Detox

What happens in medical detox

Medical detox, also called withdrawal management, helps you get through withdrawal as safely as possible. Here is why it matters for some substances, what monitoring and medicines involve, and what comes next.

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Detox is a first step

Detox is care that helps you through withdrawal. Withdrawal is the set of symptoms your body goes through when you stop or cut back on a substance it has come to depend on. Clinicians often call detox withdrawal management.

Detox can safely manage the physical symptoms of withdrawal. On its own, though, it does little to change long-term substance use. That is why federal health agencies describe detox as the first stage of treatment, not the whole of it.

Why medical supervision matters for some substances

Withdrawal is different for each substance. For some, it can be dangerous.

Alcohol

Stopping suddenly after a long period of heavy drinking can cause painful or even life-threatening withdrawal, including seizures. A severe form called delirium tremens can cause sudden confusion, fever and hallucinations.

Benzodiazepines

Stopping these medicines suddenly, or lowering the dose too fast, can cause withdrawal reactions, including seizures, which can be life-threatening. Federal guidance recommends lowering the dose gradually.

Opioids

Opioid withdrawal is very uncomfortable but usually not life-threatening. Vomiting and diarrhea can cause dehydration. A bigger danger comes after: withdrawal lowers tolerance, so a much smaller dose than before can cause an overdose.

Cocaine

Withdrawal often has no visible physical signs, but it can bring strong cravings, low mood and exhaustion. In some people it is linked with suicidal thoughts, so mood needs watching.

The three parts of detox

SAMHSA, the federal agency for substance use and mental health services, describes detox as three parts that can happen at the same time or one after another. FHE Health describes its detox in the same three phases.

Step 1
Evaluation
The team checks which substances are in your body, screens for other medical and mental health conditions, and learns about your situation. This guides your care during and after detox.
Step 2
Stabilization
The team helps you through withdrawal until you are medically stable, often with medicines. You learn what to expect in treatment. With your permission, family can be involved.
Step 3
Getting ready for ongoing treatment
The team prepares you to move into the next level of care and explains why following through with treatment matters.

What assessment and monitoring involve

Detox starts with questions about what you use, how much, when you last used, the medicines you take, your health and any past withdrawal. You will usually also have a physical exam.

Tests may include blood and urine tests, including a drug screen. Some people also have an electrocardiogram (ECG) to check the heart.

During withdrawal, staff usually check your blood pressure, temperature and heart rate. Some people need fluids or medicines through an IV.

VA and Defense Department guidance describes using clinical judgment and standard rating scales to measure how severe withdrawal is. Examples are the CIWA-Ar for alcohol and the COWS for opioids. The scores help the team track your symptoms and plan your care.

The team also checks for depression and other mental health conditions. With some substances, such as cocaine, low mood and cravings can last for months after heavy use stops.

Medicines used in withdrawal management

General information from federal sources, not medical advice. Your care team chooses medicines based on your health, history and symptoms.
Substance	Medicines clinicians may use	What to know
Alcohol	Benzodiazepines, with careful monitoring, for moderate to severe withdrawal. Carbamazepine, gabapentin or valproic acid may be options for mild to moderate withdrawal when the risks of benzodiazepines outweigh the benefits.	The VA and Defense Department guideline strongly recommends benzodiazepines with adequate monitoring for moderate to severe alcohol withdrawal.
Opioids	Buprenorphine, often combined with naloxone, or methadone. Methadone for withdrawal is given in an inpatient setting or an accredited opioid treatment program. Clonidine or lofexidine can ease symptoms when those medicines are not an option.	In 2018 the FDA approved lofexidine to lessen opioid withdrawal symptoms in adults who are stopping opioids.
Benzodiazepines	A slow, planned lowering of the dose, called a taper.	The VA and Defense Department guideline recommends tapering gradually. It found too little evidence to recommend extra medicines for benzodiazepine withdrawal.
Cocaine	There are no medicines yet that reduce cocaine cravings. Medicines may be used to treat specific symptoms.	Research on medicines for cocaine is ongoing.

Opioids: plan for what comes next

For people with opioid use disorder, the VA and Defense Department guideline recommends against detox without a plan for ongoing medicine. The reason is a high risk of relapse and overdose.

The National Institute on Drug Abuse (NIDA) describes methadone, buprenorphine and naltrexone as effective in helping people with opioid use disorder stabilize their lives and reduce illicit drug use. Staying on medicine for the long term is a legitimate path in recovery.

At FHE Health, qualifying patients can receive Suboxone (buprenorphine with naloxone) or Vivitrol (naltrexone) during detox and residential stabilization. For people who need long-term medicine, FHE Health helps them move to an outside medical provider for ongoing care. Ask about this before detox starts, so a plan is in place.

Detox at FHE Health

True Again Care is a program of FHE Health in Deerfield Beach, Florida. FHE Health's medical detox provides 24/7 medical supervision. A team of addiction medicine physicians, registered nurses and licensed therapists manages withdrawal from alcohol, opioids including heroin, benzodiazepines, cocaine and other stimulants. The team uses medicine when needed and watches for complications.

Florida's Department of Children and Families licenses FHE Health for inpatient detoxification. CARF also accredits FHE Health's inpatient detoxification and withdrawal management program for adults.

What comes after detox

Detox alone is rarely enough for long-term recovery. Federal guidance says people should be encouraged to keep going with treatment after detox.

Next steps can include residential treatment, partial hospitalization (PHP) or intensive outpatient care (IOP). At FHE Health, the same clinical team supports you as you move between levels. Learn more about levels of care.

If you used opioids, remember that your tolerance is lower after detox. Using the amount you used before can cause an overdose.

Common questions about detox

How long does detox take?

It depends on the substance, how much and how long you used, and your health. NIAAA describes intensive inpatient care, which may manage withdrawal, as lasting several days to a week. Some symptoms, like poor sleep or mood changes, can last longer.

Can I detox at home?

Sometimes. Mild to moderate alcohol withdrawal can often be treated as an outpatient, with daily provider visits and someone staying with you. Severe symptoms, or past delirium tremens or withdrawal seizures, may call for inpatient care, so ask a medical provider first.

Will I be given medicine?

Often, but not always. It depends on the substance, your symptoms and your health. Your medical team decides what you need.

What should I tell admissions before detox?

The substances you use, when you last used, the medicines you take, your medical conditions and any past withdrawal. Honest answers help the team plan safe care. See what happens when you call.

Questions about detox?

Call (833) 596-3502 to talk with FHE Health's admissions team about what you use and what kind of care may be safe for you. FHE Health's medical staff recommend your care after an assessment.