Detox vs. Rehab – Are They Different?

detox vs rehab

Detox vs. Rehab – Are They Different?

Making the decision to enter a rehab facility and get clean is an enormous decision in anyone’s life. Whether you yourself are an addict, or your loved one or someone else close to you is, you know that entering a rehab facility is an experience that is often surrounded by feelings of anxiety or apprehension. Much of the anxiety and apprehension surrounding the decision to enter a rehab program is a fear of the unknown.  

Most people simply don’t know enough about the rehab process to think about it realistically and prepare. One of the most common misconceptions occurs when detox and rehab are different. This article will seek to provide prospective patients and their families with more information about what rehab and detox are, what they are not, and how they differ from one another. In doing so, we hope that this information will prove useful and help alleviate some of the anxiety and stress that comes with the decision to enter a treatment program.

What Is Detox?

The confusion between detox and rehab is centered around a misconception that rehab is merely an extended period of detox. This belief has some truth to it, which we will break down in this and the following section, but it doesn’t tell the whole story. To begin with, let’s define what detox is. Detox is the process through which harmful substances are abstained from and removed from the body. In a drug and alcohol rehab facility, the detox process seeks to stop the consumption of the substance of abuse, then works to facilitate the body’s natural processes that break down and excrete that substance over a period of time until none remains.  

To visualize this process, it helps to have a concrete example. We’ll outline how detox from heroin, one of the most commonly abused substances in the United States, occurs within the body and what might be expected from it. Heroin, or diacetylmorphine, is an opiate that produces feelings of euphoria in the user. Typically, users consume heroin by snorting it, injecting it, or smoking it.

All of these modalities of use result in different concentrations of the drug in the body. Once heroin enters the body it begins to be broken down into differing compounds known as metabolites. The breakdown of heroin into its subsidiary metabolites occurs very rapidly, which allows the drug to produce a rapid onset of euphoria. The primary metabolite that heroin breaks down into is known as 6-MAM, or 6-monoacetylmorphine, which has about 6 times the potency of morphine. Heroin is a unique precursor to this metabolite, which is why most drug testing done for heroin seeks to detect the presence of 6-MAM.

The breakdown of heroin into 6-MAM is the first step in the body’s metabolic processes. These processes are the backbone of detox, as the body is trying to continually break down the substance until it can be excreted. With heroin, these metabolic processes occur very rapidly.  Within twenty-four hours after consuming heroin, the user’s body breaks down the heroin metabolite 6-MAM into morphine.

Morphine then stays in the system at detectable levels for up to an additional seventy-two hours, before the body can fully excrete it through urine. The process of breakdown and excretion of heroin to 6-MAM, and 6-MAM into morphine, does not occur all at once. Rather, over time detectable levels of 6-MAM and subsequently morphine begins to decline until the body has completely rid itself of the substance.

The process through which the body breaks down a substance and excretes it is one important aspect of the detox that occurs during rehab.  This physical process is a normal part of how any substances that enters our body is broken down and excreted. However, in cases of substance abuse, this detox process also carries with it a number of effects that the recovering addict will feel. These effects are known as withdrawal. The withdrawal process is an important part of the detox, and so deserves some discussion.

The Withdrawal Process

Before entering rehab, many addicts think about the withdrawal process with a sense of foreboding and dread. The vast majority of people who enter a rehab facility have attempted to quit a substance before “cold-turkey,” meaning stopping the use of the drug either spontaneously or overtime with subsequently smaller doses, and then undergoing the detox process without medically managed supervision.

In a high percentage of cases, this method of quitting results in relapse. Relapse from many drugs can be extremely dangerous, and in some cases life-threatening. The act of relapse is intimately tied to the withdrawal effects that come from quitting a substance of abuse, particularly the physical and mental effects that arise once consumption has been stopped.

To illustrate how the withdrawal process is intertwined with both detox and relapse, let’s look at the physical symptoms of withdrawal from heroin. Physical withdrawal symptoms of heroin will begin to appear in the user within the first 6-12 hours after it was last used.  This relatively fast appearance of withdrawal symptoms is related to how quickly the body breaks down and excretes heroin and its subsidiary metabolites. Common physical symptoms of heroin withdrawal include:

  • Nausea
  • Vomiting
  • Diarrhea
  • Aching bones and joints
  • Yawning
  • Itching
  • Leaking of fluids from eyes
  • Excessive sweating
  • Sneezing
  • Chills and goosebumps
  • Loss of appetite
  • Restless legs
  • Insomnia
  • Desire to use again

From this list, one can immediately tell that the withdrawal symptoms from heroin are extremely uncomfortable. They can generally be described as severe “flu-like” symptoms, but this doesn’t do justice to the rapidity and intensity of their onset. One important note about the above symptoms is that the user will have a strong desire to use again, due to the chemical dependency that has been created from their habit, as well as an innate desire to make the symptoms of withdrawal go away.  

For recovering addicts undergoing heroin withdrawal, these symptoms will begin to occur within the first 6-12 hours, getting worse until they reach a peak intensity during the first 48-72 hours. After three days without using heroin, the recovering addict will generally begin to experience lessening symptoms. The symptoms from heroin withdrawal generally taper off anywhere between 5-10 days after the last consumption of heroin.  

There are a couple of key points regarding this that applies to detox from nearly all abused substances. The first is that the onset of withdrawal symptoms is tied to the breakdown and elimination of the substance in the body, or the detox process, but physical and psychological withdrawal symptoms can last well past when the last of the drug was eliminated from the body. The second important point to take away is that each person’s drug or alcohol abuse habit, and body, is different.

This results in a wide variance of symptoms experienced and the speed with which detox can be accomplished. For users that have had a long-term habit where their tolerance is high, the length of the detox process and the intensity of the withdrawal symptoms will be different than someone who has only recently begun abusing a substance. Additionally, other factors such as body-mass index, metabolism, general fitness, hydration levels, and overall health of the body can alter the length of the detox process and the time period that withdrawal symptoms are felt.

Medical Supervision

An important part of the detox process as it occurs within a rehab facility is that it is done under constant medical supervision. This is critical for both the health of the recovering addict, and in many cases medically managed detox and withdrawal can alleviate some of the most significant withdrawal symptoms. Continuing with the example of heroin, withdrawal symptoms can usually be medically managed through the application of Suboxone or other drugs that function to minimize the felt effects of heroin withdrawal.  

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Generally, the use of drugs to medically manage withdrawal from heroin results in reduced intensity and duration of withdrawal symptoms. Many long-term drug users also develop underlying health conditions as a result of their drug habit. The symptoms of these underlying medical issues are often masked by the use of the drug, and in many cases the recovering addict doesn’t realize that they had an underlying medical condition at all. Medically managed withdrawal is especially important in these cases, as the underlying medical condition can include pervasive infections or organ damage that could be life-threatening in an unsupervised situation.

Rehabilitation Programs

Once a recovering addict has completed the detox process, they can begin the process of recovery. A rehab program is a process that most frequently encompasses both detox and the recovery program that follows. Put another way, detox is a part of a rehab program as a whole, but rehab isn’t necessarily a part of detox. A rehabilitation program uses the detox phase to eliminate the substance of abuse from the recovering addict’s body, at which point they can begin to learn skills and tactics to cope with the underlying addiction that resulted in their chemical dependency.  

The vast majority of rehabilitation programs require a period of detox prior to the start of the real recovery efforts. The reasoning behind this is straightforward; to truly begin the journey of healing and recovery, the recovering addict must no longer be under the effects of their substance of abuse. Following the detox and withdrawal process, many recovering addicts will begin to interact with the world from a position of sobriety for the first time in months or even years. With sobriety comes clarity, and the ability to critically examine both oneself and the factors that gave rise to their addiction and chemical dependency.

It should be understood from the outset that rehab is a much longer process than detox. Detox and withdrawal happen relatively quickly, while an inpatient rehab program can last anywhere from 30-90 days.  Many drug rehab centers also offer outpatient recovery programs.  As opposed to an inpatient recovery program, outpatient programs allow the recovering addict the ability to undergo recovery from their own home while attending classes or workshops at a treatment facility.  

Depending on the severity of the addiction and the type of substance that one is addicted to, outpatient recovery may be a realistic option for some people. These programs will still typically require a period of detox within the facility, as detox is a critical step towards recovery. Recovery, which encompasses both detox and rehab, is a lifelong process where the recovering addict maintains their sobriety long past when they have transitioned to life outside of the facility.

The primary goal of any rehab program is to help recovering addicts achieve lifelong sobriety and freedom from chemical dependency.  Rehab programs accomplish this through a variety of techniques. The techniques and programs that the recovering addict will learn and take part in vary depending on the philosophy of the institution they are working with and their own individual outlook, goals, and lifestyle.

Many modern top-tier rehab facilities incorporate different types of therapy, such as individual, group, and family counseling to help recovering addicts work through the underlying issues that gave rise to their addiction, as well as the trauma that may have been caused by their addiction.

Additionally, many rehab facilities offer life skills courses that are geared towards assisting recovering addicts in their transition to a life of sobriety that is centered on health and wellness following their treatment program.  

Some rehab facilities have also recognized the strength that holistic approaches can offer when supplementing therapy and life skills classes. These holistic courses can aid the recovering addict in achieving greater awareness of their body and mind, allowing them to become more in touch with their thought processes and the world around them.

Unlike a detox program, which is relatively similar across nearly all people and largely depends on their habit and the substance of abuse, an ideal rehab program is tailored to the individual in order to meet their needs and maximize their chances of a successful recovery. In order to achieve lifelong sobriety, both the detox and rehab processes are critically important in any drug and alcohol recovery program.

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