One of the side effects of a substance use disorder, or drug addiction, is a chemical dependency on the substance being abused.
The brain literally relies on the drug to help remain balanced, as regular abuse has led to alterations in the chemical pathways within the central nervous system and brain. The brain therefore no longer works as it once did. If the drugs are then removed suddenly, or as they leave the system, withdrawal symptoms and drug cravings may kick in.
Withdrawal symptoms can include both physical and psychological symptoms, and some may even be life threatening without proper care. Detox is the natural process of the body removing toxins and drugs from the body; however, medical detox supports this process with medical interventions, as needed, and oversight.
Some of the factors that may influence the duration of detox include:
- Polydrug abuse: Use of more than one drug concurrently can extend the withdrawal timeline.
- Level of dependence: More drugs used for longer periods of time generally indicates a higher level of dependence and a more significant withdrawal syndrome.
- Co-occurring medical or mental health conditions: Other medical or mental health issues occurring simultaneously with drug abuse can prolong the withdrawal process.
- Biological or genetic factors: a predisposition to addiction either through biological factors or a family history can impact withdrawal and drug dependence.
- Environmental aspects: Support systems, stress levels, and previous trauma can play a role in the length and severity of withdrawal.
While detox is highly personal, in general, a detox program lasts 5-10 days, depending on the particular circumstances of the individual.
There are a two main settings for detoxification programs: outpatient or inpatient. An outpatient detox program may have individuals come in for sessions once daily for a period of a week or so. This form of detox may work for those suffering from mild to moderate withdrawal symptoms.
Outpatient detox offers flexibility in scheduling. When someone has a strong support system at home with people who are all on board with helping the person to remain compliant, it may be beneficial.
A residential, or inpatient, detox program can range from 5-7 days most of the time (though some programs may last 10 days), depending on the particular needs of the individual. This type of detox is more comprehensive, structured, and supportive. Vital signs can be closely monitored 24 hours a day, seven days a week, and trained professionals can ensure that clients remain safe and are not a danger to themselves or others during this time. There is virtually no potential for a return to drug use during inpatient detox, and temptations can be more easily avoided in this setting. Acute withdrawal symptoms are managed during both forms of detox, which, depending on the drug, typically peak within the first few days and begin to taper off within a week or so.
Medical detox often includes the use of medications to manage withdrawal symptoms and drug cravings for both inpatient and outpatient programs. Particularly for addictions to certain substances of abuse, such as alcohol, benzodiazepines, and opiates, a medical detox program can help to diminish potentially dangerous withdrawal symptoms, often by slowly lowering the amount of drugs in a person’s system instead of stopping them suddenly and risking a fatal outcome.
Admission and First Steps in Detox
Individuals wishing to enroll in a detox program can usually contact the treatment provider directly in order to determine if they have availability in the program. Substance use disorder treatment, which includes detox, is considered to be one of the 10 essential health benefits under the Affordable Care Act, meaning that care is covered by insurance at the same level as other medical or surgical services are covered. In order to obtain insurance coverage for detox, the individual may need to first visit their primary care physician to get a referral for substance abuse treatment services. For many policies, detox must first be deemed “medically necessary,” and often, the chosen detox program is required to be in-network in order for coverage to be provided for the lowest out-of-pocket costs. Insurance companies, and substance use treatment providers, can help families and individuals to sort out their coverage and determine how to use it successfully to cover detox services.
Once admitted to detox, generally speaking, the Substance Abuse and Mental Health Services Administration (SAMHSA) reports that there are three main components of a complete detox program: evaluation, stabilization, and preparation for entrance into a treatment program. An evaluation often includes both a drug screening to determine what substances are currently in the bloodstream, as well as a medical and mental health assessment. The drug screening can help treatment providers to better understand how to proceed with detox, what medications to use or avoid, and which type of program may be best suited for the individual.
Underlying medical or mental health concerns can influence treatment. Mental illness accompanies drug abuse about half of the time, according to the National Alliance on Mental Illness (NAMI), and a dual diagnosis of a mental disorder and a co-occurring substance use disorder needs to be addressed during detox to avoid complications with the withdrawal process. NAMI further reports that inpatient detox for a period of up to a week is generally the optimal option for treating co-occurring mental health and substance use disorders. Once a detailed assessment has been performed, the bulk of a detox program then focuses on helping the individual to safely remove the drug(s) from the body and establishing a level of physical stability before continuing on with a substance abuse treatment program.
The National Institute on Drug Abuse (NIDA) publishes that detox may be an important first step in substance abuse treatment; however, it should not be used as a standalone form of care. Instead, it needs to be followed with a more comprehensive program that likely uses both behavioral therapies and medications. Many substance abuse treatment providers may discharge individuals from detox and enroll them directly into a treatment program. Comprehensive treatment plans may allow for seamless movement between levels of care as the need arises. Substance abuse treatment providers and the professional staff at detox facilities can facilitate the move from detox into a comprehensive treatment program.
Detox, in general, addresses the physical aspects of addiction and substance dependence, and a substance abuse treatment program focuses on the behavioral and psychological ramifications. Behavioral therapies focus on modifying thoughts and emotions that are negative and self-destructive, thereby helping to change potentially harmful actions and behaviors. It is only after a person is physically stable that the emotional side effects of substance abuse can be fully understood and managed. Potential triggers are uncovered and coping strategies for preventing relapse are learned during treatment. Detox is not a “cure” for addiction, but rather an important part of a more complete treatment plan that builds a strong foundation for a sustained recovery.