What is Inpatient Detox & How It It Different from Outpatient

What is Inpatient Detox?

People may have severe withdrawal symptoms if they suddenly quit drugs or alcohol. Detox (short for detoxification) can help manage these symptoms.  

Chronic alcohol use changes body chemistry and functioning, negatively affecting how the body looks and operates. Some of these changes are reversible when a person quits drinking. Others stop progressing, but don’t reverse. In other cases, though, they continue to progress even after stopping drinking.

Detox is usually the first step in treating substance abuse problems. It can occur in both inpatient or outpatient settings. 

In inpatient detox, people stay in a hospital or treatment facility. The support staff provides care and supervision. 

Inpatient detox is also more expensive than outpatient detox. It’s usually for people who experience significant body chemistry changes from their addictions.

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What is Inpatient Detox & How It It Different from Outpatient

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Inpatient vs. Outpatient Detox

Detox can usually occur safely and effectively in inpatient or outpatient settings. However, a person who experiences delirium tremens (DTs) will require intensive inpatient care. 

Thirty years ago, before intense inpatient detox protocols were available, DTs had only a 60 to 70 percent survival rate. Today, less than 5 to 10 percent of people who go into ‘full-blown’ DTs will die. 

Inpatient Detox

With inpatient detox:⁴

• People stay in the hospital or treatment facility
• Support staff provide constant care and supervision
• It prevents easy access to drugs and alcohol
• It separates people from substance-using environments

Some drawbacks of inpatient detox include:^{1, 4}

• It’s more expensive than outpatient detox
• It sometimes encourages people to develop unnecessary dependence on staff

People with the following conditions should consider inpatient detox:^{1, 4}

• Severe addictions
• Long-term substance abuse
• Severe withdrawal symptoms
• High risk of relapse
• Other health complications
• Home environment that is not supportive of abstinence or sobriety

Outpatient Detox

With outpatient detox:⁴

• People travel daily to the hospital or treatment facility
• It’s less expensive than inpatient detox
• It’s less time-consuming

Some drawbacks of outpatient detox include:⁴

• Increased risk of relapse: As people spend time outside the facility, they have easy access to drugs and alcohol. 
• High rate of treatment failure: People can choose not to attend their treatment sessions. In one study involving 164 patients, more inpatients than outpatients completed alcohol detox.⁴

Outpatient detox is usually for people with mild-to-moderate withdrawal symptoms. Those with severe addictions or withdrawal symptoms are better off with inpatient detox.⁴

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What to Expect in Inpatient Detox

Detox has three components:²

• Evaluation
• Stabilization
• Fostering

These components are part of what to expect during detox. 

Before Detox

People will first undergo evaluation. 

This process includes:²

• Talking about the person’s health and substance abuse history
• Detecting and measuring the level of drugs and/or alcohol in the body
• Assessing withdrawal symptoms 
• Assessing home environment for available support (e.g., stable living environment, supportive family vs. homelessness, living with active addicts, etc.)
• Screening for co-occurring mental and physical conditions
• Assessing medical, psychological, and social situations to determine addiction treatment after detox

During Detox

People usually experience withdrawal symptoms as they flush drugs or alcohol from their bodies. One focus of detox is for medical professionals to help them attain a medically stable, substance-free state. 

Stabilization includes:²

• Addressing acute intoxication and withdrawal
• Setting the person’s treatment expectations
• Discussing the person’s role in treatment and recovery
• Involving family, employers, and other significant people, if necessary

Stabilization is usually achieved with medications. There are other approaches like:

• Tapering: The person reduces their intake amount of the addictive substance to lessen the impact of withdrawal. This approach is sometimes used with benzodiazepine, alcohol, and opioids.^{6, 7}
• Rapid detox: The person goes under anesthesia while the substance flushes out. This is an expensive hospital procedure.⁸
• Social intervention: Instead of taking medications and receiving routine medical care, the person stays in a supportive, non-hospital environment.²

It’s common nowadays for addiction treatment programs to mix medical and non-medical approaches. 

After Detox

Detox is just the start of substance abuse treatment. People who discontinue treatment after detox usually return to drugs or alcohol.⁹

Another focus of detox is fostering the person’s entry into further treatment like:^{4, 9}

• Inpatient or outpatient rehab
• 12-step programs like Alcoholics Anonymous (AA) and Narcotics Anonymous (NA)
• Further medical or surgical consultations
• Behavioral therapy like individual counseling
• Relapse prevention

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What is Detox?

Detox can be described as “managed withdrawal.” It helps manage withdrawal symptoms as people flush drugs or alcohol from their bodies and ‘normal’ functioning restores.^{1, 2, 3, 4}

Besides managing withdrawal, detox has other objectives:^{1, 4}

• Cleanse the body of drug and alcohol
• Help people achieve a medically stable, substance-free state
• Treat comorbid medical or psychiatric conditions
• Prepare people for long-term treatment and recovery

What is Medically Assisted Detox?

Medically assisted detox involves medications and medical professionals. It’s designed to: 

• Prevent complications associated with drug and alcohol withdrawal
• Ensure that the detox process is safe and comfortable

People usually equate inpatient detox with medical treatment. This is not surprising, as almost 80% of detox procedures use medications.⁹

Medications used for alcohol detoxification include:^{4, 9}

• Benzodiazepines
• Acamprosate
• Naltrexone

Medications used for opioid detoxification include:⁹

• Methadone
• Buprenorphine
• Naltrexone
• Lofexidine

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How Long Does Inpatient Detox Take?

The length of detox varies and depends on different factors:^{1, 2, 4}

• Type of addictive substance: For example, physical alcohol withdrawal symptoms may last for a week. Benzodiazepines and other drug withdrawal symptoms, however, could last for two weeks or longer. The psychological urge to drink or use can last for several years or more.
• The number of substances used: Detox time may take longer if the person used more than one substance.
• Amount of substance used: The higher the quantity of the addictive substance that was used, the more time is needed to flush it out.
• The severity of withdrawal symptoms: People with severe symptoms may need more time to stabilize.
• Length of substance abuse: People who used drugs or alcohol for a long time may have developed a more intense physical dependence. This affects detox time. 
• Person’s physical and mental state: People motivated to start detox immediately may handle withdrawal symptoms better than those who don’t want to detox.
• Co-occurring disorder(s): Having one or more mental health conditions besides addiction can lengthen the detox process.

Withdrawal Symptoms

Substances usually associated with challenging withdrawal symptoms include:

• Opioids: Users may experience intense opioid cravings and severe body changes (e.g., nausea, sweating, cramping, and flushing) that increase the risk of relapse.
• Alcohol: Severe withdrawal includes seizures, delirium tremens, and even death.
• Methamphetamines: People going through methamphetamine withdrawal may experience severe and intolerable depression. This can trigger suicidal thoughts and tendencies.
• Benzodiazepines: Withdrawal symptoms can last up to 3 months. This is because of the slow tapering process that prevents potentially fatal symptoms like seizures. 
• Cocaine: Cocaine withdrawal is more psychological than physical. Cocaine detox involves managing cravings and anxiety. 

Different addictions share common withdrawal symptoms like:⁵

• Anxiety
• Sweating
• Cold flashes
• Decrease in appetite
• Fatigue
• Muscle weakness
• Insomnia
• Tremors or shaking
• Nausea
• Vomiting
• Headaches
• High blood pressure
• Irregular heartbeat
• ‘Goose flesh’ (piloerector spasms around hair, used to describe ‘cold turkey’ withdrawal)

Other Detox Options 

Here are the other detox options: 

• Outpatient detox: Less expensive than inpatient detox. This is suitable for people with mild-to-moderate withdrawal symptoms.
• At-home detox: Done in the comfort of people’s homes. This is dangerous, as there won’t be doctors around if people experience severe withdrawal. If they succeed, it’s hard to stay sober because they are exposed to triggers at home. 
• Quitting “cold turkey:” Also dangerous because of severe withdrawal symptoms. For example, abruptly stopping alcohol use can cause fatal delirium tremens. 
• Natural detox: Involves supplements, teas, and spiritual support like yoga or acupuncture.
• Detox cleansing kits: DIY versions of medical detox. These cleansing pills or drinks are meant to help with withdrawal symptoms. However, they’re not FDA-approved or medically proven to succeed. 

Note: Quitting “cold turkey” and using at-home detox techniques are both highly discouraged. These methods are dangerous and can have life-threatening consequences. 

Natural detox and detox kits may look harmless at a glance. But they don’t have enough medical evidence to support their safety and effectiveness. 

Outpatient detox can be effective for certain people. The choice to undergo inpatient or outpatient detox will depend on the person’s addiction and any additional medical condition(s) they have.

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