Detox: What to Expect

What detox is

Detox (also called withdrawal management) helps your body get through withdrawal safely after you stop drinking or using. SAMHSA describes three parts: an evaluation of your health, help getting stable, and getting you ready to start treatment.

Detox is a strong first step, but it is not the whole plan. Federal health agencies say detox on its own is not enough to help most people stay in recovery. The real work starts with the care that follows.

Medical detox vs. social detox

• Medical detox: doctors and nurses watch you and can give medicine to ease symptoms and keep you safe.
• Social detox: a supportive, non-hospital setting with staff and peers, and little or no medicine. SAMHSA says it should still check vital signs and have quick access to emergency care.
• Social detox is not a good fit if you have had severe withdrawal before, or if each withdrawal has been worse than the last. If you drink heavily or take benzodiazepines, ask a doctor which setting is safe for you.

How long withdrawal usually lasts

Everyone is different. Your amount, how long you have used, your health, and other substances all matter. These are general ranges from medical sources, not a promise.

• Alcohol: symptoms often start within 6 to 24 hours after the last drink and usually peak at 24 to 72 hours. Shakes, sweating, anxiety, nausea and poor sleep are common. Seizures most often happen in the first 48 hours. A severe form called delirium tremens (DTs) can cause confusion, fever and hallucinations, and can be deadly. Sleep and mood can stay off for months.
• Opioids (heroin, pills, fentanyl): with heroin, symptoms usually start within 12 hours; with methadone, within about 30 hours. Fast-acting opioids may cause symptoms for 4 to 5 days; methadone can take a week or longer. Expect aches, runny nose, sweating, cramps, vomiting and diarrhea. It feels awful but is usually not life threatening. Tell the team exactly what you use, including fentanyl.
• Benzodiazepines (Xanax, Klonopin, Valium and others): never stop suddenly on your own. The FDA warns that stopping fast can cause seizures that can be life threatening. Seizures have been reported 1 to 12 days after stopping. Some people have symptoms for weeks or even months. A doctor can plan a slow taper.
• Stimulants (meth, cocaine): the crash brings tiredness, low mood, big appetite, vivid dreams and strong cravings. It is usually not physically dangerous, but depression can be deep, and cravings and low mood can last for months. If you have thoughts of suicide, call or text 988 right away.

Get emergency help now

Alcohol and benzodiazepine withdrawal can be dangerous. Call 911 if you or someone with you has any of these:

• A seizure
• Fever, severe confusion, or seeing or hearing things that are not there
• An irregular or racing heartbeat
• Vomiting or diarrhea so bad you cannot keep fluids down
• Thoughts of suicide (call or text 988, or call 911)
• Signs of overdose: will not wake up, slow or no breathing, blue or gray lips

What to bring

Call the program first and ask what is allowed. Rules differ.

• Photo ID and insurance or Health First Colorado card
• A list of all your medicines and doses, plus the medicines in their original bottles if the program asks
• Important phone numbers written on paper
• Comfortable clothes for several days, socks, and a warm layer
• Basic toiletries (ask which products are allowed)
• A little cash for vending or a phone card
• A book, journal or something calm to do

What happens after detox

Right after detox is a risky time. If you used opioids, your tolerance drops fast, and most opioid overdose deaths happen in people who have just detoxed. A plan for the next step helps keep you safe.

A good detox helps you set up that next step before you leave. Options include residential treatment, a partial hospitalization program (PHP), an intensive outpatient program (IOP), regular counseling, sober living, and recovery meetings.

Ask about medicine too. For opioid use disorder, the FDA has approved methadone, buprenorphine and naltrexone. For alcohol use disorder, naltrexone, acamprosate and disulfiram are approved, and NIAAA notes these medicines are not addictive.

Questions to ask a detox program

• Is a nurse or doctor on site 24 hours a day?
• Do you use medicine to ease withdrawal?
• Can you start or continue buprenorphine or methadone?
• Do you take my insurance or Health First Colorado? What will I owe?
• How long do people usually stay?
• Can you help with mental health needs?
• Will you help set up my next level of care before I leave?
• Can my family call or visit?