Detox, also known as detoxification or withdrawal management, protects your physical and mental health as you stop use of alcohol or other drugs. Detox programs provide medical supervision of the withdrawal process.
There are both outpatient and inpatient options for medical detox. Consult a medical professional to determine your detox needs and develop a treatment plan.
A detox program should evaluate your physical and mental health before withdrawal, stabilize and monitor your symptoms, and prepare you for treatment in an outpatient or rehab setting.
Withdrawal symptoms and timelines vary based on the substances you’ve used, the length of time you’ve used them, your age and overall health, and the type of medical care you receive.
It’s normal to have questions about what to expect when you stop using alcohol or drugs. Will you have physical or mental health symptoms? If so, how long will they last?
Stopping use of a drug you depend on can cause physical and mental withdrawal symptoms. Withdrawal is different for everyone, and there are many ways to prepare for, manage, and treat withdrawal symptoms. For some, the best approach is a drug or alcohol detox program.
Recovery is possible, and detox can be a first step.
Detox, short for “detoxification,” is also known as withdrawal management or medical detox. There are both outpatient and inpatient programs that provide physical and mental health care for people who are experiencing symptoms of withdrawal from alcohol or other drugs.
For people who need withdrawal management, receiving appropriate clinical supervision is a critical step before beginning substance use treatment. This is to prevent serious health consequences from withdrawal. The level of supervision may vary depending on the risk of medical complications from withdrawal symptoms.
Health care providers with experience in treating substance use disorders can evaluate your detox needs, manage your withdrawal symptoms, and prepare you for ongoing treatment and long-term recovery. Studies show that patients who directly enter treatment after detox are less likely to resume substance use than those who go through only detox are.
Detoxification (detox) programs provide medical and mental health care for people experiencing withdrawal symptoms from stopping or reducing use of alcohol or other drugs.
Effective detox programs don’t just remove “toxins” from your body; they help you carefully manage your physical and mental symptoms and prepare you for ongoing treatment for substance use disorder. Since detox programs go beyond simply removing dangerous chemicals from your system, many medical professionals now use the term withdrawal management. This term is also considered less likely to perpetuate stigma.
You can undergo withdrawal in a variety of settings with levels of services appropriate to your needs. However, everyone’s detoxification process should involve:
Evaluating your physical and mental health ahead of withdrawal.
Stabilizing your symptoms.
Preparing you to directly enter a treatment or rehabilitation program.
After detox, you may enter rehab or another inpatient or outpatient treatment program, where you would receive care for weeks or months to maintain your recovery. You can get further help with sustaining your recovery after treatment through a 12-step program or other counseling sessions.
Your health care provider can assess your situation and suggest a level of medical detoxification care. In recommending a medical detox placement, providers may look at your situation as it relates to these factors:
Different drugs carry different risks of serious withdrawal symptoms. Alcohol and benzodiazepine withdrawal can lead to seizures, unstable vital signs, confusion, and even death. In contrast, opioid withdrawal, while deeply uncomfortable, is rarely medically serious.
If you have or expect to have mild or moderate withdrawal symptoms, you could undergo medical detox on an outpatient basis with minimal supervision. If your symptoms are more intense or life-threatening, you may need to be supervised for withdrawal in a hospital. If you have been diagnosed with both a substance use disorder and another mental health disorder, you may require a level of care that offers more intensive counseling.
The American Society of Addiction Medicine defines five categories of withdrawal management programs: Level 1-WM, Level 2-WM, Level 3.2-WM, Level 3.7-WM, and Level 4-WM.
Level 1-WM, or ambulatory withdrawal management, is completed on an outpatient basis for mild withdrawal. Your care is monitored daily or every few days by a health care professional.
Level 2-WM is the next level of outpatient withdrawal management, sometimes undertaken at a day hospital. Your extended care for moderate withdrawal is monitored by credentialed health care professionals for the entire day, but you go home at the end of each day. With this type of care, it is important to have supportive household members to watch over you at night.
Level 3.2-WM is clinically monitored withdrawal management for moderate symptoms. You stay at a residential facility where staff and peer support is available 24 hours a day.
Level 3.7-WM is medically monitored inpatient management of severe withdrawal. You receive 24-hour nursing care, and a physician is available as needed.
Level 4-WM is the most intensive type of inpatient treatment for severe withdrawal and is known as medically managed withdrawal. You receive 24-hour nursing care plus daily physician visits to treat medically unstable symptoms in a hospital or a similar setting.
Learn more about these levels of care at the American Society of Addiction Medicine website.
The cost of detox varies depending on the number of days in treatment, the level of services, the location, and other factors. It’s possible to get help with paying for this type of care, however. Sources of support include:
Health insurance marketplaces. The Affordable Care Act considers mental and behavioral health services “essential health benefits.” This means substance use disorder (SUD) treatment is covered at least in part through insurance offered on the federal, state, and District of Columbia health insurance marketplaces, including through Medicaid.
Medicare Part A. The insurance program for people 65 and older covers some SUD-related services if certain conditions are met.
Government funding. The Substance Abuse and Mental Health Services Administration distributes block grants to programs in all 50 states, the District of Columbia, and the U.S. territories. These funds supplement prevention, treatment, and recovery services covered by private insurance, Medicaid, and Medicare.
Many people who decide to stop using alcohol or other drugs try to do so “cold turkey” and without medical support. It’s tempting to want to stop using substances on your own. And there is a long-standing misconception that the most effective way to stop substance use is through willpower alone.
However, trying to quit cold turkey without any medical support has a lower chance of success than seeking medical support and supervision to stop substance use. This is partly due to the way dependence affects the brain, undermining the parts of it concerned with willpower and decision-making. In addition, quitting cold turkey can result in dangerous withdrawal symptoms that lead to serious medical complications — particularly with alcohol and benzodiazepines. Withdrawal from other substances, such as heroin and other opioids, can be very uncomfortable and painful. Without medical support, this discomfort could cause you to return to substance use.
Medical support can provide you with medications and therapies to manage withdrawal symptoms, connect you with treatment, and help sustain your recovery. So, although you may want to go it alone, it’s often a good idea to seek out medical care when quitting a substance.
As part of the detox process, a trained medical professional will evaluate your mental health to better understand how stopping substance use and entering treatment could affect you. This is designed to answer questions such as:
Getting answers to these and other questions can improve your chances of success in alcohol and drug detox and treatment.
Evaluation. Your health care provider conducts a comprehensive evaluation of your physical and mental health and your living situation. This helps determine your needs during and after detox, including the level of care, the type of setting, and any specialized services you require. An evaluation involves:
Stabilization. Stabilization is the process of resolving your physical and mental withdrawal symptoms. During this step, your medical provider helps you safely manage withdrawal symptoms until you no longer depend on the substance.
Depending on your symptoms and condition, stabilization may take place at home or in a detox facility, as outlined above. Close medical supervision is most important for people experiencing withdrawal from substances that cause the most serious symptoms, such as alcohol and benzodiazepines. If your symptoms are severe, a provider may prescribe an anti-seizure medication or other medications and refer you to counseling.
During this phase, your health care provider can also familiarize you and your loved ones with the post-withdrawal treatment process.
Entry to treatment. Once stabilization is complete, your provider gets you ready for post-withdrawal treatment or rehabilitation to continue your care. You may be referred to inpatient or outpatient treatment. Providers may also recommend you undergo aftercare following treatment in the form of a 12-step program or counseling.
Withdrawal symptoms can be mild, serious, or even life-threatening. Common symptoms include:
The Substance Abuse and Mental Health Services Administration categorizes withdrawal as being either “acute” or “protracted.” Symptoms of acute withdrawal start within a few hours or days of stopping the drug and can lessen or end after a few days or weeks. Symptoms of protracted withdrawal can last several weeks or even months.
The symptoms and length of withdrawal depend on:
Although each case is unique, different substances have different commonly reported withdrawal symptoms and timelines.
Alcohol. Long-term heavy use of alcohol can unbalance the brain’s chemistry. That’s why some people experience symptoms when they significantly decrease or stop their alcohol use. These can be mild (e.g., anxiety, insomnia, or tremors) to serious (e.g., delirium tremens, hallucinations, or seizures). Severe cases of alcohol withdrawal can be life-threatening and require emergency care. Symptoms of acute withdrawal are typically mild and last only one to three days. However, there is considerable variation; in more serious cases, delirium tremens can persist more than seven days after the last drink.
Delirium tremens (DTs) is the most severe form of alcohol withdrawal. DTs is characterized by shaking, confusion, disorientation, agitation, and hallucinations.
This condition affects people who have stopped drinking but have a history of consuming large amounts of alcohol. Individuals who have been drinking for a long time, have experienced alcohol withdrawal in the past, or have a seizure disorder are at higher risk of developing DTs.
While only 5% of people going through withdrawal experience DTs, the symptoms are serious and potentially fatal. If you or someone you know is experiencing symptoms, call 911 and seek medical care immediately.
Benzodiazepines. When you stop using benzodiazepines, such as diazepam (Valium) and alprazolam (Xanax), you may experience severe withdrawal symptoms. The type and onset of those symptoms depend on several factors, including the drug type, dose, and length of use as well as whether you were using other substances at the same time. Symptoms may include anxiety, trouble sleeping, seizures, and psychosis. Symptoms of acute withdrawal typically last two to four weeks for short-acting benzodiazepines (e.g., oxazepam, alprazolam, and temazepam) and two to eight weeks for long-acting benzodiazepines (e.g., diazepam and nitrazepam). If benzodiazepine use is tapered off rather than abruptly stopped, more serious withdrawal symptoms such as seizures and psychosis can be averted.
Cannabis. If you use cannabis heavily over an extended period and then stop, you may feel withdrawal symptoms. These include anger, anxiety, headaches, problems sleeping, depression, stomach issues, and sweating. Symptoms of withdrawal typically last up to two weeks.
Nicotine. Symptoms of stopping use of cigarettes and other nicotine products may include cravings, irritation, anxiety, difficulty concentrating, and trouble sleeping. These symptoms can be mild or intense. Symptoms of acute withdrawal generally peak within three days of quitting and last for three to four weeks.
Opioids. Stopping use of opioids such as fentanyl and heroin can result in unpleasant withdrawal symptoms such as cold flashes and goose bumps, watery eyes, runny nose, diarrhea and vomiting, bone and muscle pain, severe cravings, irritability, yawning, and sleep difficulties. Symptoms of acute withdrawal generally last for four days to three weeks, depending on the type of opioid used.
Prescription stimulants. Stopping long-term use of amphetamine-based prescription stimulants — such as Dexedrine and Adderall — can cause physical and mental health symptoms. They include uneasiness and other mood changes, hunger, strange or bad dreams, tiredness, and disrupted motor skills. Most symptoms of amphetamine withdrawal go away in about a week.
Methamphetamine. Halting use of this stimulant generally causes mild to moderate withdrawal symptoms. You may have intense cravings for the drug and experience other effects such as itchy eyes, paranoia, sleeplessness, fatigue, and decreased libido. These acute symptoms usually start within hours, peak on the first or second day, and subside after two weeks. Other symptoms — including mild issues with sleep and appetite and more serious issues like depression and thoughts of suicide — may occur for up to three weeks, however.
Cocaine. If you stop using cocaine after a long period of use, you may develop withdrawal symptoms such as depression, hunger, lethargy, and sleeplessness. Usually, withdrawal symptoms are mild and resolve within two weeks without treatment; however, they can persist for up to four weeks. The severity of symptoms also depends on factors such as the amount of cocaine regularly used, the frequency of use, and other physical or mental health conditions.
Content reviewed by Jasleen Salwan, M.D., MPH, FASAM, June 2023.
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