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Medical Detox: Types of Centers, Benefits & More

Medically Reviewed By: Benjamin Caleb Williams RN, BA, CEN

Written By: Phillippe Greenough

Article Updated: 09/14/2020

Number of References: 3 Sources

Medical detox programs are a crucial resource that can make the difference between successful recovery or a lifetime of addiction. The focus of these detox centers is to reduce the discomfort of detox as much as possible through the latest medications and intense medical supervision. Here, we will explore who may need this style of detox, the process itself, and the specific services and resources provided by a medical detox.

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Who Needs Medical Detox?

While detoxing from many drugs is extremely uncomfortable, there are several drugs that could produce life-threatening issues during withdrawal. Either way, medical detox centers are designed to treat life-threatening symptoms as well as symptoms that are merely uncomfortable. Intended as the first step towards treatment and recovery, medical detox is meant to help patients get through this process in the most successful, safest, and most comfortable way.

There are different levels of detox care depending on the individual needs of each patient. Some factors which may indicate one detox type over another include:

  • The Specific Drug(s) Someone Used
  • Length of Time Someone Used
  • The Amount of Drugs Someone Regularly Used
  • Co-Occurring Mental or Physical Health Issues

The Medical Detoxification Process

The main purpose of medical detox centers is to manage the severe and potentially fatal symptoms that someone will experience. Because patients are often in a dangerous situation there is a great deal of medical supervision and care provided by these facilities. The process itself is quite strict and rigid as this is required to ensure the safety of patients. The arc of treatment through a medical detox will begin with an assessment or evaluation, stabilization and symptoms reduction, and finally a handoff to a continuing care provider for further treatment.

Evaluation

Evaluation for medical detox begins by first identifying the drug(s) someone is attempting to detox from. Different drugs produce different symptoms, either mental, physical, or both. The evaluation is commonly done in an interview setting followed by medical exams to monitor the progression of withdrawal symptoms. Getting an accurate picture of how fast the symptoms appear and worsen can inform doctors about the maximum symptom severity someone may expect. Additionally, blood work is commonly done and vitals will be taken regularly throughout the rest of the detox process.

Medical Stabilization

Once the drug has been identified and withdrawal symptoms have begun to appear, stabilization is the next phase. This consists of minimizing the symptoms through the use of medications and other treatment measures to ensure a patient’s vital signs stay in a normal and safe range. Since some drugs may produce possibly fatal complications during the detox process, this is commonly the most sensitive period of detox and requires the most care. Depending on the severity of symptoms, patients may take part in therapy and group sessions. If they are too unwell to participate, they may remain bedridden for the first few days; it all depends on the particular drug, the person, and their use habits.

Facilitating Entry Into Treatment

This phase may begin shortly after stabilization has begun, but will last until someone is discharged from the detox center. During detox, a caseworker will work with a patient to develop an aftercare plan to be carried out after detox has completed. This is a roadmap towards recovery which can include further treatment, either inpatient, outpatient, sober living, or a variety of other options. Medical detox centers almost always have connections to the wider recovery community in their area and will use these connections to help patients move towards whichever treatment options best suit their needs.

Types of Medical Detox

There are several options for the level of care regarding drug detox. Which one someone chooses essentially comes down to their using habits. Those who used heavily for long periods may benefit more from a very comprehensive detox program, while those who used for a shorter period may prefer a less intense level of care. We have articles detailing the specifics of each, but we have general overviews here:

Physician Aided Outpatient Detox

Known as “Level 1” detox by the American Society of Addiction Medicine (ASAM), physician aided outpatient drug detox is the least restrictive of drug detox architectures. Level 1 medical detox programs are intended for those who are experiencing mild withdrawal symptoms from drugs that will not be life-threatening or dangerous. These programs are technically outpatient but differ only in that there is no additional treatment program aside from medications to manage the withdrawal symptoms and a brief check-in with the clinician.

ASAM recommends that someone attempting this level of detox should have a solid social support network in place, such as family and friends, who are encouraging and helpful towards their recovery. During this level of detox, the provider will typically help the patient enter into further, more in-depth treatment programs.

This type of detox program may be preferable to some people as it affords great flexibility and customization. The greatest benefit of this mode of drug detox is that it affords detox with minimal disruption to work, school, or family life. Since it is so flexible, this type of detox can be worked into almost any schedule. This can be a double-edged sword, however, as this flexibility can fall short with regards to helping someone to change their habits and to seek and enter actual addiction treatment.

Outpatient Detox

Outpatient detox programs are more comprehensive than physician aided outpatient detox and are referred to as “Level 2” detox by ASAM. Level 2 detox programs are intended for those who will be experiencing mild to moderate withdrawal symptoms, but which still are not life-threatening or dangerous. These programs entail medications to manage withdrawal symptoms, as well as monitoring by registered or licensed nurses for several hours per day.

While similar to Level 1 detox, there is more interaction between patients and medical professionals as well as a more comprehensive therapeutic approach to treatment. There may be groups or classes involving addiction education, healthy coping strategies, or group therapy included in the daily schedule. Finally, there is more of an emphasis on continuing treatment after this level of detox, and nurses or caseworkers will be more encouraging in this regard.

Outpatient is one of the most common types of detox performed. It can provide detox services while being minimally disruptive to other aspects of someone’s life. Additionally, due to the greater support services that outpatient provides, a patient will have more resources when it comes to finding further addiction treatment. Conversely, someone is free to return home every night and is not strongly supervised. Due to this, if someone is deep in their addiction, they may relapse or simply finish detox and then go back to using full time.

Outpatient Detox Guide

Inpatient Detox

Also known as one type of “Level 3” detox program by ASAM, the key distinction is that these programs require 24-hour supervision and daily medical support throughout the detox process. Level 3 detox programs are intended for those who have moderate to severe withdrawal symptoms and may experience life-threatening complications.

These programs integrate close medical care with support services such as daily groups and counseling sessions every day. Both inpatient and residential detox provide 24-hour monitoring, typically by trained clinicians or nurses, depending on the specific type of Level 3 program. Residential detox programs that do not provide 24-hour on-site medical support are commonly referred to as “social setting” detox programs.

Inpatient and residential detox centers are quite comprehensive regarding entry into addiction treatment. These programs surround someone with others who are likewise going through drug detox and working to better their lives. Making connections in this way can be very helpful, and the options for further addiction treatment after detox are plentiful in inpatient settings. That being said, inpatient programs can be very disruptive to someone’s work or school schedule and are usually quite expensive.

Acute Detox

Acute inpatient detox centers are known as “Level 4” detox by ASAM and are the most comprehensive type of detox available. Level 4 detox programs are recommended for those who will experience severe withdrawal symptoms. Acute detox centers require 24-hour on-site medical professionals in case of emergency and may be hosted at general hospitals, psychiatric hospitals, or specialty detox centers.

The key factor which distinguishes Level 4 detox from most other types is the constant availability of trained medical professionals, as well as the presence of life support equipment should the need arise. Aside from trained nurses, there are typically physicians on site 24 hours a day as well. In addition to the medical aspect, there are licensed counselors or clinicians present at least 8 hours per day for support services.

Acute detox centers certainly provide the highest level of care, although that care does come at a price. This price may be very reasonable considering the detox completion success rate is higher for acute/inpatient programs compared to outpatient or self-detox. If someone is suffering severe withdrawal symptoms, then this type of detox may be their only option. Along with providing the highest quality medical care, they also provide the best chances for someone successfully continuing their recovery. While inpatient programs usually have higher recovery rates than other types of treatment, they are much more expensive, as well as the program itself being much more restrictive.

Inpatient Detox Guide

Hospital Detox

Typically recommended only in emergency situations, this is still an option nonetheless. Technically considered a Level 4 detox, general hospitals are not intended for drug detox, however, they are equipped with the trained staff, medications, and equipment to handle these situations safely and effectively. With emergency rooms open 24 hours a day 365 days a year, this may be the only option for someone in a dangerous situation.

Hospital detox is not a “detox program” in the normal sense but is more an accelerated and lightweight version of a proper detox program. Evaluation and stabilization are intense, although usually less comprehensive than a specialty drug detox program. The concept of facilitating entry into treatment is present, although not emphasized as highly as it would be during a detox program. Evaluation in this setting is more focused on immediate health concerns and is followed by observations to gauge withdrawal symptom progression. Stabilization is likewise brief, although very thorough and comprehensive, with the immediate symptoms being treated, medications being administered to reduce the danger, and a taper prescription being sent with the patient upon discharge.

Hospital detox is recommended for emergency situations only. The treatment is brief and not as psychologically comprehensive as a professional detox program but nonetheless comes with a large cost. A short ER visit for emergency detox can be upwards of $1,000 for only a few hours of stabilization and a prescription that must still be filled and paid for after discharge.

Regardless of the treatment type, on page 45 of Alcohol Health & Research World – Vol. 22, No. 1, from 1998, Motoi Hashita, M.D. notes that “Treatment outcome may have more to do with patient characteristics than with detoxification settings.” This seems to agree with observations; people who are strongly committed to their recovery seem to do well in long term recovery regardless of their treatment circumstances, so long as they are able to make it through withdrawal safely.

What Treatment Will You Receive During Detox?

While the exact treatment schedule will vary depending on the type of detox program, there are very general commonalities between all types. A broad outline of what a detox program entails includes:

  • Holistic Drug Detox – This is a more natural approach to detox which enlists the regenerative abilities of the body in the process of recovery. Through physical fitness, nutrition practices, and massage therapies the brain chemistry can be affected, reducing the time until full biological recovery.
  • Mindfulness & Meditation During Detox – These practices have been used to treat chronic pain and stress disorders for over 30 years, and recently have been deployed towards the psychological treatment of addiction. Aimed at restoring healthy cognitive functions and behaviors, this approach is still new but is showing promising results.
  • Technology-Based Treatment Techniques – A variety of technologies are being leveraged to aid addiction treatment, especially in our post-pandemic world. From biofeedback therapies, brain mapping, virtual CBT, telehealth appointments, and software-assisted guided meditation, technology is opening new avenues of treatment and increasing accessibility.
  • Daily Medication Administration and Medical Exams
  • Meetings with Doctors and/or Psychiatrists to Determine Treatment Effectiveness
  • Additional Therapies such as Counseling and Recovery-Oriented Education
  • Meetings with a Case Worker to Develop an Aftercare Plan

The more resources that someone has to further their recovery, the better chances they have to achieve long term sobriety. To this end counseling, therapy, diet, exercise, and support groups are often integrated into detox programs.

Finding a Medical Detox Center

It is highly recommended to continue treatment after detox has been completed. Almost all drug and alcohol treatment centers will require that detox be completed before therapeutic addiction treatment is started. Some detox centers will offer further treatment options in house, but if not, they can certainly refer someone to a nearby treatment facility.

Working from the aftercare plan which was developed with a case worker during a person’s time in detox will provide a good starting point. If there was no aftercare plan developed, then someone may search for other treatment programs, find 12 step meetings, or seek out other support groups which provide drug or alcohol addiction treatment.

Detox is the first, and often most difficult, step in the journey of recovery. Once detox has been completed there is often a tendency for an addict to think that the journey is over. This attitude may increase the chances of relapse if further treatment and care is not pursued as soon as possible.

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