If you are addicted to alcohol, pills, or illegal drugs, the first step toward recovery is detox. Also called detoxification or withdrawal, detox is the process of clearing the substance from your body.
There are two main ways to detox: cold turkey and tapering. In many cases, you can pair either method with prescription medicine designed to ease withdrawal symptoms and/or prevent relapse.
Cold Turkey vs. Tapering
With some substances, an abrupt stop can be dangerous. Most addiction experts caution against the cold turkey approach. They suggest tapering, or slowly weaning off the drug, instead.
Substances that can be dangerous to stop cold turkey include:
- Opioids, such as OxyContin (oxycodone), fentanyl, and heroin
- Benzodiazepines (or “benzos”), such as Xanax (alprazolam) and Valium (diazepam)
With heroin and alcohol, doctors won’t give you these substances to wean you off them. You will get prescription drugs that act in the body like heroin or alcohol in order to ease withdrawal symptoms. Your health care providers will then taper you off these medications.
The taper period varies depending on how long you’ve been using the drug and how much you’ve been taking. You should expect to gradually lower your dose over a period of several weeks or even a few months.
If you are heavily addicted to any of the above substances and try to stop cold turkey, you may experience uncomfortable and dangerous withdrawal symptoms, such as rapid heart rate, hallucinations, and seizures.
Where to Detox
Drug addiction, also called substance use disorder, is a mental health problem. It has both physical and psychological effects. For that reason, detoxing on your own, without any guidance or supervision, is generally not wise.
Still, you can choose to go through detox in a variety of settings. You may choose your home or outpatient or inpatient rehab. The right option for you depends on many factors, such as:
- The substance you use
- The degree of your addiction
- Whether you have a history of severe withdrawal symptoms
- Whether you have other health problems
When in doubt, talk to your doctor or an addiction specialist about the best choice for you.
If you’re not sure where to start, call the Substance Abuse and Mental Health Services Administration (SAMHSA) helpline at 1-800-662-HELP (4357). It’s a free, confidential service that anyone can use to get information about substance abuse treatment.
Detox at Home
Some people prefer to detox in the comfort of their own home. This option might also seem preferable if you don’t have insurance and can’t pay for a treatment program.
The catch is that detox at home generally means going it alone. You won’t have a professional to guide or supervise you. You also may not have the option of using medication to make the process easier. Not all of the medications doctors use for detox are available to take on your own at home. People who detox at home (and don’t follow it with an appropriate substance abuse treatment program) may be more likely to relapse. They also face a higher risk of overdose if they relapse. That’s because once the drugs are out of your system, your body won’t be able to tolerate the same amount as before.
At-home detox may be OK if you’re otherwise healthy and haven’t been using drugs for very long. If you believe it’s your best option, get a doctor to review your situation and approve the plan before you start. At the very least, you should arrange to have family or friends supervise you through the process.
You should certainly go to the emergency room (ER) anytime you’re having serious withdrawal symptoms like difficulty breathing, rapid heart rate, or seizures. But, heading to the ER to detox isn’t necessarily the best plan. Many emergency rooms are not prepared to treat addiction. If you simply show up and you’re not having a medical emergency, they might just refer you to a local substance abuse treatment center.
But it may be possible to detox in a hospital without going through the ER. In recent years, as the opioid epidemic has exploded, more hospitals have expanded their addiction services. Some prescribe buprenorphine, a narcotic that eases the symptoms of opioid withdrawal without making users feel “high.” In this case, your primary doctor would have to admit you. Talk to your doctor about whether hospital detox would be right for you.
Outpatient detox help can take many different forms. Some people who don’t require a lot of supervision might simply check in with their regular doctor’s office or a home health agency at scheduled intervals during their detox. Others might get check-ins from nurses. Some people attend a daytime program at a hospital or substance abuse treatment facility but go home at night.
The main benefit of an outpatient detox program is that you get to stay in your own home but still have professional support. Outpatient programs also tend to be less expensive than inpatient ones.
Outpatient care, also called ambulatory care, might include medication-assisted withdrawal to make the process easier. If you’re detoxing from opioids, you might get Methadone or buprenorphine. If you’re quitting alcohol, you might get naltrexone.
The main downside of outpatient programs is that they don’t provide 24/7 support and monitoring.
Some inpatient detox programs rely on peer support along with some medical care. Others may include complete medical monitoring with doctors and nurses available at all hours.
Inpatient medically monitored programs tend to be the most expensive option. But, if you don’t have insurance or the money to pay for this type of care, some inpatient detox programs serve people who can’t pay.
Intensive inpatient medical rehabs offer the highest level of care and monitoring. These programs can keep you safe and medically stable while you taper off dangerous drugs.
After a program like this, you might transfer to a residential facility with less supervision or a fully outpatient program after you’ve gone through detox and your health is stable.