If you (or someone you love) are suffering from an alcohol use disorder (AUD), the first step in recovery may involve treatment at a detox center. Detox is needed first (before additional treatment) when the level of alcohol use is severe enough that suddenly stopping drinking can be very uncomfortable and potentially dangerous.

A severe level of alcohol consumption is the state of being so dependent on alcohol that the body actually needs it in order to feel normal and function. In such cases, if drinking stops abruptly or if you “quit cold turkey,” it may cause:¹

• Anxiety
• Restlessness
• Confusion
• Hallucinations
• Shakiness
• Nausea and vomiting
• Unstable changes in blood pressure and heart rate

If you are struggling with a dependency on alcohol, understanding what to expect during and after a detox program can help ease anxiety about starting a recovery program. Call 800-839-1686Who Answers? to speak to a treatment specialist and talk about your alcohol detox options.

What is Alcohol Detox?

Detox is the safe removal of a substance from the body while keeping all physiological functions intact. Safe detoxification puts your body through a safe withdrawal process that is closely monitored by a physician. The use of both psychotherapy and medication in a detox program is important for successful results.²

Detox programs can be broken down into 3 main types:

• Inpatient
• Residential
• Outpatient

Inpatient Detox

Inpatient detox usually requires a 2-7 day stay at a hospital, medical facility, or detox center and is recommended if you have severe medical issues and/or mental health-related diagnoses in addition to AUD. It is also recommended if you have been through a detox program before.

Residential Rehab

Residential rehabilitation (rehab) is where you would live at a center for approximately 1-3 months. This is a better fit if you have struggled to abstain from or cut down on the use of alcohol, or if you have limited social supports.

Outpatient Detox

Outpatient detox is also a possibility as is detox via telemedicine, instead of going to a detox center in person. Although getting help from a medical professional over the phone doesn’t offer the same close monitoring as inpatient detox, one study found telemedicine to be effective.³ In this case, patients confirmed they could:

• Be mentally and physically stable
• Be motivated for treatment
• Have strong social support
• Be able to use a computer and the internet

In this particular outpatient detox program:

• Patients detoxed over the course of 4-11 days via videoconferencing
• Peripheral devices monitored blood pressure and blood oxygen saturation (the body needs a specific balance of oxygen in the blood)
• A local pharmacy dispensed prescribed detox medications every 1-2 days

Outpatient detox is not a fit if you don’t have social support, have a history of withdrawal seizures, have suicidal thoughts, or have other serious illnesses.⁴

In addition to the logistics of the preparation for detox one study showed that 6 sessions of group cognitive behavioral therapy (CBT) helped to “mentally prepare the group members for detoxification in a supportive environment.”⁵

What to Expect at an Alcohol Detox Center

The first stage in the alcohol detox timeline is the intake process that generally involves:

• A structured interview to gather information about you and your level of alcohol use
• Completion of questionnaires (e.g., a symptom checklist)
• A physical examination including measures such as blood-alcohol content (BAC), pulse, liver function tests, and urine sample for drug screening

This intake is important because the information gathered can help determine if you are at risk for complications during detox. Many people experience mild alcohol detox symptoms during detox such as agitation; however, some can experience severe symptoms such as seizures.⁶ If it is determined that you are at risk, the clinician can tailor the treatment plan to help reduce such complications.

After the intake, the clinician will review the treatment plan with you, which usually includes both therapy (group and/or individual) and medication.

Medications Used at Detox Centers

The medications most often used during detox include vitamin supplements and benzodiazepines.

Vitamins are important during alcohol detox because excessive alcohol use inhibits the absorption of nutrients, such as vitamin B1, vitamin B12, folic acid, and zinc.

Benzodiazepines are often prescribed as anti-anxiety drugs because, like alcohol, they depress the central nervous system (CNS). Depression of the CNS means that the body needs to use a lot of energy to process the substance, leading to issues such as slower brain activity, decreased breathing, and decreased heart rate.

Because of this, benzodiazepines are often prescribed as part of an alcohol detox treatment plan to slowly wean the body off of alcohol and its depressant effects. This is similar to the role that methadone and suboxone play in the treatment of opioid addiction.

What Happens After Detox?

After a person has successfully completed detox, follow-up treatment is usually recommended in order to prevent relapse. This follow-up typically includes therapy and possibly medication (at this stage, it may include medication that helps to reduce cravings for alcohol).

Therapy usually involves cognitive behavioral therapy (CBT) since it has been known to be extremely effective. CBT typically emphasizes regaining control over reactions to triggers and the decision-making process involved with drinking and developing coping skills and lifestyle changes.

It is best to plan to engage in such aftercare services for about 1 year after completing an alcohol detox program.¹

Choosing a Detox Center

Step 1

Compile a list of your goals, needs, and circumstances. For medication-assisted treatment, some important factors to consider include:⁸

• Are you pregnant or trying to conceive?
• Are you at risk for binge drinking?
• Do you have other health problems that are induced by or exacerbated by drinking (e.g., heart problems, anxiety, depression, PTSD, cardiac disease)?
• Do you have social or legal problems caused or worsened by drinking?

If you have another medical condition or mental health disorder, an inpatient program may make more sense. If you’ve struggled for a long time to stop drinking or if you are feeling isolated or without a strong social network, a residential program might make more sense for you.

Step 2

Speak with your physician about your interest in an alcohol detox center and program. Given that your physician knows your medical history, you and your physician can work together to come up with a plan. This is also a good idea because, with your primary care doctor involved in your care, you can have a more complete team of professionals working with you.

Step 3

Consider the quality of various detox programs, their cost and location, and what your health insurance plan covers in order to identify specific programs that could work for you. It helps to be prepared with a list of questions for your insurance company, such as:¹

• What types of services does my plan cover? Detox, inpatient or outpatient rehab, residential rehab?
• How do they decide what services to cover?
• What are my copays and other costs?

It also helps to be prepared with a list of questions to ask the treatment facilities you are considering, such as:¹

• What type of health insurance do you accept?
• What are the credentials of your staff? Are they licensed?
• Do you offer both group and/or individual therapy as well as medication treatment?
• Do you offer to counsel prior to starting the detox program?
• Is telemedicine a possibility?
• How do you help prevent severe withdrawal symptoms?
• How do you help prevent relapse?
• Do you provide an aftercare program or refer to those that do?

If the treatment facility or program you are considering doesn’t provide therapy to prepare for detox, or if you want to get started with therapy in general, you want to find a psychotherapist (a licensed counselor or psychologist) who specializes in the treatment of substance use disorders.

Licensed counselors have a masters-level education; they can include:

• Licensed Clinical Social Workers (LCSW)
• Licensed Marriage and Family Therapists (LMFT)
• Licensed Chemical Dependency Counselors (LCDC)

A psychologist has a doctorate in psychology (PhD), and a psychiatrist is a medical doctor (MD) who specializes in psychiatric issues. Psychiatrists primarily provide medication treatment, but some may do therapy as well. It is important that the mental health professional be licensed in the state that you reside.

Depending on the psychotherapist’s assessment, it is possible you can work with them for outpatient therapy while getting outpatient medication treatment at a different facility. Talk with your health insurance company or primary care doctor for referrals to professionals who provide substance use treatment.

Detox is a very critical part of recovery from a severe AUD. It is important that you (or a loved one) find the best detox center and program that meets your needs. If you are looking for information on Alcoholics Anonymous meetings and local detox centers for yourself or a loved one, call 800-839-1686Who Answers?.

References

1. WebMD. (n.d.) Alcohol detox and rehab programs: What to know.
2. Das, S.K. (2020). Detoxification of drug and substance abuse.
3. Ghodsian, S., Brady, T.J., Eller, K., Madover, S., Beeson, D. & Marchman, D. (2018). Telemedicine detoxification treatment for alcohol, opioid, or sedative-use, hypnotic-use or anxiolytic-use disorders. Addictive Disorders and Their Treatment, 17(3), 143-146.
4. Davis, C. (2018). Home detox – supporting patients to overcome alcohol addiction. Australian Prescriber, 41(6), 180-182.
5. Croxford, A., Notley, C.J., Maskrey, V., Holland, R. & Kouimtsidis, C. (2014). Behavioral therapy preparation for alcohol detoxification. Journal of Substance Use, 20(1), 61-68.
6. Perry, E.C. (2014). Inpatient management of acute alcohol withdrawal syndrome. CNS Drugs, 28, 401-410.
7. Firth, G. & Manzo, L.G. (2021) How alcohol affects nutrition and endurance [University student health center resources page].
8. Roberson, C. (2015). Alcohol Use Disorder-Medication Assisted Treatment.