For many decades, 12 step programs have been helping people in their recovery journeys. Individuals with drug and alcohol use disorders need an integrated treatment approach, and 12 step programs are a vital part. People with loved ones struggling with substance abuse can also find support and hope with specialized 12 step programs.
Detox treats drug or alcohol dependence, which isn’t the same thing as addiction. Dependence is characterized by the onset of withdrawal symptoms when you suddenly stop using a substance. Non-medical detox is a detox program that doesn’t involve medication to treat symptoms of withdrawal. Rather, it focuses on providing a high level of emotional support and promoting feelings of health and wellbeing during the detox process.
Here, we look at non-medical detox, including what it is, how it works, and who the best candidates are for this type of program.
To understand how detox works, it’s important to understand dependence. Dependence develops as the result of heavy substance abuse. When you heavily abuse drugs or alcohol, the brain attempts to compensate by reducing or increasing the activity of the neurotransmitters affected by the substance.
For example, alcohol acts on the neurotransmitters dopamine, GABA and glutamate. Initially, alcohol increases the activity of dopamine, which produces feelings of pleasure, and GABA, which is responsible for feelings of calm. At the same time, it decreases the activity of glutamate, which governs feelings of excitability.
With heavy alcohol use, the brain tries to normalize function by reducing dopamine and GABA activity and increasing glutamate activity. This leads to tolerance, which means that you need to consume larger doses to get the same effects smaller amounts once produced. But the more you use, the more the brain tries to compensate by changing its chemical function. At some point, the brain will adjust to the presence of drugs or alcohol and function more comfortably when they’re present in the body.
When you suddenly stop using once you’ve become dependent, normal neurotransmitter function will rebound. This causes physical withdrawal symptoms which vary, depending on the substance. During detox, withdrawal is allowed to follow its course until all traces of drugs or alcohol are out of the cardiovascular system and the brain’s chemical function has begun to return to normal.
The American Society of Addiction Medicine identifies five levels of detox, the first three of which are non-medical.1
The first level, Level I-D, is outpatient detox, which is the least restrictive environment for detox. This level involves detoxing at home while making regular visits to an outpatient clinic for monitoring.
The second level, Level II-D, is also outpatient detox, but participants spend each day at a clinic where they’re monitored by licensed nurses. At night, clients return home.
The third level, Level III.2-D, is non-medical inpatient detox. This level of detox involves living at a residential detox facility offering around-the-clock staff and peer support.
The fourth and fifth levels of detox, Level III.2-D and Level III.7-D, are considered medical detox. The fourth level is monitored by medical and mental health professionals, who may provide medications as needed to treat withdrawal symptoms. The fifth level is medically managed detox and involves hospitalization and around-the-clock medical attention for severe symptoms and dangerous complications.
The level at which detox is entered depends on a number of factors, including the severity of the dependence, how much of the substance is in the body at the time of detox, age, the general state of physical and mental health, and the risk of relapse. An intake assessment at the beginning of detox will help determine which type of program is right for you.
Different drugs produce different withdrawal symptoms. Not everyone will experience all of the withdrawal symptoms associated with a particular drug, and symptoms can range from mild to severe. In some cases, withdrawal can turn dangerous or even fatal.
Alcohol withdrawal symptoms typically set in between two and 12 hours after the last drink. Early alcohol withdrawal symptoms include cravings, anxiety, headache, nausea and vomiting, tremors, and insomnia. Between 12 and 24 hours after the last drink, hallucinations may occur, lasting around 48 hours. Between 24 and 48 hours after the last drink, you may experience withdrawal seizures, particularly if you’ve gone through alcohol withdrawal before.
In some cases, severe alcohol withdrawal (known as delirium tremens or DTs) may occur. Symptoms, which can be fatal, include disorientation, severe anxiety, fever, severe tremors, and increases in blood pressure and heart rate.
Withdrawal from heroin and prescription painkillers can be excruciating, although it’s not considered dangerous. Opioid withdrawal symptoms are flulike and include a runny nose, chills, sweating, muscle aches, abdominal cramps and diarrhea, and nausea and vomiting. Intense cravings also occur with opioid withdrawal and may last longer than other withdrawal symptoms. Withdrawal from heroin and short-acting prescription painkillers generally lasts four to 10 days. Withdrawal from long-acting painkillers, including extended-release medications, can last up to 20 days.
Stimulants, including illegal drugs like cocaine and meth and prescription medications like Ritalin or Adderall, cause withdrawal symptoms such as irritability, paranoia, insomnia, anxiety, deep depression, and heart palpitations. Symptoms generally last one to two weeks, although cravings and depression can linger for months. Most people begin to enjoy improvements in mood, sleep, and energy around a month after quitting stimulants.
Sedatives, including barbiturates and benzodiazepines like Xanax and Valium, typically cause withdrawal symptoms within 24 hours of the last dose. Sedative withdrawal can be dangerous or fatal. Mild symptoms of sedative withdrawal include headaches, muscle aches, anxiety, hallucinations, nausea and vomiting, and tingling in the arms and legs. Serious symptoms include heart palpitations, seizures, and dangerous shifts in heart rate and blood pressure.
People detoxing from alcohol, opioids or central nervous system sedatives are typically placed in a medical detox program. Both alcohol and benzodiazepines produce withdrawal symptoms that may include dangerous shifts in core body functions. These serious complications can come on suddenly, and medical supervision and access to medication is paramount for safety during detox from these substances. While opioid withdrawal isn’t particularly dangerous, it can be extremely uncomfortable. Medications provided during medical detox help reduce the severity of opioid withdrawal and shorten the duration of detox.
Non-medical detox is ideal for people who have very mild withdrawal symptoms or who are detoxing from drugs like marijuana or stimulants. Since no medications have been approved or shown effective for treating symptoms of withdrawal associated with these substances, the focus of detox is on providing support and promoting comfort and wellbeing during withdrawal. If someone in non-medical detox experiences complications of withdrawal, transfer to a hospital will be necessary.
Whichever detox program you enter, it’s important to engage fully with care providers and stay in detox for its duration.
Inpatient non-medical detox involves staying at a residential detox facility, which may be a stand-alone center or connected to a treatment facility. You’ll have the freedom to take a walk outside, watch TV, or play games with others in detox. During the day, you’ll engage in a variety of programs.
In general, detox has three overlapping components: evaluation, stabilization, and fostering entry into treatment.
A variety of assessments during detox help care providers develop a comprehensive, individualized treatment plan to follow once detox is complete. According to the National Institute on Drug Abuse, individualized treatment is essential for successful recovery. There is no one-size-fits-all treatment that works for every individual.
Assessments during detox determine your state of physical and mental health and identify issues in your life that need to be addressed, such as relationship, financial or legal problems. They will help identify unmet housing, educational or vocational needs, and missing coping skills. Assessments include medical and mental health screenings and evaluations, drug screenings, and sessions with therapists to help identify the underlying issues behind your addiction.
In early non-medical detox, care providers focus on providing comfort and support. Clients are encouraged to relax or socialize during down times. Since medications aren’t used in non-medical detox to reduce the intensity of symptoms, a variety of complementary therapies help reduce discomfort and promote positive emotions and feelings of wellbeing. Complementary therapies commonly used in detox include:
All of these complementary therapies help reduce the intensity of cravings, which can be very uncomfortable in detox. Clients in detox are encouraged to exercise and get adequate sleep to help them maintain a stable mood.
Without treatment after detox, the relapse rate for addiction is very high. One study published in the Irish Medical Journal found that 91 percent of people who participated in an opioid detox program (but not treatment) relapsed after detox, 59 percent of them within a week.2 Those who engaged in treatment for at least six weeks after detox either stayed in recovery or had a significantly delayed relapse.
A central focus in non-medical detox is fostering motivation to continue with treatment after detox. Motivational interviewing, an effective short-term therapy, is used to help clients identify personal reasons for wanting to recover from their addiction. It helps to build motivation to enter treatment. Psychoeducational groups during detox help clients better understand addiction, how it’s treated and how recovery occurs, which imparts hope that recovery is possible.
Care providers in detox help clients address barriers to treatment, such as dependent children at home or a lack of transportation or funding. They help facilitate the transition from detox to treatment.
Detox has very little impact on addiction. Addiction is characterized by compulsive substance abuse despite the negative consequences that result, and treating it requires addressing a person’s multiple needs.3 Treatment after detox is aimed at preventing relapse by addressing underlying issues and restoring function to all areas of your life.
Common underlying issues behind an addiction include a history of trauma, co-occurring mental illnesses like anxiety and depression, and the kind of chronic stress that comes from poverty or living with illness or abuse. The underlying causes of addiction must be identified and resolved for a successful recovery.
Restoring function to your life is another major focus in addiction treatment. Addiction causes a myriad of life problems surrounding relationships, employment, finances, and legal and health problems. Ultimately, addiction stems from a lack of coping skills, such as an inability to manage emotions or be comfortable with being uncomfortable. Treatment helps individuals develop skills and strategies for dealing with distress, negative emotions, stress, and mental illness symptoms so they no longer need drugs or alcohol to cope.
According to the Substance Abuse and Mental Health Services Administration, a holistic treatment plan offers the best chances of a successful recovery.4 Addressing physical, mental and spiritual issues through a variety of therapies helps to ensure that treatment will be effective.
Traditional treatment therapies are “talk” therapies that help you become more aware of your thoughts and emotions and how these affect your behaviors. Cognitive-behavioral therapy (CBT) is the most effective and most commonly used therapy in addiction treatment.
Cognitive-behavioral therapy helps you identify thought distortions that can perpetuate dysfunctional behaviors. Examples of thought distortions include all-or-nothing thinking, putting a negative spin on everything, and catastrophizing or blowing things out of proportion. Through CBT, you replace unhealthy thought and behavior patterns with healthier ways of thinking and behaving, and you learn emotional coping skills that go a long way toward preventing relapse.
Other traditional therapies used in treatment include acceptance and commitment therapy, which helps you accept rather than avoid negative emotions; dialectical behavior therapy, which helps you develop tolerance for distress; family therapy, which helps to restore function to the family system; and psychoeducational groups, which combine addiction education and skills development.
Complementary therapies are experiential and involve hands-on activities that help people in treatment develop coping and communication skills, reduce stress and negative emotions, and enjoy whole-person healing. Art therapy is commonly used in non-medical detox and addiction treatment programs to reduce stress and change self-destructive patterns of thinking and behaving. Art therapy helps you express difficult emotions and communicate troubling experiences through making, viewing, and talking about art.
Other complementary therapies, including yoga and meditation, reduce stress and promote greater self-awareness. They help you stay mindful of your physical and emotional states and keep you rooted in the present moment where recovery happens.
Treatment plans are highly individualized and based on your unique and specific needs. They’re also dynamic, changing as your needs do. Other interventions used in a high-quality treatment program include:
Life skills classes, which help you develop the practical skills you need in order to be independent and successful in recovery.
12-Step Participation, which provides support and opportunities to develop healthy relationships
Vocational rehab, which helps you develop important job skills and find employment you’ll enjoy
Educational assistance, which can help complete a GED or apply for financial aid to return to school
Legal assistance, which helps you navigate the legal system and find affordable representation.
Non-medical detox improves comfort and feelings of wellbeing during withdrawal. Once brain function normalizes and the worst of withdrawal is over, you’ll begin to look to the future and see the possibilities. Keep an open mind in detox. It’s the eye-opening beginning of a long but worthy journey, and moving into recovery with hope is foundational for long-term success.