Detoxification is the process of removing a substance and/or its effects from patients who are addicted to the substance. It is not a distinct treatment in itself. Instead, it is the first step in the comprehensive treatment of patients with substance abuse.

The overall goals of detoxification are for the patient to stop taking the substance as quickly and safely as possible and to treat the acute physical effects of withdrawal. Such substances may include alcohol, illegal drugs and prescription medications that are no longer beneficial or are being used for nonprescribed purposes. Withdrawal from many substances can be dangerous or even fatal if not performed under medical supervision.

Detoxification may occur on an inpatient or outpatient basis. The choice between these options depends on various factors, including the substance that was abused, how heavily it was abused and the duration of abuse.

Patients undergo a thorough assessment before detoxification, which includes a complete evaluation of their medical history and a physical examination. During detoxification, patients are withdrawn from their substance of abuse in a consistent manner. Medications are frequently used to treat the symptoms of withdrawal. They may prevent or reverse the symptoms or keep them from becoming worse. Sometimes, a similar substance may be substituted for the substance that was abused.

Withdrawal from different substances produces varying symptoms, and different medications may be used to treat each of them. Sedatives and alcohol are among the most commonly abused substances. They can have very serious withdrawal symptoms, including seizures, delirium and death. Withdrawal from stimulants, such as cocaine, can cause a number of mood disturbances (e.g., depression, anxiety, paranoia) and psychosis (loss of contact with reality). Opioids, or narcotics, may cause withdrawal symptoms such as diarrhea, abdominal cramping, rapid pulse and high blood pressure.

There are several variations of detoxification for patients with dependence on or addiction to opioids. These involve the use of medications, including opiate blockers, to halt the action of narcotics and reduce withdrawal symptoms. Such rapid detoxification occurs in an intensive care unit of a hospital. Depending on the variation, the patient may be unconscious or awake. Rapid detoxification can occur as quickly as four to eight hours or five to 30 minutes. However, it is important to note that rapid detoxification is a controversial treatment with limited support for its use and can result in serious problems including death that are unlikely to occur when other forms of detoxification are employed.