Back To Top

Drug and Alcohol Detox

Learn about benefits and steps of detox from alcohol and drugs.

What is drug and alcohol detox?

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.

Defining detox

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.

Frequently asked questions about detox

Who can advise me on the type of detoxification program to use?

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:

  • Current and past substance use and potential to experience withdrawal.
  • Physical health conditions and complications.
  • Mental health conditions and complications.
  • Readiness to recover from dependence on alcohol or other drugs.
  • Potential for returning to substance use.
  • Your home or living environment during recovery.

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.

What types of detoxification programs are there?

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.

How much does alcohol and drug detox cost?

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.

Why is it not advised to quit without medical support?

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.

Why is a mental health assessment an important part of the detox process?

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:

  • Are you at risk of harming yourself or others in the process of withdrawal?
  • Do you need treatment for a mental health condition that’s occurring alongside your dependence on substances?
  • Do you need counseling to cope with the psychological effects of withdrawal?
  • Are you taking any medication that can interact with medications to manage withdrawal symptoms?

Getting answers to these and other questions can improve your chances of success in alcohol and drug detox and treatment.

Steps of drug and alcohol detox

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:

  • Testing your urine and blood. Typically, drugs are detected through urine tests, while other blood tests may be done to assess your vital organs, such as your kidneys and liver.
  • Screening for co-occurring physical and mental health issues.
  • Assessing other social factors (e.g., housing situation) that may determine the course of your post-withdrawal treatment.

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 and timeline

Withdrawal symptoms can be mild, serious, or even life-threatening. Common symptoms include:

  • Headache
  • Irritability
  • Fatigue
  • Trouble sleeping
  • Paranoia
  • Depression
  • Diarrhea
  • Vomiting
  • Seizures
  • Unstable vital signs
  • Confusion
  • Psychosis

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:

  • Which substances you use and how long you’ve used them.
  • Your age and overall health.
  • Whether you quit “cold turkey” or gradually taper off use.
  • The type of medical care you receive.

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.

What is delirium tremens?

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.

Find treatment and recovery options.

Content reviewed by Jasleen Salwan, M.D., MPH, FASAM, June 2023.


7 Common Withdrawal Symptoms and What You Can Do About Them, Centers for Disease Control and Prevention, Dec. 12, 2022

Alcohol Withdrawal, StatPearls, January 2022

Chapter 3, An Overview of Psychosocial and Biomedical Issues During Detoxification, Detoxification and Substance Abuse Treatment, Substance Abuse and Mental Health Services Administration, 2006

Chapter 4, Withdrawal Management, Clinical Guidelines for Withdrawal Management and Treatment of Drug Dependence in Closed Settings, World Health Organization, 2009

Delirium Tremens, ScienceDirect, June 28, 2023

Detoxification and Substance Abuse Treatment: A Treatment Improvement Protocol 45, Substance Abuse and Mental Health Services Administration

Introduction to Alcohol Withdrawal, Alcohol Health and Research World, 1998

Management of Alcohol Withdrawal in the Emergency Department: Current Perspectives, Open Access Emergency Medicine, March 19, 2020

Opiate and Opioid Withdrawal, MedlinePlus, April 30, 2022

Opioid Withdrawal Symptoms, Healthdirect, Australian Government Department of Health and Aged Care

Prevalence of Cannabis Withdrawal Symptoms Among People With Regular or Dependent Use of Cannabinoids: A Systemic Review and Meta-Analysis, JAMA Network, April 9, 2020

Read This Before Trying To Quit Smoking ‘Cold Turkey,’ Truth Initiative, Dec. 27, 2017

Substance Abuse and Mental Health Block Grants, Substance Abuse and Mental Health Services Administration  

Substance Abuse Treatment Advisory, Protracted Withdrawal, Substance Abuse and Mental Health Services Administration, July 2010

Substance Use Disorders,

The Benzodiazepine Withdrawal Syndrome, Addiction, 1994

The Risks and Benefits of Quitting ‘Cold Turkey,’ Medical News Today, March 23, 2021

Transitioning From Detoxification to Substance Use Disorder Treatment: Facilitators and Barriers, Journal of Substance Abuse Treatment, November 2016

Treatment for Alcoholism and Substance Use Disorder, Medicare Interactive

Treatment for Amphetamine Withdrawal, Cochrane Database of Systemic Reviews, April 2009

What Is Cocaine? DrugFacts: Cocaine DrugFacts, April 2021

Withdrawal, Alcohol and Drug Foundation

Withdrawal Symptoms in Abstinent Methamphetamine-Dependent Subjects, Addiction, October 2010