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 recovery from drug or alcohol addiction. Since alcohol withdrawal is life-threatening when severe, medical alcohol detox is an absolute necessity. Medical drug detox is indicated for all individuals who have shown signs of physical and psychological dependence on a substance.

If you believe that you have a problem with drug or alcohol use, a medical detox program can help you secure a healthier future. The Recovery Village’s medical detox program provides a foundation upon which to build new and healthy habits. No matter where you choose to initiate your recovery path, learning about the characteristics of detoxification programs allows you to find the program that best fits your needs.

What Is Medical Detox?

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

Medical detox refers to ridding the body of toxic addictive substances under the supervision of a team of licensed medical professionals. This team is usually headed by a physician and consists of 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 that a hospital emergency department plays in the management of long-term medical conditions. Similar to an ER visit for an asthma attack, medical detox for addiction provides stabilization for an acute flare-up of a chronic condition, but by itself does not change the long-term course of the condition.

For most people who seek inpatient or residential drug and alcohol treatment, medical detoxification is the first priority, and detox occurs at the beginning of treatment. While detox by itself 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 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. 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 out medical detox treatment when they are at risk of experiencing the effects of withdrawal from drugs or alcohol. Along with tolerance (the need for higher amounts of a drug to achieve a given effect), the presence of withdrawal indicates that the body has become physically dependent on a substance. Each substance has its own 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: In the body, alcohol inhibits the activity of the central nervous system, which has direct control over automated body functions like regulating temperature, heart rate, blood pressure, stress responses and motor movements. Thus, withdrawal from alcohol can cause an elevation in body temperature, increased heart rate, high blood pressure, anxiety and tremors, among other symptoms. 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, called delirium tremens, can be fatal without intervention.
• Benzodiazepines: Sometimes called “benzos” for short, these medications are sedatives used to treat anxiety or unremitting seizures. Benzodiazepines have a similar chemical effect on the body as alcohol and thus have similar withdrawal symptoms. Examples of benzodiazepines include alprazolam (Xanax), lorazepam (Ativan), diazepam (Valium) and clonazepam (Klonopin).
• Opioids: Used for centuries, opioids are medications from the poppy plant that are most often utilized 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 own 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. 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 and vomiting. While opioid withdrawal is not a fatal condition on its own, its symptoms can be extremely uncomfortable
• Prescription Drugs: Many prescription medications can be misused to achieve a high or find relief from 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 all 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.
• Synthetic Drugs: The most infamous synthetic drug is the prescription opioid fentanyl, but many other “designer drugs” like bath salts, krokodil or kratom can create significant withdrawal symptoms that medical detox can successfully address.

What to Expect During Medical Detox

During medical detox, clinical staff helps tailor medical detox care to each person’s needs. To ensure that 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, medical detox can begin.

Medications Used In Detox

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

Some of the medications most commonly used during detox include:

• Methadone: Used to prevent opioid withdrawal since the 1950s, methadone 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 taper off of methadone gradually. Because methadone is an opioid itself, treatment centers which prescribe it to treat opioid use disorder must be federally licensed to do so.
• Naltrexone: Used for both the treatment of opioid and alcohol use disorders, naltrexone acts as a long-acting opioid blocking agent. Because of this action, it can precipitate opioid withdrawal in anyone who has recently used opioids. This potential interaction means that to receive naltrexone during detox, a patient must be abstinent from opioids for a seven-day period.
• Vivitrol: An injectable form of naltrexone, Vivitrol is often utilized during treatment for opioid and alcohol use disorders. While the oral form of naltrexone must be taken daily, the effects of 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.
• Suboxone: Since 2002, Suboxone has been approved for the treatment of opioid use disorder. It is equally effective to methadone in treating withdrawal symptoms. Its active ingredient, 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). Suboxone requires prescribers to undergo one day of training due to its physiology and status as an opioid used in treatment.
• Sublocade: 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 be effective in addressing 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 keep in mind that Sublocade can only be administered to individuals who have already received a stable dose of transmucosal form of Suboxone for a minimum of seven days.

How Long Does Medical Detox Last?

The length and intensity of detox depends on many factors including:

• Type of substance used: The type of substance used will primarily determine 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, physical dependence can develop in as little as six to eight weeks with regular, frequent use.
• Quantity of substance used: Heavier substance use tends to promote faster tolerance as the body must take more drastic measures to acclimate itself to the presence of a large amount of a drug.
• Individual factors: body chemistry, weight, metabolic rate and genetic makeup all help determine the onset of substance withdrawal, and the response of that withdrawal 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 has been shown to be both 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, all of whom have been trained in the treatment and management of 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 detox takes place at a licensed detox facility with medical oversight from experienced and caring staff.

Next Steps After Detox

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

Finding Medical Detox Near Me

When you decide to look for a detox facility, you’ll likely search online for nearby options. 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 per day

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 facility for substance use disorder treatment, has such detoxification services available 24 hours a day. 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 who have co-occurring mental health conditions. 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 process of addiction recovery, The Recovery Village can help you progress toward your sobriety goals. Reach out to an intake coordinator today to get started.

Editor – Megan Hull

Megan Hull is a content specialist who edits, writes and ideates content to help people find recovery. Read more

Medically Reviewed By – Dr. Kevin Wandler, MD

Kevin Wandler holds multiple positions at Advanced Recovery Systems. In addition to being the founding and chief medical director at Advanced Recovery Systems, he is also the medical director at The Recovery Village Ridgefield and at The Recovery Village Palmer Lake. Read more