Drug Detox FAQ

Physical addiction occurs when the body becomes dependent on a chemical in order to carry out its voluntary or involuntary activities. As the addict uses more of the drug, a tolerance to the chemical develops, meaning that the body needs larger quantities of the drug to get the desired effects. When the body and brain rely on a drug in order to function, the sudden absence of the chemical can cause tremors, loss of motor coordination, digestive disturbances, muscle spasms, and many other unpleasant side effects. To maintain a sense of stability, the brain stimulates powerful cravings for the drug and a compulsive need to obtain and use the substance. This is why addicts often end up relapsing in spite of their desire to be drug-free and healthy.

Psychological addiction is characterized by the need to continue using drugs in order to feel happy, mentally focused, or emotionally stable. But according to Psychology Today, it is difficult to separate psychological addiction from physical addiction. The same withdrawal process that causes discomfort and pain in the body also causes psychological symptoms like anxiety, restlessness, and depression if the user tries to quit too suddenly. Very few addicts experience physical withdrawal without any psychological side effects, and vice versa.

Withdrawal symptoms can vary from one drug to another. However, because many drugs target the same neurological processes and influence the production of the same brain chemicals, withdrawal symptoms are often similar. Soon after you stop using a drug — usually within 12 hours — you may experience early withdrawal symptoms such as:

• Watery eyes
• A runny nose
• Restlessness
• Cold sweats
• Frequent yawning
• Muscle cramps
• Anxiety
• Difficulty sleeping

As the hours pass, withdrawal symptoms can become more uncomfortable and more severe. The late effects of withdrawing from drugs include:

• Nausea
• Vomiting
• Diarrhea or constipation
• Stomach cramps
• Bone pain
• Depression
• Hallucinations
• Confusion
• Seizures

Unlike alcohol withdrawal, which can include life-threatening fevers, high blood pressure, delirium, and convulsion, withdrawing from drugs is usually not fatal. However, withdrawal from prescription medications in the benzodiazepine family (Ativan, Xanax, Valium, Klonopin, and other widely prescribed sedatives and muscle relaxants) can cause abnormal neurological activity, including seizures. Safe withdrawal from these drugs requires a gradual reduction of the dose to taper the user off the medication.

Drugs that alter the way the brain processes certain chemicals, such as dopamine, serotonin, adrenaline, or norepinephrine, cause withdrawal when levels of these chemicals get too low. For example, opiate pain relievers like oxycodone, hydrocodone, and hydromorphone influence the way the brain processes dopamine, a neurotransmitter that generates sensations of pleasure, contentment, and well-being. According to the Macalester College Department of Psychology, the effects of opiate abuse on the brain’s dopaminergic system are responsible for the addictive properties of these drugs, as well as the uncomfortable side effects of withdrawal. By comparison, over-the-counter pain medications like ibuprofen and acetaminophen do not cause withdrawal symptoms because they do not alter the way the brain processes neurochemicals like dopamine.

Even certain psychotherapeutic drugs that are generally considered to be non-addictive, like antidepressants, can cause withdrawal symptoms if medication usage is stopped too abruptly. These medications affect the brain’s natural levels of neurotransmitters that affect mood and energy levels.

Not all illicit drugs cause obvious physical withdrawal symptoms; however, the user may still experience intense cravings, fatigue, and an emotional crash during the withdrawal period. MedlinePlus notes that many heavy cocaine users do not experience severe physical side effects when withdrawing from the drug. Side effects like paranoia, agitation, exhaustion, and insomnia are more common with cocaine addiction.

For the user who is withdrawing from a drug, no withdrawal symptoms are worse than the ones he or she is experiencing. Methamphetamine users report severe fatigue, paranoia, nightmares, agitation, insomnia, and abnormal crawling sensations on their skin. Meth withdrawal can be painful and prolonged, lasting as long as several weeks. Cocaine abusers may suffer from serious emotional depression, often accompanied by thoughts of suicide, for months after they stop using. Even marijuana withdrawal, commonly viewed as mild compared to the effects of withdrawing from harder drugs, can cause agitation, loss of appetite, insomnia, and sleep disturbances.

Withdrawing from opiate drugs — heroin, morphine, codeine, oxycodone, hydrocodone, and other natural or synthetic drugs derived from opium-based compounds — is notoriously unpleasant. According to the University of Maryland Medical Center, these symptoms are rarely fatal; the most common complication is relapse. The discomfort of withdrawal drives many drug users back to their old habits, even if they desperately want to quit.

During detox, drugs are removed from your system so that you can think more clearly and focus on your recovery. The time that it takes to detox from drugs depends on several factors: the primary drug of abuse, the length of time you’ve been using, and any co-occurring physical or psychological health conditions.

• The University of Washington’s Alcohol & Drug Abuse Institute states that marijuana withdrawal symptoms usually begin within the first 24 hours after stopping the drug. Symptoms are at their most severe within two to three days. After one week, many users are no longer experiencing withdrawal symptoms, although some continue to have difficulty sleeping.
• The first signs of opiate withdrawal begin within six to 12 hours after stopping the drug, states the Western Journal of Medicine. These early symptoms — runny nose, teary eyes, yawning, goose bumps, and sweating — can feel like a bad cold or a case of the flu. Within two to three days, the user will feel the effects of withdrawal on the central nervous system, with symptoms like agitation, restlessness, anxiety, high blood pressure, a rapid heart rate, and muscle spasms. Within five to 10 days, most symptoms have resolved.
• For heavy cocaine users, the crash that follows cessation of the drug is almost immediate. Depression is quickly followed by anxiety, restlessness, feelings of fatigue, and an overwhelming urge to seek and use cocaine again in order to feel “normal.” Although the initial feelings of exhaustion and agitation may resolve in a matter of days, depression may continue for months after stopping the drug. Along with depression, the user may experience anhedonia, or an absence of pleasure in sober activities.
• Like many other drugs, meth withdrawal takes place in stages. Many users experience the most severe symptoms within the first day after they stop using the drug. These symptoms include paranoia, anxiety, insomnia, fatigue, and delusional thinking. Over the next 14 days or so, the user will continue to experience these symptoms, but they may become less severe. Failure to eat or sleep during meth binges can lead to intense food cravings and long periods of sleep.
• Prescription tranquilizers and sedatives. Along with opiate painkillers, prescription tranquilizers and sedatives have become some of the most widely prescribed — and widely abused — drugs in the US. Withdrawal from benzodiazepines, a class of sedatives and muscle relaxants that includes popular drugs like Xanax and Ativan, requires a medically supervised drug taper to prevent dangerous side effects, like seizures. The American Academy of Family Physicians advises that long-term users of benzodiazepines should be reduced over two or three months, or even longer in some cases.

Professional detox support can make withdrawal faster and more comfortable. In a medically monitored detox program, you can receive medications and other comfort measures to reduce withdrawal symptoms and help clear the drugs from your system more quickly.

A relapse is a return to drug abuse after the user has made a commitment to quitting. Relapse is extremely common among drug abusers; in fact, slipping back into drug use is the rule rather than the exception. For example, the Foundation for a Drug-Free World notes that 93 percent of meth users relapse after finishing treatment, usually because they can’t tolerate the severity of withdrawal or the intensity of their cravings. Although there are many potential causes and triggers for a relapse, the following situations make the addict especially vulnerable:

• Trying to go through withdrawal without the support of a medical detox program
• Dropping out of detox or rehab before completing the program
• Having a co-occurring mental illness, such as anxiety or depression, which isn’t addressed in treatment
• Lack of a strong support system in the community
• A return to your old lifestyle without the right skills for coping with emotional or situational triggers

Today, most addiction treatment specialists focus on preventing relapse and reducing the severity of a slip after treatment. If a relapse does occur, you should have resources at your disposal to help you get back on track, such as access to a counselor, sponsor, support group, or alumni organization.

A detox program is a formal, professionally administered plan to help the drug user safely clear the chemicals from his or her body with minimal discomfort. Medical detox programs include intensive monitoring by clinical personnel, as well as pharmaceutical therapy to reduce the symptoms of withdrawal and prevent the likelihood of relapse after treatment. Non-medical detox programs focus on behavioral modification rather than pharmaceutical intervention. Patients in non-medical detox may receive fluid replacement or nutritional supplementation, but they do not receive detox medications.

Detox programs are offered in a variety of settings, including hospitals, dedicated rehab centers, outpatient clinics, community health centers, and correctional facilities. Publicly funded detox programs are offered at little or no charge, while private detox centers may accept private payment or health insurance.

There are many possible approaches to drug detox, ranging from do-it-yourself detox using nothing but home remedies to state-of-the-art detox programs that include pharmaceutical therapy and 24-hour monitoring. Listed below are a few of the most commonly used detox options:

• Quitting cold turkey. The only advantage to quitting drugs cold turkey is that you can save money on the cost of a detox program; however, this is probably the most dangerous and least effective way to break free from addiction. Without medical supervision, you could be at risk of changes in blood pressure, seizure activity, convulsions, hallucinations, confusion, and other serious side effects of withdrawal. For many people who try to detox alone, the cravings, agitation, depression, and anxiety cause a relapse before they’ve completed the withdrawal process.
• Home detox kits. Home detox kits, available at drugstores, health food stores, and online, contain a combination of herbs, vitamins, and minerals that supposedly help you flush drugs from your system. Many users purchase these kits in the hope of clearing drugs like marijuana from their system before a urinalysis. But according to Columbia University, home kits are rarely effective. For the user who’s serious about leading a drug-free life, a home detox kit can’t cause the behavioral changes or psychological transformation that are necessary for long-term sobriety.
• Outpatient detox programs. Outpatient detox programs are conducted at clinics, private doctors’ offices, rehab facilities, mental health centers, and other locations within the community. These programs allow patients to receive medical monitoring by doctors or nurses during business hours, and to take detox medications under supervision while living at home or in a transitional housing situation. Outpatient detox is appropriate for patients who are motivated to keep their appointments and adhere to the requirements of the program without extensive supervision or structure.
• Inpatient detox. Inpatient detox programs provide intensive monitoring, pharmacotherapy, and 24-hour supervision for drug users who are at risk of serious side effects or relapse. In an inpatient program, patients stay on site while they undergo treatment. In order to provide continuity of care, an inpatient detox program may transition to a full rehab program within the same residential treatment facility.
• Holistic detox programs. Holistic detox programs draw from a variety of alternative or complementary therapies, as well as traditional medical approaches, to detoxify the mind and spirit as well as the body. A holistic detox program may include nutritional counseling and spiritual support, as well as complementary detox therapies like massage, acupuncture, or yoga. Herbal remedies may be combined with conventional Western medicine to provide the best outcome.
• Sub-acute detox. Sub-acute detox programs may be offered through an inpatient treatment facility, such as a hospital or rehab center, or at an outpatient clinic. Sub-acute detox is recommended for patients who are generally in good physical and mental health, and who are currently medically stable. This level of treatment is appropriate for patients who don’t require 24-hour supervision and who are committed to a recovery program. Medication and counseling may be provided as part of the program.
• Medical detox. This level of detox is often conducted on an inpatient basis; however, intensive outpatient programs may offer medical detox, as well. A medical detox program is appropriate for patients who need pharmaceutical therapy as well as other clinical services, such as medical monitoring, IV fluid replacement, or nutritional support. According to the S. Department of Health and Human Services, the primary purpose of medical detox is to ensure that the patient remains safe and stable during withdrawal, avoiding seizures, delirium, and other life-threatening side effects.

Detox medications address the two primary challenges of early recovery: the management of withdrawal symptoms and the prevention of relapse. Some detox medications can facilitate the detoxification process by helping the patient remain drug-free while the chemicals are flushed from the body. Other medications address the symptoms of withdrawal, such as nausea, headaches, fevers, muscle pain, anxiety, or high blood pressure. Medications are prescribed by a licensed health care provider as part of a detox program.

• Anti-anxiety medications. Sedatives in the benzodiazepine family may be prescribed on a short-term basis to help reduce the anxiety, restlessness, and muscle spasms associated with drug withdrawal. Because these drugs have the potential to be addictive, their use should be limited and carefully monitored.
• Medications for alcoholism. There are several medications used in the treatment of alcohol addiction. The oldest of these drugs, disulfiram, discourages alcohol abuse by causing unpleasant side effects when the user is exposed to any product containing alcohol. Newer medications, including acamprosate and naltrexone, work by blocking the pleasurable effects of drinking rather than by causing an aversion to alcohol.
• Drugs for opiate abuse. For centuries, pharmacists have worked to develop drugs that could resolve the problem of opiate abuse. Ironically, heroin was proposed as a cure for morphine addiction in the late 1890s. Since the 1960s, the most popular detox medication for opiate addiction has been methadone, a synthetic opiate that helps the user manage cravings and avoid relapse. Two other drugs, buprenorphine and naltrexone, have also been used to help opiate addicts get through the detox process and stay on track with their recovery program.
• Drugs to alleviate secondary withdrawal symptoms. A number of prescription drugs and over-the-counter medications can be prescribed to relieve physical withdrawal symptoms, such as nausea, diarrhea, headaches, or muscle pain. These drugs make it easier to cope with the side effects of withdrawal, so you can move into the next phase of recovery.

Drug users who show the signs of chemical dependence or addiction can benefit from drug detox. You don’t have to be acutely intoxicated to go through detox, although many patients are still under the influence of drugs when they start the process. If you feel unstable, unfocused, anxious, or depressed when you can’t use drugs, or if you have physical withdrawal symptoms when you try to stop using, you can improve your chances of a successful recovery through a professional detox program.

Detox is only the beginning of a long but gratifying journey toward recovery. One of the goals of detox is to prepare the patient for the next step in the rehab process. After completing a detox program, which may last from two or three days to two or three weeks or more, the patient is introduced to a more advanced stage of recovery, which includes services like individual therapy, group therapy, family counseling, 12-step programming, relapse prevention training, behavioral modification, and life skills classes. This phase may take place at a residential treatment center, outpatient facility, or through a partial hospitalization program.

Ideally, detox should be part of a continuum of care rather than an isolated process. As part of your detox program, you should have access to an intake counselor, case manager, or discharge planner who can help you transition to the next phase of treatment. Many programs transition to the next phase of treatment within the same facility, reducing the risk of relapse and encouraging the patient to continue. If you haven’t received counseling on further treatment options, contact a therapist, social worker, or admissions specialist at a drug treatment center to find out how you can enroll in the next phase of rehab.