Author: Jaclyn Ahearn, LICSW

If you are wondering if you or your loved one might have a substance use disorder and are looking for answers about the next steps in treatment, one of the first things you will need to consider is detox.

What is Detox?

When it comes to drug and alcohol addiction, the first step of treatment is to go to a detox program or center to clear substances from the body. These programs typically address both the initial physical and psychological, or emotional, symptoms associated with no longer consuming a substance.

Addiction is based on the habitual or repeated consumption of a substance, and no longer consuming that substance can cause difficult symptoms. For these reasons, it can be helpful to enter a detox facility to receive emotional support and healthcare services that will aid in a safe and comfortable detox.

Detox centers are staffed with supportive counselors, nurses, or otherwise therapeutic staff members to assist you while in the program, and often offer therapy to help you in recovery.

Medical Detox

Detoxification centers are available for medical detox if you have developed a drug dependence and will experience withdrawal symptoms. Detox centers provide a safe and medically supported first step into recovery. Depending on the particular substance, medications are sometimes available to alleviate some of the physical symptoms of withdrawal.

Non-Medical Detox

Non-medical detoxes are best if you are experiencing mild withdrawal symptoms and thus do not require medication to assist in the detox process. Non-medical detox is not a safe option if you are withdrawing from benzodiazepines or alcohol, due to the risk of seizures and death associated with these types of withdrawal.

These detox programs may emphasize the social and emotional aspects of withdrawal and the changes that come with discontinuing the use of a substance.

Is It Safe to Detox at Home?

Due to the risk of fatality associated with withdrawal from some substances, it is generally not safe to detox at home if you have been using drugs for some time or have an addiction. An addictions specialist or medical provider will be able to determine if it is safe for you to detox at home or outside of a detox center.

Call 800-934-1582(Who Answers?) to speak to a rehab specialist about your options.

For some substances, such as marijuana or certain stimulants, medical detox may not be necessary. Still, the psychological impacts of withdrawal can be significant, which is why many people seek professional support for detox.

Many people consider tapering their substance use, or gradually reducing their use, as an alternative to eliminating their use of the drug suddenly. This decision is best made with your providers to ensure a safe withdrawal process. If you use substances like benzodiazepines or opioids, for example, you can often slowly taper on an outpatient basis.

This option may not be desirable, however, since you’ll experience withdrawal symptoms which may be difficult to manage on your own. You may prefer to be in the comfort and safety of an inpatient detox center to ensure a successful and complete detox.

Treatment After Detox

For many people with a substance use disorder, detox is the first step in eliminating the drug from your system, but where to from there? Many treatment options are available and detox programs will be equipped with resources and referrals for the next steps in your recovery journey.

Residential Treatment Programs/Rehabilitation Centers

Residential treatment programs or longer-term rehab centers offer more substantive treatment options if you require a more supportive and lengthy treatment approach.

Living in a treatment center offers you the option to change your physical location and gain supports around the clock to set yourself up for long-term recovery from a substance use disorder.

Partial Hospitalization Programs (PHPs)

A PHP is a 5-day-per-week program in which you will attend therapy groups with peers in the program, meet with an individual therapist or case manager, and will likely engage in social activities with program attendees. Programs like this provide a significant amount of structure and social support while still allowing you to live at home.

Intensive Outpatient Programs (IOPs)

IOPs allow you to live at home while attending treatment, which consists of multiple therapy groups and often occurs over the course of weeks. IOPs are another available option for outpatient treatment, while you can remain living at home and attending to other social obligations.

Many different types of IOPs exist, ranging from 3 to 5 days per week.

Outpatient Therapy

Outpatient therapy services are most appropriate if you have stable recovery, which often involves total abstinence from the substance of choice.

While working with a therapist over time, you can continue developing skills related to emotional regulation and relapse prevention techniques to aid in your recovery.

Do I Need a Detox Center?

As mentioned earlier, not everyone needs to go to a detox center. There are some drugs that you can quit without the use of medications or the need for medical supervision—you may still experience some withdrawal symptoms, but nothing severe.

If you have an opioid addiction, it’s recommended that you detox in a facility (vs at home) as your withdrawal symptoms can be severe and require medications.

Opioid Addiction and Withdrawal

If you are wondering if you have developed an opioid use disorder, for example, you may want to consider if you meet the criteria for diagnosis. According to the DSM,³ common symptoms associated with opioid use disorders are as follows:

• Opioids are being consumed more and more over time to achieve the same effect
• Repeated, unsuccessful attempts to stop using opioids
• The use of opioids in hazardous or unsafe situations
• Tolerance, or growing less responsive to the drug’s effects over time, requiring more of the drug to get a similar effect
• Continued use of opioids even though there are consequences, including psychological or physiological distress

Although opioid withdrawal is not fatal, it is considered one of the most uncomfortable and difficult detoxes to experience due to the following symptoms:

• Restless legs
• Severe body aches or overall body discomfort
• Excessive sweating, or sometimes cold sweats
• Gastrointestinal distress or discomfort
• Nausea or vomiting
• Anxiety or depression symptoms, including irritability

Many of the withdrawal symptoms associated with opioids may also be related to the withdrawal of other substances.

To find a detox center or rehab center, call 800-934-1582(Who Answers?) to speak to a caring treatment specialist.

Addiction vs. Dependence

In 1968 the World Health Organization and the American Psychiatric Association replaced “drug addiction” with “drug dependence.”¹ An essential question in the medical community is, “Does addiction or dependence better capture the compulsive and often debilitating behaviors that are observed?”

The word addiction is often used to refer to the negative consequences of compulsive or chronic substance use. Consider some of the following commonly observed behaviors or symptoms of substance use disorders:

• Avoidance of close friends or family, often due to a desire to hide substance use from loved ones
• Development of physical tolerance to the substance, meaning more substance is needed for the same result over time
• Struggling to meet demands of life, from maintaining a home to going to work
• Withdrawing from close friends and family
• Significant and pervasive changes to personality or mood
• Financial strain
• Medical or physical problems without an otherwise known cause

It may be helpful to also distinguish between the physical and emotional toll that a substance use disorder can have on a person. The reality is that substance use disorders have strong physiological and psychological effects. Although you may hear more frequently about the difficulty of a substance addiction due to the physical discomfort associated with withdrawal symptoms, in truth, the emotional impacts can be more severe.

Many myths relate to what substances are considered safe or addictive. The legality of a substance does not necessarily relate to its addiction potential or even its safety. While alcohol is legal to consume across the U.S. for those age 21 and older, it is also one of few substances that withdrawal from can result in death.

The truth is that people often take medications without understanding the potential for dependence and addiction that those medications may carry. For example, medications in the drug class of benzodiazepines (such as Xanax, Klonopin, and Ativan) are prescribed to treat anxiety disorders. Many people do not realize that benzodiazepines have abuse potential and the potential for tolerance and withdrawal.² Benzodiazepines and alcohol affect the nervous system in similar ways and benzodiazepine withdrawal can result in seizures or death, as with alcohol withdrawal.²

References

1. Maddux JF, Desmond DP. Addiction or dependence? (2000). Addiction, 95(5), 661–665.
2. Longo, L.P., & Johnson, B. (2000). Addiction: part I. Benzodiazepines—side effects, abuse risk and alternatives. American Family Physician, 61(7),2121-2128.
3. American Psychiatric Association. (2013). Diagnostic and statistical manual of mental disorders (5th ed.).