A Basic Guide to Detoxing before Rehab
Some programs offer the total spectrum of services - from intake assessment and medical detox to primary care and ongoing aftercare - but usually, you need to get detoxed before you can be admitted to rehab.
Read on to learn more about:
- Why you need to detox completely before starting off with rehab – why you can’t detox and begin addiction treatment at the same time.
- Your basic detox options.
- Whether you might be a candidate for ambulatory (home) detoxification – a more affordable option.
Stabilizing Prior to Rehab
Most rehab programs require that you be sober and stabilized before admission. Reasons for this include:
- People within the acute intoxication and initial withdrawal window can require more medical care and observation than most treatment programs can provide.
- The physical and psychological symptoms of early withdrawal make full participation in addiction treatment difficult or even impossible (it’s a waste of time trying to learn new skills when confused, agitated and nauseous.)
- The behaviors of unstabilized clients can disrupt the treatment environment and affect other clients in the program.
The Basic Detox Options
You have 4 basic options:
- Go it alone.
- Detox at home with medical assistance (ambulatory detoxification).
- Detox in a residential facility with social support, but little medical support.
- Detox under full medical observation.
1. Cold-Turkey on Your Own
Warning - This is not medical advice. Always see a doctor prior to starting any detox program. Dependence on certain drugs, such as alcohol or benzodiazepines, can result life-threatening withdrawal symptoms upon sudden stoppage.
You may choose to go it alone and white knuckle through a cold-turkey detox, and this approach has some obvious advantages, such as: it’s free, you can start whenever you want to, there are no waiting lists and no real planning is required.
However, detoxing without assistance isn’t always the best choice. Some of the disadvantages include:
- The withdrawal from certain substances, such as alcohol or
benzodiazepines, puts you at risk of serious complications – and symptoms can
intensify quickly and without warning from mild/moderate to dangerous or life
threatening. Sudden benzo withdrawal is almost never advisable.
- In some cases, without appropriate medication at the start of withdrawal, you won't stop symptoms from progressing to very serious or dangerous levels.
- Untreated withdrawal symptoms can be very uncomfortable.
- Without support, quick relapse is more likely.
2. Ambulatory Detoxification
For many people, ambulatory detoxification represents the best balance between medical management of symptoms and maximal comfort/lowest expense and disruption – and who wouldn’t want to stay at home if possible?
In an ambulatory detoxification program you check-in with a doctor or at a detox clinic for a certain period each day to receive:
- A medical assessment
- The medications necessary to control symptoms
- Medical observation each day to ensure safety
- Advice on what specific warning signs could indicate a worrisome intensifying of symptoms
- Treatment planning for the next steps of recovery
3. Residential Social Detoxification
In a residential social detox you spend your nights in a supportive monitored environment. This can be a good choice for a person who:
- Does not need constant medical monitoring
- Cannot abstain without around-the-clock support
- Lacks a safe place to live
- Cannot travel easily for daily medical visits or in case of emergency need
4. Residential Medical Detoxification
Here you get 24 hour a day medical observation and management of withdrawal symptoms.
The 3 Stages of Managed Detoxification
Regardless of the level of care, all managed detox programs provide three essential services:1
- Facilitated entry into treatment
You get evaluated to identify the degree of intoxication or dependence, the possible presence of any co-occurring mental or physical health issues and to identify any social issues that could complicate the withdrawal process. This evaluation gives you a solid foundation for a treatment plan – rather than just guessing about what you might need.
Stabilization is pretty much what it sounds like – helping you get safely past acute intoxication and withdrawal to a stable sober state.
3. Facilitating Entry to Treatment
Detox, though an essential first step, rarely teaches what’s needed for lasting recovery. By getting involved with a managed detox program you gain an initial introduction to addiction treatment therapies and receive an individualized treatment plan for the next steps in the recovery process.
So, by getting involved with a formal managed detox program you:
- Increase the safety and comfort.
- Increase your odds of making it past the acute withdrawal phase.
- Get a professional evaluation that ensures a correct level of services.
- Are more likely to continue on through the next steps of addiction treatment – where you’ll learn what you need to know to maintain recovery.
What about Ambulatory Detoxification?
If your doctor doesn’t anticipate severe withdrawal symptoms, he or she may recommend that you try an ambulatory detoxification – coming in daily for evaluation and medication, but spending the bulk of the period comfortably at home.
Ambulatory detox may be a good choice for you if:
- There are no indications of seizures or other life-threatening symptoms.
- You have no prior history of complicated withdrawal.
- You have a safe and supportive recovery environment.
- You can travel easily to daily evaluations (or to an ER, if needed.)2
- You understand and will comply with directions, or you have a supportive person to stay with you who can understand and comply with the direction given.
- You have no co-occurring physical or mental health conditions or any physical or mental health conditions present are well managed and unlikely to complicate the detox.3
Finding a Detox Provider
You can find a detox provider by:
- Asking your family doctor – he or she may provide detox services and if not, can refer you to someone who can.
- Contacting a local addiction treatment clinic/rehab – though they may not offer detox services they will be working closely with local providers.
- Asking around at AA/NA meetings
- Using the Substance Abuse and Mental Health Services Administration’s treatment locator tool, which will provide you with a list of detox providers in your local area
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