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Updated on September 27, 2022

Guide to Drug Detox

What Does it Mean to “Detox” From Drugs?

Chronic substance use changes body chemistry, which may have negative effects on how the body looks and functions. 

Some of these changes are reversible when a person quits drinking or using. Others just stop progressing, but don’t reverse. However, certain changes will continue to progress even after stopping drinking. 

When someone quits using drugs, their body tries to adjust back to it’s ‘before’ state. These adjustments can cause unpleasant, sometimes life-threatening withdrawal symptoms, including:

  • Nausea
  • Hallucinations
  • Instability in blood pressure/heart rate
  • Seizures  

If withdrawal occurs, drug detox (detoxification) is necessary. It’s a process that aims to manage and minimize the harmful effects of withdrawal. Toxins are poisons, and detox is the removal of the poisons (or effects of those poisons) from the body.

Drug detox has other objectives aside from managing withdrawal. These include:1, 2, 3

  • Cleansing the body of drugs
  • Helping people become medically stable and drug-free (returning body chemistries back to normal functions)
  • Treating comorbid medical or psychiatric conditions
  • Preparing people for long-term addiction treatment and recovery

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Benefits of Detoxing From Drugs

Not all drug addiction treatment starts with detox. 

In 2014, only 18% of drug users in the U.S. aged 12 years and older went through detox when they started treatment.1

Starting treatment with drug detox has several benefits: 

  1. Better withdrawal management: If withdrawal symptoms occur, medical professionals and staff are present to ensure safety and comfort.
  2. Lower chances of relapse: One reason people return to drug use is that they want to avoid painful withdrawal symptoms. Detox helps them endure withdrawal with less pain and misery than quitting ‘cold turkey’ or suddenly. 
  3. Preparation for long-term addiction treatment and recovery: People can proceed to inpatient rehab or outpatient treatment after achieving a stable and substance-free state. 

5 Common Drug Detox Methods

Here are five common detox methods for drug addiction: 

1. Inpatient Detox

Inpatient detox has the following benefits:1, 2

  • People reside in the hospital or treatment facility
  • 24/7 available health professionals and staff
  • Prevents easy access to drugs
  • Separates users from unsafe settings
  • Great for people with severe addiction, severe withdrawal, a high risk of relapse, or health complications

Because of the added services, inpatient detox is more expensive than outpatient detox. It also sometimes encourages residents to be dependent on staff.

2. Outpatient Detox

Outpatient detox has the following benefits:3

  • People go home after receiving detox treatment from the hospital or treatment facility 
  • Less expensive than inpatient detox
  • Less time-consuming than inpatient detox

Outpatient detox may seem completely promising, but it has lower success rates than inpatient detox. 

In outpatient settings, people can choose not to attend treatment sessions. They also have easier access to drugs outside the treatment facility. This increases their chances of relapse.

3. Medically-Assisted Detox

Medical detox can occur in an inpatient or outpatient setting. Doctors and staff are available to help people during the detox process.  

Medications are often involved. These can reduce or block the effects of drugs on the brain, making withdrawal more manageable. 

Some examples of detox medications are:

  • Methadone: An opioid that acts on the same brain receptors targeted by illicit and misused prescription opioids.4, 5
  • Buprenorphine: Another opioid that works similarly to methadone.4, 5
  • Naltrexone: Blocks receptors in the brain to prevent attachment of opioids.4
  • Lofexidine: Blocks the release of norepinephrine, a hormone that contributes to opioid withdrawal.6
  • Clonidine: Works similarly to lofexidine.7
  • Diazepam: Helps relieve withdrawal symptoms of benzodiazepine, methamphetamine, and cocaine.8

There are other medically-assisted approaches like:

  • Tapering: The user gradually reduces their drug intake to lessen withdrawal effects. It’s a common approach for benzodiazepines and opioids.9, 10
  • Rapid detox: The user goes under anesthesia while the body gets rid of drugs.11

4. Social Detox

When talking about drug detox, people usually think about the medically-supervised type. However, medical care and detox medications are not the only means for drug detox.

Social detox doesn’t utilize medications or routine medical care. Instead, it relies on a supportive, non-hospital environment. 

It’s rare nowadays to find a purely medical or social detox program. 

Some social detox programs use medication but employ non-medical staff. Some medical programs have components for addressing drug addiction’s social or personal aspects.3

5. Natural/At-Home Detox (Not Recommended)

Some people may be tempted to detox without professional assistance. For example, quitting “cold turkey” and at-home detox are common approaches. 

There are detox cleansing kits marketed to help avoid or reduce withdrawal symptoms. These include cleansing pills or drinks that aren’t FDA-approved or medically proven to succeed. 

Natural detox approaches, like supplements, teas, and spiritual support (like yoga or acupuncture), are also options.

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Drug Detox Timelines (By Drug)

Detox is “managed withdrawal.” It's usual for detox timelines to coincide with the start and end of the drug’s withdrawal period.

Here are some examples: 

Opioids

Opioids include drugs like heroin, morphine, methadone, and fentanyl. Opioid withdrawal can be very uncomfortable but is not usually life-threatening.

For heroin and short-acting opioids, withdrawal symptoms start within 8 to 24 hours after last use. They last for 4 to 10 days.

For morphine and other long-acting opioids, withdrawal symptoms start within 12 to 48 hours after last use. They last for 10 to 20 days.

Symptom treatment and supportive care are often enough to manage mild withdrawal. Methadone, buprenorphine, and clonidine are prescribed for moderate to severe withdrawal cases.8

Benzodiazepines

When used appropriately, benzodiazepines are effective against anxiety and sleep disorders. People can develop dependence if they use this drug for several weeks.

Withdrawal symptoms of short-acting benzodiazepines start within 1 to 2 days after the last dose. They last for 2 to 4 weeks or longer.

Withdrawal symptoms of long-acting benzodiazepines start within 2 to 7 days after the last dose. They last for 2 to 8 weeks or longer.

The safest way to manage withdrawal is to gradually decrease the dose. It’s typical for detox to last up to 3 months. The slow tapering process prevents potentially fatal symptoms like seizures.

If the person already experiences withdrawal, the first step is to stabilize them with diazepam. The stabilization process lasts for 4 to 7 days.8

Stimulants

Stimulants include drugs like methamphetamine, amphetamine, and cocaine. 

These drugs have varying effects. They also have similar withdrawal symptoms starting within 24 hours of last use and lasting for 3 to 5 days.

Diazepam is prescribed for sedation when the user experiences significant distress or agitation. It’s given every 30 minutes until the user becomes calm. 

If diazepam is not enough to manage withdrawal, the person must be immediately transferred to a hospital for psychiatric care.8

Other

Withdrawal symptoms of inhalants start within a few hours to a few days. Symptoms can last for up to 2 weeks. Withdrawal management involves supportive care and medications for headaches and other symptoms.8

Cannabis withdrawal is usually mild but is still a challenging task. Symptoms can last between 1 to 2 weeks. Withdrawal management happens through supportive care and medications for withdrawal symptoms.8

Which Detox Method is the Safest?

Any detox method is safe as long as health professionals are available for the possible case of severe withdrawal symptoms. 

Medical detox can occur in an inpatient or outpatient setting. However, the inpatient setting is safer, as medical assistance is available 24/7.

Inpatient detox also has a higher rate of completion than outpatient detox. Published opioid detox data showed that inpatient detox has a 70% success rate compared to just 37% in outpatient detox.12

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Risks of Quitting Drugs ‘Cold Turkey’

Abruptly quitting drugs has too many risks even if someone thinks they have the willpower to do so. If they experience withdrawal symptoms, no doctor will be present for immediate assistance. 

And even if they succeed, staying sober is difficult because they are still exposed to triggers at home. This increases the chances of relapse.

What Happens After Detox? 

Detox alone is not enough to overcome drug addiction. People who discontinue treatment after detox usually go back to drugs or alcohol.4

Detox is just the first step before pursuing other treatment programs like:2, 4

  • Inpatient or outpatient rehab
  • 12-step programs like Narcotics Anonymous (NA)
  • Relapse prevention
  • Individual or group counseling
  • Other behavioral therapies and outpatient programs
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Resources

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  1. Zhu, He, and Li-Tzy Wu. “National trends and characteristics of inpatient detoxification for drug use disorders in the United States.BMC Public Health vol. 18 : 1073.
  2. Hayashida, Motoi. “An overview of outpatient and inpatient detoxification.Alcohol health and research world vol. 22,1 : 44-6.
  3. Detoxification and Substance Abuse Treatment [Internet].” Rockville (MD): Substance Abuse and Mental Health Services Administration (US); 2006. (Treatment Improvement Protocol (TIP) Series, No. 45.) 1 Overview, Essential Concepts, and Definitions in Detoxification. 
  4. Treatment Approaches for Drug Addiction.National Institute on Drug Abuse (NIDA). January 2019.
  5. How do medications to treat opioid use disorder work?National Institute on Drug Abuse (NIDA). December 2021.
  6. Healthwise. “Lofexidine.University of Michigan Health. Accessed February 19, 2022.
  7. Wakeman, Sarah. “Lofexidine: Another option for withdrawal from opioids, but is it better?Harvard Health Publishing. August 10, 2018.
  8. 4, Withdrawal Management.Clinical Guidelines for Withdrawal Management and Treatment of Drug Dependence in Closed Settings. Geneva: World Health Organization; 2009. 
  9. Ten Questions You Might Have About Tapering (And Room For Your Own): An Informational Booklet for Opioid Pain Treatment.UC Davis Center for Design in the Public Interest and UC Davis Health System. Accessed February 6, 2022.
  10. Ogbonna, Chinyere. “Tapering Patients Off of Benzodiazepines.Am Fam Physician vol. 96,9 : 606-608.
  11. Gold, Carl et al. “Rapid Opioid Detoxification during General Anesthesia: A Review of 20 Patients.Anesthesiology vol. 91 : 1639.
  12. Day, Ed, Julie Ison, and John Strang. “Inpatient versus other settings for detoxification for opioid dependence.Cochrane Database of Systematic Reviews Issue Issue 2 .
  13. Mark, Tami et al. “Factors associated with the receipt of treatment following detoxification.” J Subst Abuse Treat vol. 24,4 : 299-304.

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