Things to Consider When Choosing Alcohol Detox Centers

Deciding to seek treatment for alcohol use disorder can be difficult, and choosing alcohol detox treatment can feel overwhelming. If you are unable to control your alcohol consumption or experience negative side effects when you stop drinking, detoxification services may be necessary. You may feel fear, anxiety, or uncertainty. One way to lessen these uncomfortable feelings is choosing alcohol detox treatment that best fits your needs.

In this article:

• What Types of Alcohol Detox Centers Exist?
• What Do Alcohol Detox Centers Do?
• Commonly Prescribed Medications for Alcohol Detox
• How to Choose an Alcohol Detox Center
• Getting Help in Choosing Alcohol Detox

What Types of Alcohol Detox Centers Exist?

Many types of detox are available, though not one form of detox is best for everyone. You should receive a clinical assessment to help determine which option is best suited for your needs. After the assessment is completed, the provider will review the options with you. These options include:^1,2

• Ambulatory detoxification without extended onsite monitoring (e.g., physician offices, home healthcare) for those who are generally taking medication as prescribed and are dependent but not addicted—may not be a common setting for alcohol withdrawal due to the risk of complications
• Ambulatory detoxification with extended onsite monitoring (e.g., day hospital services, partial hospitalization) for those who may have a mild to moderate substance alcohol addiction, a low risk for complicated withdrawal, and a strong support system at home and in the community
• Clinically managed residential detoxification (e.g., nonmedical setting or social detox setting) for those with a low risk of severe withdrawal who prefer to detox at a facility, away from home, surrounded by peers who can offer support and encouragement
• Medically monitored inpatient detoxification (e.g., freestanding center) for individuals who require 24/7 care, such as those with a moderate to severe alcohol addiction
• Medically managed intensive inpatient detoxification (e.g., psychiatrist hospital inpatient center) for individuals who need 24/7 medical care, such as those with a severe risk of dangerous withdrawal and those with co-occurring mental health or medical disorders

Ambulatory Detoxification Without Extended Onsite Monitoring

Ambulatory detoxification without extended onsite monitoring is organized outpatient detox services.² This form can be delivered through physician offices, addiction treatment, or healthcare facilities. It also can be provided by trained clinicians to you at home. It is considered appropriate to have a positive and supportive social network that can keep you motivated to follow your treatment plan and abstain from alcohol use throughout detox.²

Ambulatory Detoxification with Extended Onsite Monitoring

Ambulatory detoxification with extended onsite monitoring offers similar services, but at this level, credentialed and licensed nurses monitor you for a few hours of each day.² Examples of this detox setting may include partial hospitalization programs (PHPs) and intensive outpatient programs (IOPs).

Clinically Managed Residential Detoxification

Clinically managed residential detoxification provides 24-hour supervision and support, but no medical care. At this level, there is an emphasis on peer and social support.² This detox setting may not be appropriate for someone with a risk of medical complications, such as withdrawal symptoms associated with alcohol or polysubstance use, since there is limited medical oversight.

Medically Monitored Inpatient Detoxification

Medically monitored inpatient detoxification provides 24-hour medical care and monitoring, which may include withdrawal medications to relieve symptoms and cravings, as well as any supportive care, such as IV fluids. The focus of this setting is on achieving medical stability and providing referrals to follow-up substance abuse treatment after detox is completed.²

Medically Monitored Intensive Inpatient Detoxification

Medically monitored intensive inpatient detoxification also provides around-the-clock medical oversight and care but in an acute care setting. Physicians and nurses are available to monitor your care and intervene whenever medically necessary. Examples of acute care settings include:²

• General hospitals
• Addiction treatment units within general hospitals
• Psychiatric hospitals
• Other licensed facilities

These treatment facilities are staffed with medical and nursing professionals and have access to life-saving and life-supporting equipment. Individuals treated at this level have alcohol withdrawal signs and symptoms that are severe enough that they need 24-hour care.²

What Do Alcohol Detox Centers Do?

The first thing an alcohol detox center does is conduct an assessment, which will include evaluating:

• How much alcohol you drink and how frequently
• How long you have used alcohol
• Symptoms of withdrawal
• Potential for serious withdrawal
• History of alcohol withdrawal
• History of seizures
• Mental health and medical history

Once the assessment is conducted, your detox center will discuss the treatment plan. This treatment plan outlines the course of treatment, including the medications prescribed, how and when to take them, and what their sides effects are.

Depending on the level of detox you choose and the center itself, you may come to the center multiple times a week, every day, or even stay in the facility. The frequency you attend is determined by your unique needs.

For individuals with moderate to severe alcohol withdrawal symptoms, you will want to speak to your provider about a residential or inpatient setting to ensure your withdrawal symptoms are managed on site.

Most alcohol detox centers focus on treating your physical withdrawal symptoms, meaning they continually evaluate your symptoms and risks and adjust medications as needed.

Commonly Prescribed Medications for Alcohol Detox

Medications that could be prescribed during detox include:^{2, 3, 4}

• Adrenergic medications
• Benzodiazepines
• Anticonvulsants
• Baclofen
• Antipsychotics
• Over-the-counter medications

Adrenergic Medications

Adrenergic medications can be especially helpful with the physical symptoms of withdrawal, such as elevated pulse and blood pressure.³ Common adrenergic medications include:

• Clonidine
• Propanol

Types of Benzodiazepines

Thus far, benzodiazepines have the largest amount of evidence to suggest effectiveness in treating alcohol withdrawal.³ Benzodiazepines also tend to be the preferred medication. Some common benzodiazepines include:²

• Diazepam
• Chlordiazepoxide
• Lorazepam
• Oxazepam

Anticonvulsant Varieties

Anticonvulsants are occasionally used as an alternative to benzodiazepines.³ The use of anticonvulsants especially reduces the probability that you will experience a seizure. These medications can also help reduce cravings. Common anticonvulsants include:³

• Carbamazepine
• Gabapentin
• Valproic acid

Baclofen

Preliminary research has shown Baclofen can help relieve severe withdrawal symptoms.³ However, it is not used primarily for detoxification. Baclofen is an adjunctive medication to reduce cravings for alcohol and encourage abstinence, especially in patients with liver cirrhosis and as a second-line treatment for heavy drinking.^3,5,6

Antipsychotics

Antipsychotics have also been used for a long time to assist with alcohol detox.³ These medications can help treat agitation and hallucinations. Antipsychotics can also help relieve any delusions or delirium that may occur as you detox. However, some antipsychotics can lower the threshold of seizures, so the medical team needs to weigh the potential benefits and risks before using this class of drugs. Haloperidol is a common antipsychotic that may be used.³

Over-the-Counter Medications

Additional medications that can assist the detoxification process include anti-diarrhea and anti-nausea medications. Pain medications, such as acetaminophen, can also help manage any pain associated with alcohol withdrawal.

How to Choose an Alcohol Detox Center

Aside from consulting your primary care physician and/or an alcohol use disorder treatment specialist on what options are appropriate, you will want to examine your detox goals.

Although there are thousands of detox treatment facilities, your choices may be limited, so you may not have much choice. However, if you have more than one option, you will want to compare agencies. In comparison, you will want to think about:

• Location
• Cost
• Reputation, specialties, and treatment outcomes
• Whether they offer medical care
• Length of program
• Access to wrap-around and follow-up services

Other Considerations When Choosing Alcohol Detox

Aside from your alcohol use and risk of withdrawal, many other factors could influence your treatment choices, such as the financial cost and time away from family and work. Some additional things to consider are:

• Your level of social support (i.e., co-workers, friends, and family who could help)
• Your level of financial support and stability
• Your medical condition, existing conditions, and needs
• If you need other types of specialized treatment and if they can provide it
• How long their detoxification services last
• If there is insurance coverage for the treatment
• If there is a deductible or an out-of-pocket cost and how much it is
• How your household responsibilities will be taken care of
• Your ability to take time off from work
• Your eligibility for the Family and Medical Leave Act (FMLA) or short-term disability
• If treatment is or is not aligned with your religious beliefs
• If treatment is or is not aligned with your medical beliefs
• When continued treatment or rehab is available
• The reputation of the detox center
• What types of providers are available at the detox center
• The success and outcome rates of the detox center
• How many other individuals are in detox at the same time

It is important to ask your detoxification provider what resources, if any, they provide after detox. You must understand that alcohol detox does not constitute professional alcohol addiction treatment; it is the first step on the continuum of care.¹ The rate of relapse is like that of any other chronic medical disease, and it is extremely important that after detox, you continue taking the next steps into treatment to maintain your recovery.³ Many detox providers can assist by giving you referrals for treatment and help you create a relapse prevention plan.

Getting Help in Choosing Alcohol Detox

It is recommended that before you make any decision of which alcohol detox treatment to pursue, you consult with a physician and addiction specialist. The physician and addiction specialist can help you determine what level of care is most appropriate for you, given your symptoms and risk of serious withdrawal.

If you are interested in seeking detox and treatment, please call 800-996-6135(Who Answers?) to get connected with a treatment specialist who can assist in this process.

Resources

1. Substance Abuse and Mental Health Services Administration. (2019). Treatment options: What happens next?
2. Substance Abuse and Mental Health Services Administration. (2015). Detoxification and substance abuse treatment.
3. Sachdeva, A., Choudhary, M., & Chandra, M. (2015). Alcohol withdrawal syndrome: Benzodiazepines and beyond. Journal of Clinical and Diagnostic Research, 9(9), VE01–VE07.
4. Bergeron-Parent, C. (2020). Alcohol withdrawal in my office…Yes! Family Doctor: A Journal of the New York State Academy of Family Physicians, 8(3), 52–55.
5. Addolorato, G., Leggio, L., Ferrulli, A., Cardone, S., Vonghia, L., Mirijello, A., Abenavoli, L., D’Angelo, C., Caputo, F., Zambon, A., Haber, P. S., & Gasbarrini, G. (2007). Effectiveness and safety of baclofen for maintenance of alcohol abstinence in alcohol-dependent patients with liver cirrhosis: randomised, double-blind controlled study. The Lancet, 370(9603), 1915–1922.
6. Andrade, C. (2020). Individualized, high-dose baclofen for reduction in alcohol intake in persons with high levels of consumption. The Journal of Clinical Psychiatry, 81(4).