Medical detox

What it is

Medical detox is withdrawal with medical staff watching. When someone stops drinking or using a drug after a long stretch, the body reacts. That reaction is withdrawal, and it can range from uncomfortable to dangerous. In detox, nurses and doctors check on the person, track their vital signs, and use medicine where it helps to keep them safe and as comfortable as they can be.

Detox clears the substance from the body. It does not treat the reasons someone used it. That is why detox is almost always the start of treatment, followed by a program such as residential care or an intensive outpatient program.

Who it is for

Anyone whose withdrawal could be risky needs medical detox rather than quitting alone. Withdrawal from alcohol and from some prescription sedatives can cause seizures and other serious problems, so those are the clearest cases. Opioid withdrawal is less often dangerous on its own, but it is hard enough that many people cannot get through it without help, and medicine can make it far more bearable.

A facility decides whether someone needs detox, and in what setting, with an assessment at intake. People with other health conditions, people who have had bad withdrawals before, and people who use more than one substance are more likely to be placed in a hospital or a residential detox unit. Someone with milder symptoms and a stable home may be offered outpatient detox, where they come in each day and sleep at home.

What to expect

Detox starts with an intake assessment: what was used, how much and how often, other medicines, health history, and any past withdrawals. Staff then watch the person closely, often around the clock in a hospital or residential unit. They check vital signs, ask about symptoms, and give medicine when it helps. For opioids, a facility may start buprenorphine or methadone during detox and continue it afterward.

The days can be rough. Poor sleep, sweating, shaking, nausea, and anxiety are common. Staff are there for those hours. Most detox programs also begin planning what comes next while the person is still there, so there is a place to go when detox ends.

How long it takes

Usually a few days, sometimes longer. It depends on the substance, how long and how heavily it was used, and the person's health. Alcohol and sedative withdrawal follow a different timeline than opioid withdrawal, and the facility will explain what it expects. Detox is over when the acute symptoms have passed, not when the person feels ready to go home.

Cost and coverage

Medicaid, Medicare, and most private insurance plans generally cover detox when the plan finds it medically necessary, and the plan decides what that means and which facilities are in network. Some facilities offer a sliding fee scale based on income, and some receive state or federal funding for people who cannot pay. Each listing on this site shows what the facility reports accepting. Ask the facility to confirm your coverage before you arrive; it deals with insurers every day and can tell you what to expect.

How it compares

Detox is the most medical level of care and the shortest. It comes before treatment rather than replacing it. Inpatient and residential care is where many people go straight from detox, especially when home is not a safe place to recover. Partial hospitalization and intensive outpatient programs are the next steps down, for people who can sleep at home. An opioid treatment program can take over the medicine started in detox.

How to choose

Questions worth asking a facility:

• Is detox done here, or does the facility send people elsewhere for it?
• Who is on staff at night, and is a doctor or nurse available around the clock?
• What medicines do you use for withdrawal, and can they be continued after detox?
• What happens on the last day? Is there a plan for the next level of care?
• Do you accept my insurance, and what will I owe?

Every state page on this site can be filtered to facilities that report offering detox. Pick your state from the list on this page, or start from the full list of states.