Do I need detox? When detox is necessary

The admission to ourselves that we need help and are willing to go to any lengths to get it is a monumental moment in the lives of recovering people. What often follows is the discussion regarding the next right step to take. For many it will require a safe, effective detox to begin the rest of the work that is required for a full and thriving recovery.

What Is Detox?

For many with an alcohol or a substance use disorder breaking the cycle of using is a daunting effort. Detoxification is simply the process the body goes through as it rids itself of the chemicals and toxins produced by our substances of choice in the case of addiction. As the body begins to rid itself of the toxins produced by the substances that have become a dependency one can expect to experience some unpleasant possible side effects. The body is constantly in a state of detoxing when it comes to many things that we ingest but with addiction it can be a particularly dangerous process. This is especially true of opioids, benzodiazepines, and alcohol. 

Dangers of Detoxing Alone:

Many who struggle with addiction believe they can detox alone doing a “cold turkey” approach, or a sudden stop. Sequestering themselves alone at home or in a hotel room for a period of a few days they believe they can “white knuckle” their way safely into recovery. These attempts are most often unsuccessful but more so considerably dangerous. Especially depending on the level of physical dependency and the nature of the substance from which one is trying to detox. A hard stop approach to detox can be complicated by the following:

• Pre-existing medical issues
• DTs (Delirium Tremens)
• Stroke
• Seizures
• Hallucinations

It is also worth noting that failed attempts at detoxing alone can lead to eventual subsequent overdoses as those who are experiencing the unpleasant effects of detox tend to overuse as a response to these unwanted symptoms.

Symptoms that Indicate Detox is Necessary:

When someone enters inpatient treatment, it is a required part of the protocol to spend five to seven days in detox at most facilities. Many patients feel they don’t require detox or have a low-level dependency however most reputable treatment facilities will require a stay in detox as a matter of safety. Since the treatment professionals have no way of gauging the level of one’s dependency or potential reaction to withdrawal it is simply a matter of caution and a matter of avoiding any liability for neglect by the providers of treatment.

A patient experiencing any number of the following symptoms would be considered a candidate for a medically supervised detox.

• Mood changes/Irritability 
• Nausea
• Vomiting
• Headaches
• Body Aches
• Digestive Upset
• Sweating
• Insomnia
• Confusion/Memory changes
• Tolerance (the need to use more of a substance)
• Cravings
• Previous failed attempts at detoxing

What Is Medically Supervised Detox?

A medically supervised detox takes place under the supervision of a trained, licensed medical professional. Most often these occur in treatment centers but there are also clinics set up to do detox only. A five to seven day stay in a detox treatment facility would be an option for those who either don’t plan to do inpatient rehab or plan to check in to a facility that doesn’t offer medically supervised detox. In such facilities a patient is monitored round the clock and given medications to help ease the effects of withdrawal and lessen the symptoms of detoxification.

For those addicted to opioids, several medications may be given to help them taper including Suboxone. These medications may be administered in lowering doses even after the detox process if the patient remains in a care facility. Tapering shows a more successful long-term outcome according to some studies. Some patients stay on these medications for a longer period even after their stay in a treatment center if they remain under the care of a supervising physician.

For alcohol, benzodiazepines are often administered to help with the anxiety and depression that can occur as one tapers from this substance as well. Since benzos tend to mimic the effects of alcohol many treatment providers won’t prescribe them long-term but do administer them as a part of the tapering process from alcohol as a means of helping regulate the intensity of the emotional withdrawal as well. Most providers taper the use of benzos while the patient remains in treatment leaving them drug-free by the time their stay in treatment is concluded.

Upon leaving a detox center or treatment facility one may receive a shot of Vivitrol or a prescription for Naltrexone (the oral equivalent of the medication) to reduce cravings and prevent the euphoric effects of a substance in the event of a slip or a relapse. This medication is proven effective for both alcohol and opioid addictions. Studies show a success rate of up to 90% when used in conjunction with ongoing counseling.

While medically supervised detoxes tend to be the most expensive they are also the safest and some would argue the most effective. If payment or lack of insurance is an issue, ask the facility if they have any grant beds (slots that are covered by grant money from various sources) or scholarship openings. Certain non-profits and corporations have relationships with some facilities offering payment or partial payment for qualified patients. It is always worth inquiring.

Erring On the Side of Safety:

Anyone who has a relationship with a substance to the point of questioning whether they need to detox need ponder this question no more. The answer is “yes!” Whether it is simply a matter of abstaining from using as in the case of those who have a mild dependency, or those who find themselves in full physical dependency to their substance it is always safest to err on the side of supervision and accountability.

Which Substances Usually Need Medical Detox:

The answer depends on the substance as much as on the person. A rough guide, to be confirmed with a clinician who knows your history:

• Alcohol: medical supervision. NIAAA warns that stopping suddenly after prolonged heavy drinking can be life-threatening, with seizures among the possible symptoms, and that doctors can prescribe medication to make withdrawal safer. Confusion, hallucinations, or a seizure during withdrawal is a 911 call.
• Benzodiazepines (Xanax, Klonopin, Valium, Ativan): medical supervision and a taper, never a sudden stop. The FDA's boxed warning says dependence can develop within days to weeks even at prescribed doses, and that stopping abruptly can cause life-threatening seizures.
• Opioids (painkillers, heroin, fentanyl): withdrawal is rarely fatal on its own but is severe, and quitting at home usually fails for that reason. The larger danger is afterward: SAMHSA lists using again after a period of abstinence as an overdose risk factor because tolerance has dropped. Medical detox that starts buprenorphine or methadone, or a direct start on those medications without a separate detox, is the safer path. Have naloxone in the house either way.
• Stimulants (cocaine, methamphetamine, Adderall): withdrawal is mostly exhaustion, heavy sleep, hunger, and low mood, and is not usually a medical emergency. The risk to watch is deep depression and thoughts of suicide in the first week or two; if those appear, call or text 988, and see a clinician rather than waiting it out.
• Cannabis: irritability, poor sleep, and low appetite for a week or two; medical detox is rarely needed, but a doctor can help if symptoms are unmanageable.

If you are still considering quitting at home after reading that, talk to a doctor first, tell them exactly what you use and how much, and have one sober person who knows your plan and can call for help. Quitting alone in a locked room is the version that goes wrong.