What is drug and alcohol detox?
When your body is used to a substance, stopping it can cause withdrawal. Symptoms range from anxiety, sweating and nausea to seizures and hallucinations. Detox programs watch you closely, treat symptoms with medication when needed, and keep you as safe and comfortable as possible.
Treatment providers and insurers describe care using The ASAM Criteria, a set of placement guidelines from the American Society of Addiction Medicine (ASAM). The fourth edition, published in 2023, no longer treats withdrawal management as a separate track. Instead, it builds withdrawal care into these levels:
- Level 1.7 – Medically Managed Outpatient: withdrawal care during office visits.
- Level 2.7 – Medically Managed Intensive Outpatient: several hours of daily monitoring, then you go home.
- Level 3.7 – Medically Managed Residential: 24-hour care in a residential setting with nurses on site and physician oversight.
- Level 4 – Medically Managed Inpatient: hospital care for the most serious cases.
Many states and health plans are still moving to the fourth edition, so you may also hear older third-edition labels such as 3.7-WM (medically monitored inpatient withdrawal management) or 3.2-WM (clinically managed residential withdrawal management). In the fourth edition, the services once called 3.2-WM are part of Level 3.5 residential care.
Not sure which setting is safest? Call (877) 847-2855 to talk through options and check your insurance benefits. It's free and confidential.
Who needs medically supervised detox?
A clinician decides the right setting after an assessment. You are more likely to need supervised detox if you:
- Drink heavily every day or have had withdrawal seizures or delirium tremens (DTs) before
- Take benzodiazepines (such as Xanax, Klonopin or Valium) daily, even as prescribed
- Use opioids such as fentanyl or heroin and have tried to stop on your own without success
- Use more than one substance at a time
- Are pregnant, older, or have heart, liver or lung problems
- Have a mental health condition, or thoughts of suicide
Important: Withdrawal from alcohol and benzodiazepines can be life-threatening. Don't stop suddenly without medical guidance. If you or a loved one has a seizure, confusion, chest pain or trouble breathing, call 911. If you are thinking about suicide, call or text 988, the Suicide & Crisis Lifeline.
What happens during detox?
Most residential detox stays follow a similar pattern.
Intake and assessment. A nurse or doctor asks about what you use, how much, and when you last used. They check vital signs, may run lab tests, and screen for mental health conditions. This sets your plan.
Stabilization. Staff check your symptoms on a regular schedule using standard scales and give medication to ease withdrawal. For alcohol and benzodiazepines, this often means a carefully managed taper. For opioids, it may mean starting buprenorphine or methadone.
A typical day. Expect regular check-ins on your vital signs, meals and fluids, rest, and medication. As you feel better, many programs add short counseling sessions, education groups, and visits with a case manager.
Discharge planning. Before you leave, staff should help line up your next level of care. Good programs treat this as part of detox, not an extra.
How long does detox take?
Most supervised detox stays last several days to about two weeks. Timing depends on:
- The substance. Alcohol withdrawal often starts within hours of the last drink and is usually worst in the first few days. Benzodiazepine withdrawal can last much longer because doses must be lowered slowly. Opioid timing differs between short-acting drugs like heroin and long-acting drugs like methadone.
- How long and how much you used.
- Your physical and mental health.
Some symptoms, such as poor sleep, low mood and cravings, can last for weeks. That is one reason ongoing treatment is so important. Learn more in our guide to how long rehab lasts.
How does detox compare with other levels of care?
| Setting | ASAM level (4th ed.) | Where you sleep | Medical staffing | Best fit |
|---|---|---|---|---|
| Outpatient withdrawal care | 1.7 | Home | Scheduled visits with a prescriber | Mild withdrawal risk, stable home, strong support |
| Intensive outpatient withdrawal care | 2.7 | Home | Daily on-site monitoring for several hours | Moderate risk, safe home, can travel daily |
| Residential detox | 3.7 | Facility | 24-hour nursing, physician oversight | Moderate to severe risk, or unsafe home |
| Hospital detox | 4 | Hospital | 24-hour physician and nursing care | Severe withdrawal or serious medical or psychiatric problems |
If you need hospital-level care, see hospital inpatient treatment.
Does insurance cover detox?
Under the Affordable Care Act (ACA), substance use disorder treatment is one of the essential health benefits that Marketplace plans must cover. The Mental Health Parity and Addiction Equity Act (MHPAEA) also generally requires plans that cover these services to apply limits no stricter than those for medical care.
In practice, coverage usually depends on:
- Medical necessity, often judged using ASAM Criteria
- Prior authorization, which many plans require before or soon after admission
- In-network vs. out-of-network status
- Your deductible, copays and out-of-pocket maximum
Plans vary by state, employer and plan type (HMO, PPO or EPO). Medicaid covers detox in many states, and some people qualify for state-funded care. Costs vary widely by setting and length of stay. Hospital detox generally costs the most. See does insurance cover rehab? for more.
How do you choose a safe detox program?
Look for these signs of quality:
- State licensing for withdrawal management. You can usually confirm a license on your state health or behavioral health agency's website.
- Accreditation from The Joint Commission or CARF (Commission on Accreditation of Rehabilitation Facilities).
- Medical staff on site or on call 24/7, with a physician overseeing care.
- Medication options, including buprenorphine or methadone for opioid withdrawal.
- A clear discharge plan and help with the next step.
Watch for red flags:
- Patient brokering. Paying or receiving kickbacks for patient referrals is illegal under federal law (the Eliminating Kickbacks in Recovery Act of 2018) and many state laws.
- Free flights or travel to an out-of-state program, especially paired with pressure to decide fast.
- "Free rent" or free sober housing offered in exchange for attending a certain program.
- Asking only about your insurance, or promising it will cover everything.
- Refusing to share license numbers or staff credentials.
Our guide on how to choose a rehab covers more questions to ask.
What happens after detox?
The National Institute on Drug Abuse (NIDA) notes that medically assisted detox is only the first stage of treatment and, by itself, does little to change long-term drug use. Most people step down into one of these:
- Inpatient residential treatment for structured, 24-hour support
- Partial hospitalization or intensive outpatient care while living at home
- Medication-assisted treatment, which can continue for months or years
Moving straight into treatment protects your progress. After opioid detox, the risk of overdose rises because tolerance drops fast.
You don't have to figure out the next step alone. Call (877) 847-2855 to talk with our admissions helpline about detox programs that fit your needs and insurance. It's free and confidential.
