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Patients receive a formal assessment before they begin detoxification. This includes a thorough evaluation of their medical history, particularly of any other history of substance abuse and any other current medical or psychological conditions. A physical examination is also performed before detoxification.

During detoxification, patients are withdrawn from their substance of abuse in a consistent manner. This treats the acute physical effects of withdrawal and removes the toxins from the patient’s body. Detoxification generally involves medical monitoring and support, and medications. Other therapies, such as mental health counseling, may take place at the same time as detoxification.

Depending on the substance abused and the individual patient’s reactions to the substance and medications used during detoxification, patients may remain under medical supervision for an extended period even during outpatient treatment. Patients undergoing outpatient care may also be required to return to the facility frequently for monitoring. The degree of this frequency (e.g., several times a week, weekly, biweekly) varies among patients.

Medications are frequently used to treat the symptoms of withdrawal. They may prevent or reverse the symptoms or keep them from getting worse. Because withdrawal from different substances produces a variety of symptoms, different medications may be used to treat them. In some cases, the substance that was abused may be given in increasingly smaller doses.

As an alternative, a similar substance may be substituted for the substance that was abused. Some facilities prefer symptom-triggered dosing. Here, medications are given in response to individual symptoms instead of at regular intervals.

Benzodiazepines are tranquilizers that are frequently used in inpatient and outpatient detoxification from alcohol because they can prevent the seizures and delirium of alcohol withdrawal.

Long-acting benzodiazepines are often used for alcohol detoxification. These tend to require very few doses, often just one every six hours during the first 24 hours. The dosages of short-acting benzodiazepines must be tapered over four to eight days. These medications are processed and removed from the body rapidly, so they may be safer in some patients. Short-acting benzodiazepines are generally recommended for patients with significant liver disease, cognitive impairment, unstable medical health, and those over the age of 65 years.

Opioid withdrawal is often treated with a mild synthetic opioid that is substituted for the narcotic of abuse. Methadone is among the most common of these. Its dosage is typically slowly reduced until it is no longer taken. This process generally takes about 21 days but may be more rapid depending upon how much opioid medication the person was using. Buprenorphine is another synthetic opioid that may be used instead of methadone. It is newer than methadone and may be combined with naloxone, an opioid antagonist. An opioid antagonist is a medication that blocks the effects of narcotics.

Other medications that may be used during detoxification include:

• Antidepressants. These medications may be used during stimulant (e.g., cocaine) detoxification. They help to treat withdrawal symptoms such as anxiety and depression.
  
  
• Amantadine. This medication is commonly used in the treatment of Parkinson’s disease. It is also useful in detoxification for people addicted to or dependent on stimulants. It helps to treat severe withdrawal symptoms and cravings.
  
  
• Bromocriptine. This medication affects the neurotransmitter dopamine, which is involved in emotion and mood. Bromocriptine is sometimes used to treat stimulant detoxification. It helps ease cravings and reduce mood disturbances.
  
  
• Beta blockers. These medications are frequently used to reduce the workload of the heart and blood pressure. They may be useful in stimulant and sedative detoxification. They can help to treat severe withdrawal symptoms, including anxiety, rapid pulse, sweating and cravings.
  
  
• Clonidine. This medication is generally used to treat high blood pressure. It may also ease the symptoms of withdrawal from opioids and depressants such as alcohol. When used for narcotic detoxification, it may be combined with naltrexone, an opioid antagonist.
  
  
• Carbamazepine. An anticonvulsant medication. It may be used in alcohol and other sedative detoxification to treat the seizures or delirium that may occur during withdrawal.

The duration of detoxification depends upon the substance abused, how heavily it was abused and the length of abuse. Some patients may undergo detoxification more quickly than others. Different techniques may also alter the duration of the treatment. However, detoxification generally takes several days to a few weeks.