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What Happens During Detox From Drugs and Alcohol?

18 September 2023

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Detoxification is the first step toward addiction recovery. In a clinical setting, the goal is to minimize the negative impact of withdrawal symptoms while making the experience as safe and comfortable as possible. While some people choose to detox on their own, the most effective form of detox is one that is medically assisted and supported by trained specialists. 

We spoke with Brian Couey, Psy.D, executive director at INTEGRIS Health Arcadia Trails Center for Addiction Recovery, to learn more about alcohol and drug detox.

Who is a good candidate for medical detox?

All substances have withdrawal syndromes, and they can vary depending on the substance. The symptoms can range from very mild (e.g., a bad hangover or insomnia) to severe and dangerous (e.g., having a seizure or delirium).

“It’s critical that anyone who has been engaged in prolonged or frequent use of any substance and is intending to stop consider being evaluated for medical assistance with detoxification,” Dr. Couey says.

How does alcohol detox differ from drug detox?

Alcohol, along with benzodiazepines and barbiturates (which act like alcohol in the brain), are the most dangerous substances from which to detox. 

“There is a real risk of death when detoxifying from alcohol primarily due to seizures and delirium tremens (also known as ‘the shakes’ or the ‘DTs’)”, he says. “Some estimates that the death rate as a result of DTs can be as high as 15 percent.”

Dr. Couey says detoxification from other drugs often has physical risks, but they’re often less dangerous than alcohol. Nonetheless, the discomfort and psychological and emotional destabilization that comes from detoxifying from other substances poses real risks to a person's safety and well-being.

How to detox from alcohol or drugs

Detoxification helps your body get rid of alcohol, drugs or any additional toxins you consume. In a way, detox is a reset button to give you a clean slate toward healing.

The process of undergoing detox can be complicated and will be different for each individual. Usually, you will be evaluated by medical professionals so they can tailor a plan of action that best suits you. The goal is to reduce alcohol cravings and limit withdrawal symptoms.

What is the timeline for alcohol and drug withdrawal symptoms?

Ultimately, Dr. Couey says it depends on the type of substance and other factors related to the use (e.g., amount, duration, etc.). It can range from days to weeks.

Here are some examples:

  • Alcohol and opioid withdrawals can begin within a few hours of cessation and can last up to a week or more. 
    • Alcohol withdrawal symptoms include nausea, vomiting, insomnia, increased anxiety, increased heart rate and sweating.
    • Opioid withdrawal can include many of the same symptoms but also symptoms such as diarrhea, runny nose, muscle aches and fever. 
  • Withdrawal from drugs such as benzodiazepines (e.g., Xanax, Valium) can take a couple of days to onset and may not peak in severity for as long as two weeks into the withdrawal syndrome. 
    • Withdrawal from benzodiazepines can include nausea, panic attacks, anxiety, sweating, headaches, muscle pain and heart palpitations.
  • Stimulant withdrawals for drugs like cocaine and meth may begin as early as a few hours after stopping and may take several weeks to fully resolve.
    • Withdrawal from stimulants such as cocaine and meth can include severe fatigue, severe mood dysregulation, disturbing dreams and motor agitation.

Which factors depend on the length or severity of detox?

There are many factors that determine the length or severity of detox.

They include the following:

  • Type of substance
  • How long and how much someone has been using
  • Age
  • Overall health
  • Genetics
  • Whether they are receiving appropriate medications to assist with detoxification
  • Symptom management

How long does alcohol or drug detox take?

Dr. Couey says this is a tough question to answer because there are so many different types of substances all have a unique timeline.

In general, though, the most acute symptoms for substances such as alcohol and opioids, with proper medication, will improve within a few days to a week. However, after the acute withdrawal symptoms improve, people will experience protracted or “post-acute” withdrawals which can last much longer. 

“This ‘post-acute withdrawal syndrome,’ while milder than the acute withdrawals, can last several weeks to months,” he says. “This comes from the damage to the brain that has occurred with prolonged use. Post-acute withdrawal syndrome is often a significant trigger for many people to relapse.” 

Detox medications

For alcohol, medications that mimic the effects of alcohol in the brain are generally used, and then the doses are progressively lowered to give the body plenty of time to physiologically adjust to not having the substance. 

Benzodiazepines are commonly used for this purpose along with other medications to address ancillary symptoms such as hypertension medications or vitamins to prevent alcohol-related neurological disorders such as Wernicke-Korsakoff Syndrome. 

Opioid withdrawal is often treated with exceptionally effective agonist medications such as buprenorphine. 

Stimulant withdrawal treatment may include medications such as anti-depressants to help with severe mood dysregulation, sleep disturbance, and fatigue. Moreover, once the acute withdrawal has resolved, there are many medications that have been demonstrated as reliable in reducing cravings, relapse, or overdose. Some of these include Acamprosate, injectable or oral Naltrexone, and disulfiram, among others. 

What are the benefits of choosing inpatient rehab?

Inpatient rehab is the safest and most reliable way to detoxify and to begin a journey into recovery, according to Dr. Couey. 

“Home environments are often filled with multiple stressors and tend to have a lot of vulnerability for people, which severely limits their chances of successfully stopping their use,” he says. “So many things can go badly when someone tries to stop drinking or using on their own.

Inpatient care is the gold standard for effectiveness and increases the chances that someone will be safe and successful in overcoming their problem. However, even inpatient’s effectiveness is limited if not followed up with ongoing outpatient care. 

“Addiction is a chronic disease like diabetes or hypertension. If you stop your treatment the moment you feel better, chances are it’s going to come back,” he says.

Why should patients avoid alcohol/drug detox at home on their own?

There are serious risks with attempting detoxification without professional support. 

Alcohol and benzodiazepine withdrawal can cause deadly seizures, even in someone without a seizure history. 

Opioid withdrawal is very unpleasant and hard on the body; it can cause medical complications such as dehydration and electrolyte imbalances which are very dangerous. 

Stimulant withdrawal can sometimes result in psychosis or severe mood issues. Moreover, the risk of returning to substance use once the withdrawal has resolved is very high and there is an increased risk of overdose.

If you or a loved one are battling addiction and need help with medical detox, the INTEGRIS Health Arcadia Trails Center for Addiction Recovery offers state-of-the-art services to reach your goals. Withdrawals can be the first major obstacle in substance use disorder treatment, and our staff can guide you through the process. Contact us today at 405-216-2564 or visit our website to get in touch.

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