Substance abuse often leads to physical dependence on alcohol or drugs. This means the person will experience a physical reaction (withdrawal symptoms) if they stop using the drug. At this point, detox is a necessary first step for recovery from addiction.

Detox is the process of purging the body of addictive substances. During detox treatment, professionals help individuals slowly and safely cleanse the body of toxins and provide support for withdrawal symptoms. The goal is to treat the physical side of addiction so the individual can begin a comprehensive treatment plan that addresses the psychological aspects of the substance use disorder.

Medical vs. Outpatient Detox

Detox treatment can occur in a medical detox setting or outpatient detox program. Medical detox takes place under the supervision of a licensed medical team, led by a physician. The team may include nurses, therapists, and other clinical staff. These professionals provide 24/7 supervision and medical treatment during detox. They can prescribe medications to alleviate withdrawal symptoms and curb cravings. They also monitor the individual to ensure no complications arise during the detox process.

An outpatient detox program also helps individuals break free from dependence on substances, but it does not offer 24/hour supervision. During outpatient detox, the person lives at home and visits the detox center at scheduled times. They meet with therapists and support staff for counseling and medical monitoring of their progress. They may also receive prescription medication to treat withdrawal symptoms.

Why Medical Detox?

Withdrawal symptoms can range from mild to severe, depending on how long the person has been using drugs and what type of drugs they use. The fear of going through withdrawal is often one of the main reasons people with substance use disorders don’t get the treatment they need.

However, medical detox is designed to counter these withdrawal symptoms. With round-the-clock care and medical treatment to alleviate symptoms, the process is far more comfortable.

It is also safer. In some cases, withdrawal symptoms can be life-threatening. Seizures, dehydration, and Delirium Tremens (DTs) are some of the symptoms that can be fatal if not treated. Patients may also experience extreme emotional and mental withdrawal symptoms, such as insomnia, mood swings, confusion, paranoia, and depression. Medical detox provides a supervised environment with the right staff and medical resources available to treat these withdrawal symptoms before they become severe or life-threatening.

Medical Detox vs. Quitting “Cold Turkey”

Is it possible to detox on your own? Yes. Some people choose to go “cold turkey” and simply stop using substances without any treatment assistance. However, this can be dangerous and involve discomfort that can be avoided with medical detox.

Withdrawal can cause nausea, aches and pains, headaches, vomiting, and other unpleasant symptoms. While these may not be life-threatening, a medical detox setting can provide treatment to make the process much more comfortable.

More importantly, withdrawal can cause fluctuations in blood pressure, heart rate, and body temperature and can also cause seizures, paranoia, and fatal dehydration. During medical detox, the entire process is supervised by healthcare professionals who monitor vital signs and provide medications to mitigate withdrawal symptoms. Treatment can also be provided to address any co-occurring disorders such as anxiety or depression.

The individual who is detoxing in their bedroom at home does not have these resources available to help them. In short, medical detox is safer.

It can also be more effective for long-term recovery. Individuals who complete medical detox instead of quitting “cold turkey” are more likely to stay in treatment and experience substantial stretches of sobriety.

When is Medical Detox Necessary?

Medical detox is the best choice for individuals who are physically dependent on a substance. This treatment will reduce the risk of withdrawal symptoms that occur when drug use ceases.

To determine if you or a loved one might be physically dependent on a substance and need medical detox, look for the following signs of physical dependence:

Use of a substance over a long period of time
Use of a substance regularly or in large amounts
Tolerance (More and more of the substance must be used to get the same effect.)
Intense cravings for the substance – physical and/or psychological
Psychological symptoms (anxiety/depression) when not using the substance
Inability to quit without help

Pregnant women are also encouraged to choose medical detox treatment. Going “cold turkey” while pregnant can be harmful to both the mom and the baby. Medical detox staff can monitor vital signs of the woman and the child and provide appropriate treatment. This option allows pregnant women to withdraw as safely and comfortably as possible.

Drugs That Require Medical Detox

Withdrawal from certain substances can be more severe than others. If you or a loved one have become physically dependent on the following substances, it is important to receive medical detox treatment to start your recovery journey. This setting will provide the necessary supervision and medical intervention to ensure a safe detox process.

Alcohol

Alcohol consumption affects the central nervous system, which means it inhibits functions such as heart rate, blood pressure, and motor skills. As a result, when a person withdraws from alcohol, they can experience increased heart rate, blood pressure, and body temperature.

In some cases, they may experience Delirium Tremens (DTs). This serious alcohol withdrawal syndrome includes symptoms such as irregular heart rate, hallucinations, tremors, and seizures. Without medically supervised detox, individuals who suffer from DTs experience a 37% fatality rate.¹

Benzodiazepines

Benzodiazepines (benzos) are sedatives prescribed to calm anxiety and panic. Medications such as valium and Xanax fall into this category of drugs. During detox from benzodiazepines, 40-80% of patients experience withdrawal symptoms.²

These substances act as central nervous system depressants, which means they can cause withdrawal symptoms that are similar to the symptoms of alcohol withdrawal. Potentially dangerous symptoms include muscle spasms, tremors, nausea, hallucinations, seizures, and psychosis. Due to the risks involved with these symptoms, medical detox is recommended for individuals who are physically dependent on benzodiazepines.

Opioids

Opioids include substances such as morphine, codeine, heroin, fentanyl, and oxycodone. They are often prescribed as painkillers, and they are abused for the “euphoric” feeling they can stimulate in the brain.

When opioid use ceases or is reduced, the body experiences withdrawal that can feel like a severe flu. Symptoms include muscle aches, vomiting, diarrhea, clammy skin, and anxiety. While these symptoms are typically not life-threatening, untreated vomiting and diarrhea can lead to a fatal level of dehydration. An unsupervised person in withdrawal is also at risk of choking after vomiting, which can be fatal.

During medical detox, physicians can prescribe medications to lessen withdrawal symptoms, curb cravings, and prevent extreme discomfort. Staff also provide 24/7 supervision to prevent fatal accidents.

Stimulants

Stimulants speed up messages between the brain and body, which makes the person feel more energetic, alert, and confident. Common stimulants include cocaine, methamphetamine, MDMA, and prescription amphetamines such as Adderall. Withdrawal symptoms vary based on the drug.

Cocaine withdrawal typically causes more psychological symptoms than physical. The person may feel anxious, depressed, irritable, or paranoid, and they will experience intense cravings for the drug. While these symptoms aren’t life-threatening, they can generate an unsafe mental state. It can be helpful to be in a supportive medical detox environment where doctors can prescribe medications to address mental health-related symptoms and provide appropriate support.

Methamphetamine withdrawal can be more physically dangerous. Symptoms include fatigue, appetite changes, headaches, insomnia, muscle spasms, and psychosis. Individuals withdrawing from meth can become dehydrated and experience extreme hallucinations, anxiety, and paranoia. In a medical detox setting, doctors can monitor the individuals for signs of dehydration and prescribe sedatives to calm their nervous system.

What to Expect During the Medical Detox Process

If you choose medical detox, clinicians will provide a tailored treatment plan that addresses your unique needs. This personalized treatment makes each individual’s detox experience slightly different; however, you can expect the following basic steps:

Evaluation: The medical team completes a comprehensive review of your medical and psychiatric history. This evaluation will allow them to identify any pre-existing medical conditions, substance use disorders, co-occurring disorders, and any other mental health factors that should be considered. They will also perform blood tests to determine the level of substances in your system. After completing this thorough evaluation, the team can create an appropriate treatment plan.
Stabilization: The next phase of medical detox focuses on stabilizing your physical and mental health. The medical team may prescribe addiction treatment medications to reduce withdrawal symptoms and cravings, as well as provide mental health services to address the psychological side of substance dependence.
Addiction Treatment: While medical detox helps you break free from physical dependence on substances, it is only the first step of recovery. It prepares you physically and mentally to enter a comprehensive treatment program that will help you achieve long-term sobriety.

During detox, clinicians will explain treatment options, which include inpatient and outpatient programs. Both offer a combination of therapies and supportive services that address the psychological aspects of addiction. Treatment may include individual and group therapy, support groups, medication to treat addiction, and holistic therapies.

How Long Does Medical Detox Last?

On average, medical detox lasts 7-10 days. However, the length of detox varies based on personal history and the type of substances abused. Typically, the most intense withdrawal symptoms occur during the first week. Psychological effects, such as anxiety and insomnia, can last for weeks or months. If you experience these longer-term symptoms, medical staff may prescribe a combination of therapy and medication to treat them.

Medications Used During Medical Detox

During the evaluation phase of medical detox, staff will determine which medications will be most beneficial to include in your treatment plan. They may prescribe medications to alleviate withdrawal symptoms, curb cravings, or treat co-occurring disorders. Some medication-assisted treatment (MAT) continues after detox to prevent relapse.

The most commonly prescribed medications for medical detox and medication-assisted treatment include methadone, buprenorphine, and naltrexone.

Methadone: Methadone is a long-acting opioid that is prescribed to treat opioid use disorder. It works by attaching to the same brain receptors as other opioids, but it doesn’t create the dramatic highs (and lows) of opioid abuse. This helps block opioid withdrawal symptoms and cravings. It also reduces the effects of other opioids, so people taking methadone have less desire to abuse them. Patients taking methadone can taper off gradually to break free from opioid addiction. Because this drug is an opioid itself, it can also be addictive, so its use is highly regulated. Medical detox centers must be certified to prescribe methadone.
Buprenorphine: Buprenorphine is another long-acting opioid, but it activates brain receptors less strongly than methadone or illicit opioids. This allows the drug to minimize withdrawal symptoms and reduce cravings for individuals who are physically dependent on short-acting opioids such as heroin or oxycodone. Several forms of buprenorphine are available, including injectable and oral forms.
Naltrexone: Naltrexone is an opioid antagonist used to treat opioid and alcohol use disorders. When taken, it blocks opioid receptors so a person using alcohol or drugs does not experience the typical pleasurable feelings associated with the substances. This effectively reduces cravings and discourages substance use. Individuals must be abstinent from opioids or alcohol for one week before taking naltrexone.
Other Prescriptions: In addition to these medication-assisted treatment prescriptions, clinicians may also prescribe a combination of medications to address withdrawal symptoms or co-occurring disorders. These may include anti-psychotics, anti-nausea medication, sleeping pills, antidepressants, and over-the-counter pain medication.

Next Steps

If you or a loved one is struggling with substance abuse, medical detox can be an essential first step in long-term recovery. This treatment offers a safe place to rid your body of addictive substances and prepare your mind and body for further treatment. Most accredited treatment centers offer medical detox as part of their treatment programs.

Resources

Rahman, A., & Paul, M. (2022, August 22). Delirium tremens. NCBI Bookshelf. https://www.ncbi.nlm.nih.gov/books/NBK482134/
Macleod, J. G., & Macdonald, R. M. (1942). Infantile muscular atrophy of spinal origin: A Report of Two Cases. Archives of Disease in Childhood, 17(89), 30–40. https://doi.org/10.1136/adc.17.89.30

Medical Detoxification from Drugs and Alcohol