leaves the body.

Detox programs typically involve stabilization and preparation for treatment. This follows being assessed and screened for substance use disorders (SUDs) and other mental health conditions.

Detox services may be provided through an outpatient or inpatient treatment program, depending upon the severity of the addiction and the type of substance used.

Since detoxification from certain substances, such as benzodiazepines or alcohol, can be dangerous, it is often imperative that people have immediate access to medical care.

Different Types Of Detox Services

It’s important to know the different types of drug and alcohol detox and the settings that are available to you.

However, it is always recommended to speak with a medical professional to determine the best course of action before beginning any treatment.

Inpatient Detox Vs. Outpatient Detox

Inpatient detox, or residential detoxification, consists of going through the detox process in an inpatient setting.

Clients of inpatient programs live onsite for the duration of their treatment and typically have more severe SUDs.

Due to the setting, 24/7 care is usually available, with medical professionals such as nurses or doctors standing by, though this isn’t always the case.

Outpatient programs, including outpatient detox services, are for people who have mild to moderate drug addictions. Clients go to the center for treatment and sleep at home.

They may return to the center occasionally for monitoring but because they still live at home, more flexibility is available schedule-wise.

Sub-Acute Detox Vs. Acute Detox

The word “sub” typically denotes something that is partial or less, and the word “acute” in the medical field describes a severe, immediate onset of a disease that can be life-threatening.

Sub-acute detox refers to detoxification for less severe cases of SUDs. This includes people who are using substances that may produce milder withdrawal symptoms or people in better overall health.

Sub-acute detoxification is often done in an outpatient setting, with a doctor or other healthcare provider overseeing the process and administering any medications if appropriate.

Acute detoxification signifies a more severe addiction, which can also be due to the type of substance the person is withdrawing from.

For example, alcohol withdrawal can cause a number of serious side effects and health complications, including seizures and hallucinations or even death.

Because of this, acute detox is often best done in an inpatient setting where 24/7 medical care is provided to help ensure the person’s health and safety.

Social Detox Vs. Medical Detox

Medical detox is detoxification overseen by a licensed medical team, often consisting of a board-certified physician, nurses, and other clinical staff. It is the most recommended form of detox.

Social detox is when non-medically licensed staff help support clients through the detoxification process. If there is a medical emergency, they call for emergency medical aid.

How Do I Know If I Need To Detox?

Many people are unsure whether they require detoxification before beginning treatment for drug or alcohol abuse.

An assessment at a treatment center can help you determine the best way forward.

However, if you answer “yes” to the following questions, you may require detox:

• Do you notice a need to use more and more of the substance to achieve the same feeling as before?
• Do you have cravings for the substance and spend a lot of time thinking about using it?
• Do you spend more time using the substance than before?
• Have you tried to stop using the substance to no avail?
• Do you get withdrawal symptoms, physically, mentally, or emotionally?
• Do you have health issues that may be impacted by alcohol or drug use?

These are just some indicators of a substance use disorder and the possible need to detox.

Alcohol And Drug Detox Preparation

If the treatment center where you received your assessment doesn’t provide all of the services you require, including detox services, your next step is to find one that does.

When selecting a rehab center or detox center, keep in mind whether or not it treats your type of addiction and accepts your health insurance or offers another acceptable payment option.

If you are seeking inpatient care, ask what you are allowed to bring, which may include clothing, a notebook, prescription medication, spending money, and alcohol-free personal hygiene products.

You will also want to consider any family needs that will require attending to while you’re in treatment, including those of pets.

Making arrangements with school or work may also be required.

Drug And Alcohol Detoxification Process

The exact detox process will vary depending on the person, including the substance they are using, how long substance abuse has occurred, co-occurring health conditions, and more.

Substance Abuse Assessment

Many rehab centers provide free drug and alcohol assessments. Tests may be run to determine the amount of substance in your or your loved one’s system.

Assessments may also include physical and mental health screenings, to help determine whether co-occurring disorders or other medical conditions exist that may require specialized treatment.

From there, a treatment plan is created, customized to your individual needs.

Medication-Assisted Treatment (MAT)

Medication-assisted treatment is an evidence-based treatment methodology that uses medications in order to help ease withdrawal symptoms, hinder euphoric effects, and reduce cravings for substances.

It is intended to be paired with behavioral health treatment, such as group therapy, cognitive behavioral therapy (CBT), and other approaches, to foster long-term sobriety.

MAT can be used in both inpatient and outpatient treatment settings.

According to the Substance Abuse and Mental Health Services Administration (SAMHSA), MAT has been shown to improve retention to treatment and survival rates, allow for greater function, produce safer birth outcomes, and decrease criminal activity.

MAT Medications For Opioid Use Disorder (OUD)

Medications used for OUD include buprenorphine, naltrexone (Vivitrol), and methadone. They help block euphoria, reduce cravings, and decrease the severity of withdrawal symptoms.

MAT Medications For Alcohol Use Disorder (AUD)

Acamprosate (Campral), naltrexone, and disulfiram (Antabuse) may be used for the treatment of alcohol use disorders that are moderate or severe.

Naltrexone and acamprosate help reduce cravings, and disulfiram acts by making alcohol consumption uncomfortable.

Disulfiram is not typically used in detoxification, but in some cases may be used after detox in alcohol rehab programs and aftercare services to help people avoid alcohol.

Tapering

In some cases, a person may need to taper, or slowly decrease, their substance use. This is done to lessen the severity of withdrawal symptoms and help people safely withdraw.

Tapering may be required if a person has become physically dependent upon a substance. MAT may be useful for some people during the tapering process.

Tapering is contraindicated for individuals who are abusing or taking multiple drugs or medications.

Substances Of Abuse Involved In Detoxing

Though symptoms of withdrawal can be similar among different SUDs, their intensity can vary and, in some cases, even be life-threatening.

Alcohol Detoxification

Alcohol withdrawal may cause symptoms that are often referred to as alcohol withdrawal syndrome (AWS).

Symptoms of alcohol withdrawal can include:

• nausea
• vomiting
• headaches
• tremors
• confusion
• fatigue
• emotional upset
• sweating
• high blood pressure
• agitation
• nightmares

Delirium tremens (DT), the most serious form of AWS, may involve hallucinations, seizures, high temperature, agitation, disorientation, and possible death.

Because alcohol detox has the potential to be very dangerous, it is often recommended that people with severe AUD only stop using alcohol under medical supervision.

MAT using acamprosate, naltrexone, or other medications may be available to address alcohol withdrawal symptoms.

Opioid Detoxification

Opioid withdrawal can be very uncomfortable physically and even dangerous in some cases, with medical detox recommended.

Opioid withdrawal symptoms include:

• sweating
• chills
• nausea
• vomiting
• high blood pressure
• increased heart rate
• mood swings
• anxiety
• insomnia
• diarrhea
• body aches

The amount of time it takes to detox from opioids varies. For example, it takes less time to detox from short-acting (immediate-release) opioids than long-acting (controlled-release) opioids.

Stimulant Detoxification

Stimulant drugs include methamphetamine, cocaine, and prescription stimulants such as Ritalin and Adderall.

Stimulants can be very addictive and produce a very uncomfortable withdrawal. Medical detox may be recommended.

Stimulant withdrawal symptoms include:

• dehydration
• chills
• anxiety
• agitation
• movement issues
• nightmares
• delusions
• fatigue
• memory impairment
• depression

Stimulant detoxification can affect emotions and motor control and bring about depression and suicidal ideation.

Depressants And Sedative Detoxification

Depressants and sedatives include a wide variety of substances, such as ketamine, tranquilizers, barbiturates, antipsychotics such as Seroquel, and benzodiazepines such as Xanax and Valium (diazepam).

Depressant withdrawal symptoms include:

• depression
• insomnia
• fatigue
• anxiety
• breathing difficulty
• headaches
• hallucinations
• tremors
• diarrhea
• body aches
• lack of appetite
• dizziness
• nightmares
• seizures
• psychosis
• coma

Depressants such as benzodiazepines can cause especially dangerous withdrawal symptoms and may involve lengthy withdrawal periods.

Due to these risks, medical detox is advised for people with benzo addictions. Tapering is often recommended, and a medical team can provide a personalized tapering schedule.

The length of the withdrawal process will be affected by the type of benzodiazepine (short- or long-acting), the dose, and how it is metabolized in the body as well as by any co-occurring health conditions.

Alcohol And Drug Detox Considerations For Special Groups

Certain groups have specific considerations when it comes to the detoxification process. It is even more critical that they speak with a doctor before receiving any form of treatment.

Detoxing During Pregnancy

Detoxification during pregnancy may not be recommended due to the stress that the process can cause for the parent and unborn child.

Medical detox, with 24/7 medical care available, is always recommended for pregnant people who are able to detox. MAT may be recommended to address withdrawal symptoms.

Though using MAT comes with a risk that the baby will develop neonatal abstinence syndrome (NAS), the risk is much higher with continued substance use.

Continued substance use also comes with the risk of cognitive disorders, premature birth, stillbirth, miscarriage, and health conditions such as fetal alcohol spectrum disorders (FASDs).

Detoxing For Older Adults

Because many older adults experiencing addiction also deal with other health issues that require medications, there is a greater risk of polypharmacy when using MAT for this population.

Polypharmacy is defined as the use of multiple medications, usually five or more, to treat health conditions.

With polypharmacy, it can be difficult to know if a symptom is being caused by a health condition or a medication.

Furthermore, adding other substances to the mix, along with the slowed metabolism that comes naturally with aging, can greatly increase the chance of overdose or other health issues.

Loved ones may be able to go with an aging adult to a doctor’s appointment to discuss detoxification options and help determine the best course of care.

Detoxing For People With Other Health Conditions

As with older adults, other people with multiple health conditions such as chronic illnesses often take more than one medication.

Health issues such as diabetes, Crohn’s disease, or cardiovascular disease can increase the risk of complications, even death, during the detox process.

Furthermore, addiction can cause damage to the liver and kidneys, further complicating detoxification.

Next Steps After Drug And Alcohol Detoxification

Long-term recovery from addiction may often begin with detoxification, but it very seldom ends there.

Enrolling in a drug or alcohol treatment program following detox is recommended to get at the roots of addiction and help change critical thought and behavioral patterns.

One reason why treatment is so important is because detoxing from a substance lowers your tolerance level for that substance significantly, so relapse can put you at risk for overdose.

Behavioral health treatment options may include:

• individual, group, and family counseling
• peer support and mentoring
• holistic wellness options
• psychoeducation
• life skills education
• aftercare

Aftercare may consist of sober living housing, continuation of therapy, alumni programs, employment assistance, and other forms of support to help reduce the risk of relapse.

Find Help For Addiction Today

Detoxification can be safe and effective with the right support, and with the right help, long-term sobriety can become a reality. Contact us today, find a treatment provider, and get started.