What Happens During Drug Detox?

Detoxing from drugs or alcohol isn’t simply a case of just saying no. Getting clean is just one step of the recovery process. The substance, the length of use, and the patient’s unique circumstances will determine the best course of rehab.

Last Edited: 04/05/2021

Author: Heidi Bitsoli Heidi Bitsoli

Clinically Reviewed:

04/07/2021

Medical Reviewer:

Dr. Neil Shah

Dr. Neil Shah

When a person with a substance use disorder decides to quit using drugs or alcohol they’ll face a number of decisions, including how they’ll get clean. While some people can stop using cold turkey, most people require detoxification with the supervision of a medical provider to safely wean off of the substance while minimize withdrawal symptoms and cravings. That can better prevent relapse, as can a course of treatment that addresses the underlying issues of an individual’s addiction.

What Is Drug Detox?

Detoxification is the process where a patient gets “clean” from toxins like drugs or alcohol. Depending on the substance, it takes a bit of time for toxins to leave the system, anywhere from several days to a week, and sometimes longer. It may or may not require medical intervention, depending on the substances in question. Detox can follow an overdose — typically landing a patient in the hospital — but for people with substance use disorders (SUD), it’s usually just one step of the recovery process.

Those individuals may choose (and in some situations be compelled to by a third party such as family or a court) to enter a rehab facility and stay sober.

During the detox stage of a person’s recovery, the drug and alcohol rehab center aims to make the process go as safely and as comfortably as possible. That’s because getting clean can be accompanied by some highly unpleasant and sometimes dangerous side effects.

Depending on the severity of the addiction, the condition of the patient, and the substance they’re dependent on, a person may go through outpatient or inpatient treatment. There are cases when a person may be able to go cold turkey, but a majority of the time, a medically-supervised detox is necessary for the safety and comfort of the patient.

Detox does not address the underlying causes of addiction. Instead, detox is focused on stabilizing the patient and reducing withdrawal symptoms and cravings shortly after the substance is stopped.

What Is the Process of Detoxification?

Detoxification has changed a lot over the decades. More than 50 years ago a person who was intoxicated might spend the night (or more) in jail — more commonly referred to the “drunk tank” — as they dried out. Usually there was no medical oversight during this period of sobering up.

Over time, as we began to understand addiction as a chronic disease and one that often requires medical interventions to treat, approaches to detoxification changed substantially. While stigma still persists for addictions, the medical community has begun to view addiction as more of an illness than a moral failing or sign of weakness.

Detox involves three major components:

  • Evaluation. This stage involves testing for substances in the patient’s system as well as screening for or assessing any potential co-occurring mental or physical conditions (which will help shape the treatment plan). The patient’s home and social situation will be analyzed to better determine the best care and recovery plan.
  • Stabilization. This helps the patient through the most intense phases of intoxication and withdrawal. Sometimes medication is involved. Benzodiazepines like lorazepam or ativan, for example, may help temper the withdrawal symptoms brought on by alcohol withdrawal. Sometimes the patient’s employer, family and friends are involved as well, both to inform and prepare all parties on what to expect going forward.
  • Readying the patient for rehab. Once the patient is stable, it’s usually stressed that getting clean is not enough, and that more care is needed, typically in the form of counseling and other services to prepare them for long-term sobriety.

These three steps provide a framework for the detoxification process.

Persons with alcohol, sedative-hypnotic, or opioid disorders, for example, typically get care in a 24-hour setting. That’s because alcohol or benzodiazepine dependence are potentially life-threatening and opioid addictions can be extremely uncomfortable often leading to relapse to reduce the withdrawal symptoms and cravings and continued opioid use.

Other factors that can influence the detoxification process and whether it occurs outpatient or inpatient include unique health issues, any co-occurring conditions like depression or bipolar disorder, cultural or ethnic background, and whether a patient has been in rehab before or experienced complications during rehab.

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Side Effects of Detox

The side effects of withdrawal or detoxification can vary widely.

Sometimes, it can be like experiencing a hangover — which can also range from mild to severe — except a hangover occurs after a single episode of drinking. For withdrawal to set in, chronic use and a dependence must occur.

When a person goes through detox at a medical facility, they will feel uncomfortable, but the priority is to ensure the process is as safe and comfortable as possible.

General withdrawal symptoms include nausea, vomiting, headaches, confusion, anxiety, and depression.

Diarrhea and vomiting can lead to dehydration, an imbalance of electrolytes, and nutritional deficiencies. Nutritional deficiencies are especially problematic, as they can lead to a host of other complications.

Alcohol abuse, for example, can lead to a severe lack of B vitamins, which can cause anemia and nerve damage. Furthermore, alcohol damages a variety of tissues including the liver and brain. Chronic damage to the liver can lead to cirrhosis or end stage liver disease which can be fatal. The liver is responsible for removing toxins from the body. Alcohol can cause the brain tissue to atrophy or shrink resulting in chronic impairment of memory and cognitive abilities. Other organs may be affected too. For example, chronic alcohol use is a common cause of acute pancreatitis, a life-threatening inflammation of the pancreas, an organ responsible for regulating blood sugar and fat absorption.

A balanced diet — part of most rehab programs — is important to recovering good health. Patients are often given IV treatment with nutrients to replenish vitamin and mineral deficiencies resulting from poor diet, particularly with alcohol use.

Medications to ease discomfort and treat underlying conditions also help the patient, both short and long term.

Cold Turkey

Some people opt to quit a substance cold turkey by stopping use immediately. For some people and some drugs, this may work. Quitting tobacco can be tense at times, for example, but it’s not lethal.

Substances like opioids and benzodiazepines — where a habit can set after a few short weeks — or alcohol — especially after heavy and prolonged abuse — are difficult to quit. The withdrawal process can range from highly uncomfortable to life-threatening. This unpleasant stage can cause some people to relapse, resuming use simply to get relief from the withdrawal symptoms and cravings.

Addiction causes changes in the brain, and once the drug’s supply stops, a wide variety of symptoms can occur, including anxiety, nausea, seizures, and irregular heartbeats. Seizures and irregular heartbeats can prove deadly, especially among people with a strong dependence on alcohol, particularly if delirium tremens sets in, symptoms of which also include confusion, shaking, and hallucinations. In such cases, medical supervision and intervention is critical.

What Drugs Cause Withdrawals?

When a body goes through withdrawal the brain is often overstimulated.

In the case of alcohol, for example, which produces a sedating effect, the brain chronically compensates by having a lower threshold to become stimulated. When alcohol is suddenly stopped, this results in over stimulation which can cause a variety of issues including seizures and hallucinations, particularly tactile hallucinations (e.g., the feel that spiders are crawling on you). Other side effects from over stimulation of the brain include anxiety, restlessness, tremors, and insomnia.

Alcohol withdrawal typically sets in 8 to 16 hours after a person’s last drink. Symptoms typically last about a week, often peaking in the 4 or 5th day of withdrawal, but sometimes can drag out longer.

Common alcohol withdrawal symptoms include:

  • Anxiety
  • Perspiration
  • Nausea, vomiting, diarrhea
  • Insomnia
  • Headaches

An estimated one out of every 20 people going through alcohol withdrawal experience delirium tremens. The brain struggles to reset itself after the drinking stops and not only can heart rate or blood pressure go haywire and make a person susceptible to heart attack, stroke, or even death, but along the way a person may experience confusion, hallucinations, and irregular breathing. Because it can be life-threatening, medical help is necessary.

Other drugs and withdrawal side effects include:

  • Benzodiazepines. These include sedatives like Klonopin and Valium. They are often prescribed for anxiety, phobias, or insomnia. After three or four weeks of regular use, a patient may develop a physical dependence. Sudden withdrawal can cause dangerous seizures. Other withdrawal symptoms include headaches, heart palpitations, tremors, aches and pains, confusion (especially in older patients), nausea or diarrhea, and anxiety.
  • Cocaine. The stimulant can cause high blood pressure and heart rate, raised energy levels, elevated body temperature, paranoia, and decreased appetite. Withdrawal can begin hours after the most recent use, especially for crack. Withdrawal symptoms typically last three to four days and include sleeplessness and restless sleep, increased appetite, depression, paranoia, and plummeting energy.
  • Methamphetamines. The stimulant causes wakefulness, decreased appetite, and elevated blood pressure and body temperature. Withdrawal-goers experience anxiety, depression, psychosis, strong cravings, and fatigue. They tend to be worst for the first 24 hours after last use, but uncomfortable phases may follow. The longer a person uses methamphetamines, the longer it may take to recover.
  • Opioids. Includes narcotic pain relievers like Oxydocone and Hydrocodone, but also opiates like codeine and heroin. It has sedative, analgesic, and euphoric effects. Intoxication includes drowsiness, “nodding,” and a euphoric high. Withdrawal begins about 24 hours after the last use, and can go on for up to seven days. Withdrawal is characterized by anxiety, muscle aches, vomiting, nausea, diarrhea, gooseflesh, runny nose, and yawning.

Detox & Tapering

Tapering occurs when a person gradually uses less of a substance, so they adjust to smaller and smaller doses with less discomfort. It’s also referred to more informally as weaning. A patient should be stable before tapering begins.

Not all substances require tapering, but for benzodiazepines and opioids it can be especially helpful.

Sometimes people taper off alcohol as well, drinking smaller amounts until they adjust to abstinence. Medications like benzodiazepines can help with alcohol withdrawal anxiety. Because such anti-anxiety medications can turn habit-forming, patients should be monitored regularly. Dosages may be tapered down as well as the patient adapts to sobriety and learns to manage cravings and anxiety.

Rapid Detox

Some people may hope to get clean quickly, and a rapid detox may hold appeal.

There are outpatient clinics which offer anesthesia-assisted rapid opiate detoxification. That’s where the patient is put under and given high doses of opioid antagonists like naloxone or naltrexone. The procedure has garnered a fair amount of controversy in the wake of several deaths, cardiac events, and other complications.

Medical experts generally advise against rapid detoxes for a number of reasons:

  • It can be expensive (in the range of thousands of dollars)
  • It does not address underlying issues
  • There is not enough evidence to suggest it works
  • It has been shown to carry a number of health risks
  • It does not prevent withdrawal

Can I Detox At Home?

With the internet readily accessible, just about anyone can find a home detox kit, either online or near one’s home.

Some individuals do attempt to detox at home. Most of the time these products claim they can get people “clean” for an upcoming drug test. They may also tout liver-purifying benefits.

Such concoctions are not approved by the U.S. Food and Drug Administration.

If the product in question has laxative or diuretic effects, all a person is likely to lose is the contents of their colon or their bladder. If it’s a combination of supplements, then those risk interfering with prescription medications. If it’s a cocktail of juices, it may offer a dose of vitamins and minerals, at best.

For someone with a physical or psychological dependence on drugs, detoxing is best done under medical supervision.

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Medicine During Drug Detox

Drug addiction can take the form of a physical or psychological dependence. Medications can help with both, particularly in the detox phase of recovery.

Alcohol

For a person with alcohol addiction, severe cases may require hospitalization to monitor vital signs and stabilize the patient. Medications may help, too, including:

  • Benzodiazepines to cut the anxieties of withdrawal.
  • Anticonvulsants to help with seizures
  • Anti-nausea drugs to settle the stomach.
  • After the acute detoxification phase, acamprosate may help stabilize brain chemistry as a person gives up alcohol (usually combined with psychotherapy or similar treatment)
  • Also after the acute detoxification phase, some medicines, like disulfiram, cause uncomfortable side effects if a person drinks while taking them.

If alcohol has led to other complications — medical issues like diabetes or hypertension, or mental disorders like depression or anxiety — other medications or therapies may be prescribed at the same time.

Stimulants

When a person is quitting stimulants like cocaine or methamphetamines, they may be given antidepressants and benzodiazepines to curb any resulting depression or anxiety. Antipsychotics may be prescribed as well, especially for persons with longer histories of stimulant abuse.

Benzodiazepines

Even though benzodiazepines are frequently prescribed for anxiety, including for stopping stimulant or alcohol abuse, these sedatives and tranquilizers can be highly addictive. Even a few weeks of use can lead to dependence. Going cold turkey is not safe, so three approaches are commonly taken:

  • The first is to gradually taper the dosage to wean the patient off benzodiazepines. The amount will vary by patient, which can go on for several weeks or several months.
  • The second option is to switch to a different kind of benzodiazepine. A shorter-acting one, like alprazolam (Xanax), can give patients a rebound effect between doses. That’s where they may either experience a return of their previous anxiety, or it can grow worse. An alternative is a longer-acting benzodiazepine like diazepam (Valium).
  • A third option is to continue with the original drug but supplement with other medications to reduce withdrawal.

Opioids

Benzodiazepines may be given to help treat a number of SUDs, but it’s not advised with opioids. Because both are sedatives and affect the central nervous system (particularly, by suppressing breathing), mixing the two can make what amounts to literally a breath-taking cocktail.

Treating opioid addiction is in a way like fighting fire with fire. That’s because opioids are sometimes prescribed to treat withdrawal symptoms. Long-term opioid use affects the brain so its receptors adapt to and then become dependent on the drug. In time, greater amounts are needed for the same effect. That increases the chances of overdosing. It also scrambles pain signals. The patient may be taking more opioids for pain management, but not for the original injury. Rather, they’re dosing to stop withdrawal.

For stronger addictions, hospitalization may be required, but a few prescription options exist to reduce cravings and negative effects of withdrawal.

Maintenance medications come in the form of opioid agonists and partial agonists.

Methadone is an opioid agonist that stops withdrawal symptoms as it relieves cravings. It acts on opioid receptors in the brain, but without producing the euphoria other opioids provide.

Buprenorphine is a partial opioid agonist. It also attaches to opioid receptors, but the effect is reduced. It also can help with cravings and withdrawal, also without the high.

One other option for opioid addiction are antagonist drugs. Naltrexone, for example, prevents the opioid receptors from switching on. If a person takes an opioid drug in search of a high, the antagonist will block that from happening.

Buprenorphine is typically combined with naltrexone to form suboxone. Suboxone helps reduce cravings and withdrawals because it contains buprenorphine but it also reduces the possibility of being abused by people who take high doses of it because it has naltrexone.

Life After Detox

Detox Is just one stage of the recovery process. It’s an important one, because it helps get the patient free of toxins and stabilizes them.

It is, however, not necessarily a cure for persons with SUDs. Once they are “clean,” the next best steps for lasting sobriety usually involve working on the issues that led to substance use in the first place.

Sources

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  2. uofmhealth.org – Science Says: Addiction Is a Chronic Disease, Not a Moral Failing
  3. samhsa.gov – Detoxification and Substance Abuse Treatment: A Treatment Improvement Protocol
  4. healthline.com – Withdrawing from Opiates and Opioids
  5. kaiserpermanente.org – Alcohol and Drug Withdrawal
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  8. nih.gov – Delirium Tremens
  9. health.harvard.edu – Alcohol Withdrawal
  10. nih.gov – Management of benzodiazepine misuse and dependence
  11. drugabuse.gov – Commonly Abused Drugs and Withdrawal Symptoms
  12. drugabuse.gov – What is methamphetamine?
  13. medlineplus.gov – Opiate and opioid withdrawal
  14. hhs.gov – Guide for Clinicians on the Appropriate Dosage Reduction or Discontinuation of Long-Term Opioid
  15. cdc.gov – Deaths and Severe Adverse Events Associated with Anesthesia-Assisted Rapid Opioid Detoxification — New York City, 2012
  16. jamanetwork.com– Anesthesia-Assisted vs. Buprenorphine- or Clonidine-Assisted Heroin Detoxification and Naltrexone Induction: A Randomized Trial
  17. nih.gov – Anticonvulsants for the Treatment of Alcohol Withdrawal Syndrome and Alcohol Use Disorders
  18. medlineplus.gov – Disulfiram
  19. aafp.org – Tapering Patients Off of Benzodiazepines
  20. drugabuse.gov – Benzodiazepines and Opioids
  21. drugabuse.gov – Opioid Agonists and Partial Agonists (Maintenance Medications)

Medical disclaimer:

Sunshine Behavioral Health strives to help people who are facing substance abuse, addiction, mental health disorders, or a combination of these conditions. It does this by providing compassionate care and evidence-based content that addresses health, treatment, and recovery.

Licensed medical professionals review material we publish on our site. The material is not a substitute for qualified medical diagnoses, treatment, or advice. It should not be used to replace the suggestions of your personal physician or other health care professionals.

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