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Detoxing from Drugs and Alcohol: Symptoms and Timeline

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What Does ‘Detox’ Mean?

Toxins are poisons or unhealthy substances. Alcohol and many drugs are toxins. Chronic use changes the body's chemistry, which may have negative effects on how the body looks and functions. 

Detox involves removing all traces of alcohol and drugs from the body. This ensures that someone is physically stable enough to begin addiction therapy.

Alcohol and drug addictions result in dependence. The body adjusts to the chemical changes and needs them to continue functioning. When someone reduces their intake during detox, their brain and other organs (e.g., liver, kidneys, and GI system) must adjust to the sudden chemical drop.

As a result, many people experience a series of unpleasant withdrawal symptoms. Detox aims to reduce these symptoms to make the experience as safe and comfortable as possible.

Medical detox is the most effective type of detox. It occurs in a treatment center under the care of a medical team. 

Attempting to detox without help is often unsuccessful and can be extremely dangerous. People will likely experience challenging withdrawal symptoms. They may also become demotivated by several failed attempts.

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How Long Does Detox Take?

The detox process takes a few days to several months, depending on the drug used. Alcohol leaves the system after a few days, but cravings might persist for much longer. The body chemistry changes may also take a long time to reverse or repair.

How long detox takes depends on:

  • The substance used
  • If various substances were abused
  • How much of the substance was taken
  • How often the substance was abused
  • Any underlying, co-occurring mental health conditions 
  • Medical history
  • Age
  • Gender

Detoxing from Drugs vs. Alcohol

People addicted to alcohol and/or drugs may experience some of the same symptoms during detox, like:

  • Abdominal pain
  • Irritability
  • Sweats
  • Shaking
  • Nausea
  • Vomiting 

Detoxing from Alcohol

Some withdrawal symptoms are unique to alcohol detox, such as delirium tremens (DTs). These are caused by severe mental and nervous system dysfunction. Symptoms include severe tremors (shakes), seizures, abnormal vital signs, and hallucinations that some people experience in severe cases.

The duration of detox and withdrawal symptoms depends on the addiction severity and the person's health.

Generally, alcohol withdrawal symptoms start a few hours after the last drink. They reach their highest intensity 1 to 3 days later. In more severe addiction cases, people can experience symptoms for a few weeks.1

Detoxing from Drugs

Each drug has a different set of side effects and withdrawal symptoms, so the detox process is unique. 

For example, recovering heroin addicts are likely to experience post-acute withdrawal symptoms (PAWS) that last from 18 to 24 months. 

These symptoms include:

  • Disturbed sleep
  • Poor focus
  • Increased anxiety
  • Depression
  • Panic attacks
  • Fatigue
  • Hypersensitivity
  • Irritability
  • Mood swings
  • Restlessness
  • Memory loss
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Detoxing from Drugs and Alcohol at the Same Time

Polysubstance abuse refers to the simultaneous abuse of more than one drug. 

This can include: 

  • One or more street drugs
  • One or more prescription drugs
  • Alcohol 

Alcohol is the most commonly abused substance in polysubstance abuse cases. Sometimes people who take prescription drugs will take them with alcohol. This can lead to unwanted side effects and increased health risks.

Polysubstance abuse is very dangerous and usually more challenging to treat than an addiction to a single drug.

Withdrawal from multiple substances is more complex than withdrawal from one substance. Because of this, inpatient medical detox is usually recommended.

During inpatient medical detox, medical professionals supervise people 24 hours a day. This involves continual monitoring and medical intervention if any emergencies occur.

Supervising physicians often prescribe medications that counteract specific withdrawal symptoms. These might include anti-nausea medications to treat vomiting or antidepressants to help with mood changes.

Because of the unpredictability of polysubstance withdrawal, continual medical monitoring is essential. Medical detox reduces the chances of relapse. It also increases the chances of successful withdrawal from all substances.

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Medications Used During Detox

The type of detox medication needed depends on the drug:

Cocaine

Some of the medications prescribed during detox include benzodiazepines.

Benzodiazepines (benzos) reduce anxiety and irritability. These are common withdrawal symptoms of many drugs, including cocaine.

Benzos are sedating, which helps ease alcohol withdrawal. Because they are addictive, doctors are cautious about prescribing them.

Alcohol

Abusing alcohol regularly for an extended period can prolong PAWS. Maintenance treatment can relieve PAWS and stop cravings or make the user unable to stomach alcohol. 

Common medications prescribed to treat alcohol withdrawal include:

  • Naltrexone (Vivitrol): Blocks receptors in the brain that create alcohol’s pleasurable effects. It also reduces the urge to drink. This drug may cause some nausea or headaches.
  • Acamprosate (Campral): Relieves emotional and physical distress related to alcohol addiction. Recovering alcoholics can begin taking this medication after finishing detox. Acamprosate reduces the desire to drink by preventing negative feelings like anxiety and depression.
  • Disulfiram (Antabuse): The first approved medicine for alcoholism. If someone taking this drug drinks, the medication causes side effects like nausea and vomiting.

Heroin and Other Opiates

Opiates include heroin, morphine, and narcotic painkillers such as oxycontin. 

Methadone is used for moderate to severe opiate addictions. It binds to the same receptors in the brain. However, it doesn’t cause a ‘high.’ It helps stop cravings and withdrawal symptoms. 

Because methadone is addictive, medical professionals prescribe it with caution. 

Buprenorphine (Suboxone) works like methadone. But it’s not regulated as closely because the addiction potential is lower. Users can often take the medication home with them instead of going to a clinic every day.

Naltrexone also stops the urge to use by blocking the pleasurable sensations from alcohol and opiates. Alcohol and opiates activate some of the same receptors in the brain, so it works for both addictions.

Post-Detox Treatment Options

There are various post-detox treatment options available, including:

Outpatient Rehab

Outpatient behavioral treatment includes a wide selection of programs, most of which involve individual or group counseling.3

These programs usually offer behavioral therapy like cognitive behavioral therapy (CBT). CBT helps people recognize, avoid, and cope with situations where they’re most likely to use drugs or alcohol.

Outpatient rehab also often includes multidimensional family therapy. This type of therapy helps youths with drug or alcohol abuse problems, as well as their families. It addresses influences on their substance abuse patterns and improves family functioning.

Motivational interviewing is another type of treatment in outpatient rehab. It encourages people to change their behavior and enter treatment.

Additionally, motivational incentives use positive reinforcement to encourage abstinence from substance abuse. This is also known as contingency management. 

Inpatient Rehab

Inpatient or residential treatment can also be effective in treating substance use disorders (SUDs). This is especially true for people with unstable home environments and more severe problems like co-occurring disorders.3

Licensed residential treatment centers offer 24-hour structured and intensive care. This includes medical attention and safe housing.

Residential treatment facilities may use a range of therapeutic approaches. They generally aim to help someone live a drug-free, crime-free lifestyle after treatment.

Therapeutic communities are one type of residential treatment. These are highly structured programs where people stay at the residence for around 6 to 12 months. 

The whole community, including staff members, acts as key change agents. They influence people’s attitudes, understanding, and behaviors that are linked to substance use.

There’s also shorter-term residential treatment. This typically focuses on detox, counseling, and preparation for treatment in a community-based setting.

Recovery Housing

Recovery housing is another example of residential treatment. Recovery housing provides supervised, short-term accommodation. It often follows common practices of inpatient or residential treatment.

Recovery housing helps people become independent. People learn skills like how to pursue and secure employment or how to manage finances. Recovery housing can also connect people to community support services.

Mutual-Support Groups

Alcoholics Anonymous (AA) and other 12-step programs offer peer support for people quitting or reducing their drinking. 
Along with professionally led treatment, these groups add an extra layer of support.2

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Updated on June 16, 2022
6 sources cited
  1. Alcohol withdrawal. MedlinePlus, February 2022
  2. Treatment for Alcohol Problems: Finding and Getting Help. National Institute on Alcohol Abuse and Alcoholism, 2014
  3. NIDA. "Treatment Approaches for Drug Addiction DrugFacts." National Institute on Drug Abuse, 17 Jan. 2019
  4. Sachdeva, Ankur et al. “Alcohol Withdrawal Syndrome: Benzodiazepines and Beyond.” Journal of clinical and diagnostic research : JCDR vol. 9,9 : VE01-VE07
  5. Newman RK, Stobart Gallagher MA, Gomez AE. Alcohol Withdrawal. [Updated 2021 Nov 13]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2022 Jan-
  6. Jesse, S et al. “Alcohol withdrawal syndrome: mechanisms, manifestations, and management.” Acta neurologica Scandinavica vol. 135,1 : 4-16

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