Medical Detoxification from Drugs or Alcohol

Understand what medical detoxification does, how it works and what to expect during detox.

Medical detoxification, or medical detox, is an essential first step in drug or alcohol addiction recovery. Since alcohol withdrawal is life-threatening when severe, medical alcohol detox is necessary. Medical drug detox is indicated for those with physical and psychological signs of substance dependence.

If you believe you have a drug or alcohol use problem, a medical detox program can help you secure a healthier future. The Recovery Village’s medical detox program provides a foundation for building new and healthy habits. Wherever you initiate your recovery, learning the characteristics of detoxification programs allows you to find the program that best fits your needs.

What Is Medical Detox?

You may hear the word “detox” used in a familiar way to describe cleansing the body of unhealthy food. But what is medical detox, and how is it different than our usual understanding of the term?

Medical detox refers to ridding the body of toxic, addictive substances under the supervision of a licensed medical professional team. This team is usually headed by a physician and comprises nurses, clinical staff and therapists. Some facilities utilize advanced practice staff like nurse practitioners or physician assistants to deliver medical care during detoxification.

Like diabetes, asthma or rheumatoid arthritis, addiction is a chronic condition that flares up occasionally but can be managed. Medical detoxification plays a similar role in addiction to a hospital emergency department in managing long-term medical conditions. Like an ER visit for an asthma attack, medical detox for addiction stabilizes an acute flare-up of a chronic disease but does not change its long-term course.

For most people seeking inpatient or residential drug and alcohol treatment, medical detoxification is the priority and occurs at the beginning of treatment. While medical detox alone is not considered addiction treatment, those who complete medical detox are more likely to stay in treatment longer and have longer stretches of sobriety.

When Medical Detox Is Necessary

So if addiction is a chronic condition, how do you know when an acute treatment like a medical detox is necessary? How do you know who needs medical detox?

Individuals with addictions who believe they are at risk of being physically dependent on a substance are candidates for medical detox. The physical dependence on a substance is most likely if you have:

• Been using a substance regularly in large amounts
• Used a substance over an extended period
• Experienced a diminished effect over time from using the same amount of a substance
• Required increasing amounts of a substance to achieve the usual effect
• Craved a substance regularly when you do not have access to it
• Tried to quit using a substance and found that you could not do so without help

Individuals with substance use disorders most commonly seek medical detox treatment when they risk experiencing withdrawal symptoms from drugs or alcohol. Along with tolerance (the need for higher amounts of a drug to achieve a given effect), withdrawal indicates that the body has become physically dependent on a substance. Each substance has its characteristic pattern of withdrawal symptoms caused by chemical effects within the body that are produced when consumption of the substance is reduced or stopped altogether.

Drugs Requiring Medically Assisted Detox

Becoming addicted to any of the following substances requires evaluation and treatment for potential withdrawal symptoms:

Alcohol

Alcohol prevents central nervous system activity in the body, which directly controls automated body functions like regulating temperature, heart rate, blood pressure, stress responses and motor movements. 

Thus, withdrawal from alcohol can cause symptoms including:

• Elevated body temperature
• Increased heart rate
• High blood pressure
• Anxiety 
• Tremors
• Nausea or vomiting
• Hallucinations
• Seizures

In its most severe form, withdrawal from alcohol can be life-threatening, and symptoms can include seizures and hallucinations. The most dangerous form of alcohol withdrawal, delirium tremens, can be fatal without intervention.

Benzodiazepines

Benzodiazepines are central nervous system depressants sometimes prescribed for anxiety, seizures or sleep problems. This means your brain must work harder, making more excitatory neurotransmitters to keep you awake and rev you up. However, if you take them regularly and suddenly quit without close medical supervision, your brain keeps making the same amount of excitatory neurotransmitters, causing dangerous withdrawal symptoms, including:

• Sweating 
• Agitation
• Anxiety
• Rapid heart rate
• Hand tremors
• Trouble sleeping
• Nausea or vomiting
• Hallucinations
• Agitation
• Anxiety
• Seizures

Seizures from benzodiazepine withdrawal can be dangerous and potentially deadly without medical assistance.

Opioids

Opioids are medications from the poppy plant which have been used for centuries to treat pain. Opiates refer to the direct derivatives from the plant, such as morphine, heroin and codeine. Opioids refer to synthetic drugs with a similar action to opiates, such as oxycodone or hydromorphone. Since opioids mimic the body’s natural opioids (“endorphins”), regular intake of opioids leads to the shutdown of endorphin production, making the body reliant on the effects of the external opioids. 

The absence of these opioids creates withdrawal symptoms that are often compared to having the flu and may include:

• Cold and clammy skin
• Muscle aches
• Anxiety
• Nausea 
• Vomiting

While opioid withdrawal is not a fatal condition alone, its symptoms can be extremely uncomfortable.

Prescription Drugs

Many prescription medications can be misused to achieve a high or relieve stress. In addition to benzodiazepines and opioids, prescription drugs like muscle relaxants, sleeping medications, gabapentin and other medications can be used in a medically unintended way. Each type of prescription drug may have a relatively unique withdrawal syndrome, but gabapentin, muscle relaxants and sleeping medications work somewhat similarly to alcohol and benzodiazepines as central nervous system depressants.

Stimulants

Non-prescription stimulants include cocaine, methamphetamine and MDMA. Though stimulants do not create physically life-threatening withdrawal symptoms, many of the symptoms of stimulant withdrawal often mimic severe depression. Nonetheless, stimulant withdrawal usually requires medically assisted detox due to the risk of relapse. Unlike with many other substances, there is no medication-assisted treatment (MAT) for stimulant use, meaning that intensive medical care, detox and rehab are all the more important to help you stay off the drug.

Synthetic Drugs

The most infamous synthetic drug is the prescription opioid fentanyl. Still, many other “designer drugs” like bath salts, krokodil or kratom can also create significant withdrawal symptoms that medical detox can successfully address. Because little is known about designer drugs, which can differ widely in their ingredients, withdrawal experiences can be unpredictable. For this reason, withdrawing from synthetic drugs while in medical detox is safest to ensure unexpected withdrawal symptoms can be addressed immediately.

What To Expect During Medical Detox

A clinical staff helps tailor care to each person’s needs during medical detox. To ensure these needs are met, clients undergo comprehensive evaluations, where clinicians screen for:

• Drug and alcohol use disorders
• Co-occurring disorders
• Medical conditions
• Contributing psychological factors
• Risk for withdrawal

After evaluation, your team will design a customized treatment plan, which may consist of medications to ease withdrawal symptoms. For example, acetaminophen may be prescribed if you have muscle aches. If withdrawing from opioids, your team may prescribe a buprenorphine-based product like Suboxone.

How long the medical detox lasts depends on your withdrawal symptoms, medical history and substance use. The process is individualized, and some people require less time in medical detox than others. For example, the average length of alcohol detox ranges from two to eight days. However, an opioid detox can last much longer, sometimes from 0–120 days.

Medications Used In Detox

During detox, using addiction medications to alleviate withdrawal symptoms or decrease cravings can be helpful for some clients. However, it’s important to remember that these medications are administered on a patient-by-patient basis under the clearance of a medical professional.

Some medications most commonly used during medical detox include:

Methadone

Methadone has been used to prevent opioid withdrawal since the 1950s and has been a mainstay of addiction treatment. It is a fully activated opioid and has all of the risks of an opioid; however, when well monitored, methadone detox is highly effective at preventing opioid withdrawal symptoms. Patients can taper off methadone gradually. Because methadone is an opioid itself, treatment centers must be federally licensed to prescribe it to treat opioid use disorder.

Naltrexone

Naltrexone is used for treating opioid and alcohol use disorders. It acts as a long-acting opioid-blocking agent and can precipitate opioid withdrawal in anyone recently using opioids. This potential interaction means that to receive naltrexone during medical detox, a patient must abstain from opioids for 70 days. 

An injectable form of naltrexone, Vivitrol is often utilized during opioid treatment and alcohol use disorders. While the oral form of naltrexone must be taken daily, the effects of a single injection of Vivitrol can last for one month. Clients can only receive Vivitrol after abstaining from opioid or alcohol use for a minimum of 7–10 days.

Buprenorphine

Multiple buprenorphine products are available to help you in rehab. Buprenorphine is a partial activator of the opioid receptor and thus carries less addiction and overdose risk than methadone (though the risk is not zero). Since 2002, Suboxone has been approved for treating opioid use disorder. It is equally effective as methadone in treating withdrawal symptoms. 

One of the newest addiction treatment medications available today, Sublocade is a long-acting injectable form of buprenorphine. While oral forms of buprenorphine (Suboxone) can effectively address withdrawal symptoms, they also carry the potential for abuse. Sublocade’s method of administration helps limit the risk of abuse. However, it’s important to remember that Sublocade can only be administered to individuals who have already received a stable dose of a transmucosal form of Suboxone for a minimum of seven days.

How Long Does Medical Detox Last?

The length and intensity of detox depend on many factors, including:

• Type of substance used: The substance used primarily determines what the withdrawal syndrome will look like. Alcohol withdrawal, for instance, can be experienced in just a few hours after the last drink and may require a taper of substitute medication that lasts several days.
• Duration and frequency of use: The longer an individual has used a substance, the more likely there will be effects of physical dependence. Similarly, the more frequently an individual uses, the more likely physical reliance on a substance will develop. For drugs like benzodiazepines and opioids, a physical dependence can develop in as little as six to eight weeks with regular, frequent use.
• Quantity of substance used: Heavier substance use promotes faster tolerance as the body must take more drastic measures to acclimate itself to a large amount of a drug.
• Individual factors: Body chemistry, weight, metabolic rate and genetic makeup help determine the onset of substance withdrawal and its response to treatment.

In most cases, medical detox lasts for five to seven days.

Is Medical Detox Safe?

When a person experiences substance withdrawal, medical detox is safe and effective for eliminating substances from the body. Each step of the process is supervised by a physician-led medical team of experienced nurses and clinical staff trained in treating and managing addiction. For many substances, withdrawal can cause fluctuations in heart rate, blood pressure and temperature, so these vital signs are closely monitored by nursing staff. A safe medical detox occurs at a licensed facility with medical oversight from experienced and caring staff.

Next Steps After Detox

Effective drug and alcohol rehabilitation addresses addiction’s physical and psychological aspects. Medical detox addresses addiction’s physical consequences; thus, it can not alter the natural course of addiction. Medical detox is most effective as a component of a larger treatment program that addresses addiction’s underlying emotional, spiritual and behavioral causes. Patients in medical detox usually transition immediately to residential or partial hospitalization treatment.

Finding Medical Detox Near Me

You’ll likely search online for nearby options when looking for a medical detox facility. But then what? How will you know which program to choose? How do you find a reputable medical detox center?

Medical detoxification centers should:

• Be fully licensed and accredited by the state in which the center is located
• Have a team of professional, experienced staff who can respond to medical needs
• Provide access to treatment 24 hours daily

Medical Detox Programs at The Recovery Village

Most clients who come into treatment for drug- and alcohol-related conditions will need supervised medical detoxification. The Recovery Village, a full-service substance use disorder treatment facility, provides medical detoxification services 24 hours daily. The Recovery Village medical detox also offers 24-hour nursing care and is equipped to handle complex detoxification, including clients who use multiple drugs or have co-occurring mental health conditions. Medical detoxification services are individualized to each client’s needs.

Recovery is within your reach. Whether you have struggled with dependence on opioids, alcohol or other drugs, The Recovery Village can help jumpstart your sobriety efforts. With medical detox as the first step in a longer addiction recovery process, The Recovery Village can help you progress toward your sobriety goals. Reach out to a Recovery Advocate today to get started.

Editor – Theresa Valenzky

Theresa Valenzky graduated from the University of Akron with a Bachelor of Arts in News/Mass Media Communication and a certificate in psychology. She is passionate about providing genuine information to encourage and guide healing in all aspects of life. Read more

Medically Reviewed By – Dr. Jessica Pyhtila, PharmD

Dr. Jessica Pyhtila is a Clinical Pharmacy Specialist based in Baltimore, Maryland with practice sites in inpatient palliative care and outpatient primary care at the Department of Veteran Affairs. Read more