Drug detoxification (detox): definition, duration, process, and side effects

Drug detoxification (detox) is the process of safely removing toxic substances, such as drugs or alcohol, from the body. Its primary goal is to manage withdrawal symptoms and the negative impact that occurs when someone seizes the use of these substances. Detox is typically the first step in addiction treatment and is often followed by further therapy and support to help individuals achieve long-term recovery. 

The duration of drug detox lasts from several days to weeks, depending upon factors like the specific drug, severity of dependence, individual factors, and type of detox program i.e., inpatient or outpatient.    

The process of detoxification comprises evaluation, stabilization, and fostering entry into treatment. Evaluation includes substance testing, measuring concentrations, and screening for co-occurring conditions to determine post-detox treatment. Stabilization involves medical and psychosocial support through intoxication and withdrawal to achieve a stable, substance-free state. Fostering entry into treatment prepares patients for further care, often using a written contract to encourage engagement. Compassionate treatment is essential, ensuring patients feel supported and hopeful. Familiarizing patients with treatment and involving their support network is crucial for successful recovery.

The side effects of detox include cravings for drugs, physical symptoms, mental symptoms, digestive issues, and sleep disturbances. These side effects vary in intensity depending on the individual and the substances involved.

What is drug detoxification (detox)?

Drug detoxification is the safe and effective process of helping a person eliminate the toxins produced by the drug they have used, aiming to reduce the physical harm caused by the substance. It includes a range of medically assisted interventions to manage acute intoxication and withdrawal in individuals who are acutely intoxicated or dependent on substances of abuse.

The drug detoxification process varies for each individual based on their specific needs. Drug detoxification is valuable for individuals with a substance abuse disorder as it helps them manage the withdrawal symptoms, which are typically the most physically and mentally challenging aspects of recovery.

The book “Detoxification and Substance Abuse Treatment: A Treatment Improvement Protocol TIP 45” by the Substance Abuse and Mental Health Services Administration (SAMHSA) last revised in 2015, and published by the U.S Department of Health and Human Services, explains that supervised detox helps prevent severe complications that arise if left untreated. It serves as a form of supportive care for individuals seeking abstinence or those required to abstain due to hospitalization or legal reasons. It is a starting point for many people on the path to recovery.

How long does drug detoxification take?

Drug detoxification takes between several days to a few weeks. It depends upon the type of substance being abused, the level of dependence, and the available support for the individual as discussed in the article “Pharmacological Strategies for Detoxification” authored by Alison M Diaper et al., published in the British Journal of Clinical Pharmacology in 2014.

Drug detoxification duration is influenced by the amount and frequency of substance use. Higher doses and more frequent use prolong the process of eliminating the substance from the body. The presence of mental health issues influences the duration of detox. It’s important to recognize that detox is only the first step in treating the physical symptoms of drug addiction, and recovery is a continuous process that involves addressing the psychological impact of addiction as the patient progresses forward in the treatment.

Drug detox marks the initial phase of substance use treatment, with the duration varying based on the setting, such as inpatient or outpatient. Inpatient detox programs provide round-the-clock support under the guidance and supervision of medical professionals, while outpatient detox is typically conducted at a patient’s home or in an office setting.

After treating the initial withdrawal symptoms and stabilizing the patient, patients still experience residual symptoms called post-acute withdrawal syndrome (PAWS). The duration to resolve PAWS takes weeks, months, or years after withdrawal, as outlined in the article “Identification and Evidence-Based Treatment of Post-Acute Withdrawal Syndrome” by Brittany Haskell, published in The Journal for Nurse Practitioners in 2022.

How long does alcohol detox take?

Alcohol detox takes an average of 6.5 days in an outpatient setting while it takes 9 days in an inpatient detox according to the article “An Overview of Outpatient and Inpatient Detoxification” by Motoi Hayashida, published in the journal Alcohol Health and Research World in 1998. The initial assessment and treatment initiation on the first day usually take 1 to 2 hours, with subsequent sessions lasting 15 to 30 minutes. Inpatient care, on the other hand, involves admission to a facility for 5 to 14 days.

Withdrawal symptoms vary from mild to severe, depending on the severity of alcohol use disorder (AUD). Alcoholic addiction causes withdrawal symptoms including headache, fever, nausea, irregular heartbeat, and hallucinations when you stop drinking. These symptoms worsen quickly and are managed by professionals at a rehab facility using medications to manage pain and help with recovery. Severe symptoms include tremors, seizures, extreme hallucinations, disorientation, and, in rare cases, delirium tremens. Medical monitoring during alcohol detox is important, especially for those with pre-existing health conditions, to track vital signs and provide appropriate medication for discomfort.

How long does heroin (opioid) detox take?

Heroin (opioid) detox takes approximately a week, with the most severe withdrawal symptoms peaking around the second or third day after the last use of heroin. However, the duration and intensity of withdrawal vary depending on factors like the duration and dosage of heroin use, how it was consumed, and any underlying health issues.

 As discussed in the article “Pharmacologic treatments for opioid dependence: detoxification and maintenance options” by Herbert D. Kleber, published in the journal Dialogues in Clinical Neuroscience in 2007, heroin withdrawal typically begins with anxiety and craving 8 to 12 hours after the last dose. Symptoms peak between 36 and 72 hours, and significantly diminish within 5 days. Methadone withdrawal, on the other hand, begins later, at 24 to 36 hours, peaks at 96 to 144 hours, and lasts for weeks. Heroin addiction is a serious issue that requires comprehensive treatment and support to overcome.

How long does cocaine (stimulant) detox take?

Cocaine (stimulant) detox takes 1–2 weeks after the last use. Once the acute withdrawal phase is over, individuals encounter protracted withdrawal symptoms for a period of 1-2 months, as detailed in the 2019 article “Dependence, withdrawal, and rebound of CNS drugs: an update and regulatory considerations for new drugs development” by Alicja Lerner and Michael Klein in the Brain Communications Journal. 

Additionally, cocaine addiction causes withdrawal symptoms such as cravings, fatigue, agitation, muscle aches, vivid nightmares, aches and pains, and hallucinations. Individuals who consume high doses of stimulants, especially methamphetamine, experience psychotic symptoms like paranoia, and disorganized thoughts. This leads to potential risk of self-harm to oneself and others.

How long does marijuana detox take?

Marijuana detox takes up to 2-3 weeks or even longer. The withdrawal symptoms begin 24-48 hours after cessation and peaks between 2-6 days, as described in the article “Clinical management of cannabis withdrawal” by Jason P. Connor et al., published in 2022 journal Addiction. The duration and intensity of marijuana withdrawal are linked to the amount of marijuana consumed before stopping.   

Marijuana addiction withdrawal symptoms, including irritability, anxiety, sleep issues, decreased appetite, and restlessness, vary in duration and intensity based on usage. Inpatient detox reduces relapse risk by providing support and restricting access to substances.

How long does benzodiazepine detox take?

Benzodiazepine detox takes 10-14 days as outlined in the article “The benzodiazepine withdrawal syndrome” authored by H Pétursson, published in the journal Addiction in 1994. The most common withdrawal pattern includes a short-lived “rebound” anxiety and insomnia, typically appearing within 1-4 days of discontinuation, depending on the half-life of the specific drug. The second pattern involves a complete withdrawal syndrome lasting around 10-14 days. A third pattern is characterized by the return of anxiety symptoms persisting until treatment is initiated.   

Benzodiazepine addiction causes the brain to become both physically and psychologically dependent on them. Withdrawal symptoms occur when benzos are removed from the client’s bloodstream, and the intensity and frequency of these symptoms stretch the detoxification period.

How long does hallucinogen detox take?

Hallucinogen detox takes a few hours to a few days or even months, depending on the specific hallucinogenic substance involved. According to the article “Clinical Applications of Hallucinogens: A Review” by Albert Garcia-Romeu et al., published in the journal Experimental and Clinical Psychopharmacology in 2016, the subjective effects of a lysergic acid diethylamide (LSD), a hallucinogen lasting up to 12 hours in humans, with repeated use, LSD leads to rapid tolerance, and there is no evidence of withdrawal symptoms associated with its discontinuation. The article states that its effects lead to disorientation, anxiety, and feelings of dying, known as a “bad trip,” which typically resolve within 12 hours. In rare cases, ongoing psychotic symptoms and psychological issues have been reported. The article further explains that hallucinogens cause lasting perceptual distortions known as hallucinogen-persisting perception disorder (HPPD), where individuals experience recurring altered perceptions even after the drug’s effects have faded, sometimes lasting for weeks, months, or longer. 

Hallucinogens addiction treatment typically involves detoxification by discontinuing the drug and using medications to manage withdrawal symptoms.

How long does barbiturate detox take?

Barbiturate detox takes one to two weeks, characterized by withdrawal symptoms. Severe withdrawal symptoms, such as seizures and delirium, occur between 24 and 115 hours after discontinuing barbiturates, as described in the article “Alcohol, barbiturate and benzodiazepine withdrawal syndromes: clinical management” by Edward M. Sellers, published in the Canadian Medical Association Journal in 1998.   

Medical supervision is essential during barbiturate detox to manage withdrawal symptoms, particularly life-threatening ones such as seizures. It’s strongly advised against attempting barbiturate withdrawal without medical care due to the severity of potential symptoms.

What is the process of drug detoxification?

The process of drug detoxification is a multi-stage process aimed at safely managing withdrawal symptoms associated with stopping drug use. The book “Detoxification and Substance Abuse Treatment” by the Substance Abuse and Mental Health Services Administration (SAMHSA) last revised in 2015, published by the U.S Department of Health and Human Services has described the drug detoxification process as consisting of three key components namely, evaluation, stabilization, and the patient’s transition into treatment.  

Testing for drugs in the blood, monitoring their levels, and searching for further health issues are all part of the evaluation process. It includes a detailed look at the patient’s medical, mental, and social situation to decide on the right treatment after detox. A healthcare provider does a thorough check to see how dependent the person is on drugs, what drug withdrawal symptoms they have, and if there are any other health issues.

Stabilization helps the patient safely get through the effects of intoxication and drug withdrawal until they are physically stable and drug-free. This involves using medications, but detox methods don’t use any. Stabilization involves educating patients about the treatment process and their part in it. Practitioners involve the patient’s family, employers, or other important people if it’s appropriate and with the patient’s permission.

Preparing the patient for entry into substance abuse treatment involves emphasizing the importance of completing the entire treatment plan. For patients who have completed detox but not continued with treatment, a written treatment contract encourages them to engage in ongoing care. This contract, which is voluntary and not legally binding, is signed by patients when they are stable at the start of treatment. It outlines their agreement to participate in a continuing care plan, which includes details and contacts established before detoxification is completed.

What are the side effects of drug detoxification?

The side effects of drug detoxification are listed below.

• Cravings for drugs: It occurs when the body and brain adjust to the absence of a substance, leading to strong urges to use it again. Cravings are triggered by environmental factors, such as places or people linked to drug use, stressors like work pressure or relationship issues, and emotional states like feeling sad, lonely, anxious, or bored.
• Physical symptoms: Physical symptoms include headaches, nausea, vomiting, constipation, diarrhea, loss of appetite, muscle aches, sweating, tremors, fatigue, increased heart rate, fever and chills. The severity of these symptoms vary based on the substance, duration of use, and individual factors. 
• Mental symptoms: Drug detoxification leads to mental symptoms like anxiety, depression, irritability, mood swings, emotional dysregulation, confusion and disorientation.
• Digestive issues: Digestive issues are a common side effect of drug withdrawal. Symptoms such as diarrhea, constipation, nausea, and stomach cramps occur as the body adjusts to the absence of the substance it has become dependent on. These digestive issues are uncomfortable but are usually temporary as the body detoxifies and stabilizes. 
• Sleep disturbances: Sleep disturbances, such as difficulty falling or staying asleep, or experiencing restful sleep, are common during detox. These issues result from changes in brain chemistry, heightened anxiety or stress, or physical discomfort from withdrawal symptoms. Sleep problems affect mood, energy levels, and overall well-being during detox.

What are the types of drug detoxification?

The types of drug detoxification are listed below.

• Medical detox
• Social model detox

1. Medical detox

Medical detox is a drug detox program that uses prescription medication to aid in the detoxification process and alleviate withdrawal symptoms. Medical detoxification is conducted in a medical facility or rehabilitation center under the care of medical professionals to provide close monitoring. It is the safest and most effective approach. The 2015 article “Alcohol Withdrawal Syndrome: Benzodiazepines and Beyond” authored by Ankur Sachdeva et al, published in the Journal of Clinical & Diagnostic Research discusses benzodiazepines used in alcohol detoxification. It mentions chlordiazepoxide, diazepam, lorazepam, and oxazepam as common medication choices. The article suggests long-acting agents like diazepam and chlordiazepoxide, with their longer half-lives (up to several days), provide smoother treatment without the risk of late withdrawal symptoms such as seizures.

Medically-assisted detoxification restores the body to a normal state by blocking the euphoric effects of substances such as alcohol and opioids, thereby reducing cravings. This approach allows patients to undergo detox comfortably, with a focus on safety and medical support during withdrawal. Additionally, medically-assisted detox provides the opportunity for additional treatment of comorbidities (underlying conditions) and offers support from peers and medical personnel, reducing the risk of early relapse. Once withdrawal symptoms subside, the focus shifts to the patient’s overall well-being, including their mind, body, and spirit. The treatment center provides ongoing support for substance abuse and mental health throughout the recovery journey.

2. Social model detox

Social model detox refers to non-medical and short-term treatment services for people seeking help for substance use disorders, as defined in the book “Detoxification and Substance Abuse Treatment A Treatment Improvement Protocol TIP 45” by Substance Abuse and Mental Health Services Administration (SAMHSA), published by the U.S Department of Health and Human Services. These programs offer accommodations, meals, and emotional support to individuals who are intoxicated or going through substance withdrawal. Social detoxification programs vary from individual to individual. Onsite or inpatient treatment offers 24/7 treatment services under the supervision of doctors and nurses, while outpatient treatment allows individuals to receive medical and nursing evaluation through outpatient clinics without staying overnight at a facility. Patients visit the clinic for appointments and treatment sessions but return home afterward, continuing their daily activities outside of treatment.  

Certain social detoxification programs provide basic room and board for a “cold turkey” detoxification, while others oversee the use of medications. In certain cases, healthcare professionals prescribe medications in an outpatient setting at the start of withdrawal, with program staff supervising their administration. Regardless of the approach, medical surveillance, including vital sign monitoring, is always part of every social detoxification program.

When is drug detox necessary?

Drug detox is necessary when an individual has developed a physical dependence on a drug and needs to safely manage withdrawal symptoms as they stop using the drug. Abrupt cessation of drug use triggers withdrawal symptoms, highlighting the importance of drug detoxification to manage these symptoms in a safe environment. Several signs indicate the need for drug detox, including mood changes, physical withdrawal symptoms, increasing tolerance, intense cravings, unsuccessful past attempts to quit, and other medical issues or pregnancy. Seeking help from a healthcare professional or a detox program is advisable for a safe and effective detox process.

Safety is a major concern, particularly with substances like alcohol and benzodiazepines, which lead to life-threatening complications if detox is not managed properly. For individuals struggling to quit drugs independently, a structured detox program offers crucial support. In conclusion, drug detox is essential for those seeking to quit drugs safely, providing the necessary medical supervision and support to manage withdrawal symptoms and begin the path to recovery.

A 2022 study published in the American Journal of Physiology, Biochemistry and Pharmacology by Donne Dennis titled “Factors of Drug Dependent Patients in Detoxification” highlights the critical role of medically supervised drug detox for individuals struggling with severe withdrawal symptoms.

This research emphasizes that abruptly stopping certain drugs, especially alcohol, opioids, and benzodiazepines, triggers life-threatening withdrawal symptoms. Detoxification programs provide a safe environment with medication and therapies to manage these symptoms effectively and minimize discomfort and complications.

Is it safe to detox at home?

Yes, it is safe to detox at home for individuals with mild to moderate substance use disorder, as long as they are in good overall health and have a strong support system in place. Detoxing at home is effective for substances with less severe withdrawal symptoms, such as cannabis or mild stimulants. However, for individuals with severe addiction or for substances like alcohol or benzodiazepines that pose dangerous withdrawal symptoms, detoxing at home is risky and is not recommended without medical supervision.

The research article “DETOXIFICATION FROM ALCOHOL: A COMPARISON OF HOME DETOXIFICATION AND HOSPITAL-BASED DAY PATIENT CARE” by Carole Allan et al., published in the journal Alcohol and Alcoholism in 2000, indicates that after 60 days, 45% of the home detoxification group showed significant improvements. However, the study underscores the need for additional research to establish guidelines for matching patients with the most suitable detoxification service.

What is tapering off drugs?

Tapering off drugs refers to the gradual reduction in the medicine dose of a drug an individual is using. Tapering off drugs helps to minimize the risk of cravings and severe withdrawal symptoms. It is done under the protected and controlled supervision of a medical professional. They conduct tests and monitor vital signs during the tapering process to ensure safety. Tapering off is a gradual process that requires patience and adherence to medical advice.

In their 2021 research paper titled “A Method for Tapering Antipsychotic Treatment That  Minimize the Risk of Relapse” by Mark Abie Horowitz et al., published in the journal Schizophrenia Bulletin, recommends gradual tapering of antipsychotics to reduce the risk of relapse. Their study suggests that longer tapering periods result in lower relapse rates compared to shorter, more rapid tapering periods.

What is quitting drugs cold turkey?

Quitting drugs cold turkey refers to the abrupt stoppage of substance use without any tapering or reduction in dosage. While quitting drugs “cold turkey” is sometimes viewed as a direct and immediate method to address addiction, it poses substantial risks and is generally discouraged by healthcare professionals.

Quitting drugs cold turkey is dangerous especially for substances like alcohol, benzodiazepines, and opioids, that leads to severe withdrawal symptoms. For people with a long history of heavy drug use, quitting cold turkey is overwhelming and increases the risk of relapse due to the intensity of withdrawal symptoms.

The study “Gradual Versus Abrupt Smoking Cessation: A Randomized, Controlled Noninferiority Trial” by Nicola Lindson-Hawley et al., published in the journal Annals of Internal Medicine, highlights the effectiveness of abrupt smoking cessation, or “cold turkey,” compared to gradual reduction in cigarette consumption before a planned quit date. The research involving nearly 700 smokers showed that 22 percent of those who quit cold turkey remained smoke-free six months after their quit date, whereas only 15.5 percent of those who gradually cut back achieved the same outcome.

What are the drugs that require medically-supervised detox?

Several drugs require medically-supervised detox due to the severity of withdrawal symptoms and potential complications.

The drugs that require medically-supervised detox are listed below.

• Alcohol: Alcohol withdrawal is dangerous and even life-threatening, with symptoms ranging from tremors and anxiety to seizures and delirium tremens (DTs). Medically-supervised detox helps manage these symptoms safely and effectively using medications and supportive care.
• Benzodiazepines: In a 2021 research article titled “Benzodiazepines: Uses, Dangers, and Clinical Considerations” by Amber N. Edinoff et al., published in the Neurology International Journal, it was found that regular benzodiazepine (BZD) use leads to significant psychological and physical dependence. The withdrawal process is associated with symptoms like increased excitability, nightmares, delirium, panic attacks, hallucinations, paranoid thoughts, seizures, numbness, altered sensation of limbs, and tremors. Due to the potentially life-threatening nature of these withdrawal symptoms, benzodiazepine withdrawal is considered one of the most dangerous drugs to get detoxified from.
• Opioids: Withdrawal from opioids is indeed known for its severity and include symptoms like stomach cramps, aches and pain, feeling cold and runny eyes, as detailed in the chapter “Withdrawal Management” in the book Clinical Guidelines for Withdrawal Management and Treatment of Drug Dependence in Closed Settings published by the World Health Organization in 2009.
• Barbiturates: Detoxification from barbiturates typically involves a gradual tapering of the drug under medical supervision to minimize withdrawal symptoms and reduce the risk of complications. In cases where withdrawal symptoms are severe, medications are used to manage symptoms and prevent seizures.    
• Stimulants: Stimulants like cocaine and methamphetamine lead to intense withdrawal symptoms, including depression, fatigue, and increased appetite, which require medical supervision for management.

What is a detoxification center?

A detoxification center is a structured facility that offers medical care, supervision, and support to individuals undergoing withdrawal from addictive substances. These centers provide a safe environment for individuals to stop the use of drugs or alcohol. The level of care and services at detox centers varies based on the individual’s medical necessity. There are either inpatient or outpatient providers, with inpatient centers offering 24-hour medical assistance and supervision by healthcare professionals, and outpatient centers allowing individuals to attend treatment sessions during the day and return home at night.

Detox center programs play a vital role in guiding individuals safely through the withdrawal process, helping them manage symptoms, and preparing them for continued treatment or rehabilitation. Detox programs include counseling, therapy, and other support services to address the root causes of substance use.

What is the difference between inpatient vs outpatient detoxification?

The difference between inpatient vs outpatient detoxification lies in the intensity of care and supervision. Inpatient detox takes place in a hospital or residential facility while in outpatient detox, patients live at home and attend treatment sessions at scheduled times, allowing them to continue with their daily activities.  

The book “Detoxification and Substance Abuse Treatment: A Treatment Improvement Protocol TIP 45” by the Substance Abuse and Mental Health Services Administration (SAMHSA) last revised in 2015, published by the U.S Department of Health and Human Services explains in detail that in inpatient setting, physicians are available to assess the patient within 24 hours of admission and treatment services are provided 24/7, with daily monitoring to ensure the patient’s well-being and progress. The outpatient detox programs typically involve regular visits to a clinic or healthcare facility for medical monitoring, counseling, and support. Both outpatient and inpatient detoxification aim to safely manage withdrawal symptoms, minimize the risk of relapse, and prepare individuals for continued treatment and recovery.

Another article “National trends and characteristics of inpatient detoxification for drug use disorders in the United States” authored by He Zhu and Li-Tzy Wu, published in the journal BMC Public Health in 2018, compares the cost of treatment in different settings suggesting inpatient detoxification offers intensive medical care at a higher cost as compared to outpatient detox.

The duration of inpatient and outpatient detox treatment varies depending on individual needs and addiction history. Inpatient detoxification programs focus on detoxing from severe withdrawal symptoms and typically last for several days to months, with longer stays. Outpatient detox is suitable for those with mild to moderate withdrawal symptoms and span a few days to a few weeks. Although, transition from inpatient to outpatient treatment depends on the individual’s progress.

Motoi Hayashida’s article “An Overview of Outpatient and Inpatient Detoxification” published in the journal Alcohol Health and Research World in 1998, indicates no significant difference in long-term treatment outcomes between inpatient and outpatient detoxification. The study suggests that patient characteristics, such as the severity of psychiatric issues and the number of co-occurring symptoms, have a more substantial impact on treatment outcomes than the specific detox setting.