What is Sub-Acute Medical Detox?

Dependence on drugs or alcohol may occur with heavy abuse, causing withdrawal symptoms to occur when you quit cold-turkey. Sub-acute medical detox is one option for treating dependence to substances such as alcohol or other drugs.

Sub-acute medical detox is a type of medication-assisted detox for mild to moderate withdrawal symptoms. Here, we look at what sub-acute detox is, how it works, why it’s important during withdrawal and how it differs from medical detox and medication-assisted treatment.

Sub-Acute Medical Detox and the Levels of Care

Detoxification, or detox, is the process of allowing all traces of one or more psychoactive substances to leave the body so that brain function can begin to return to normal. Sub-acute medical detox is for people whose dependence is serious enough to produce uncomfortable symptoms, but not severe enough to warrant hospitalization. Those who are at a high risk for relapse will also benefit from sub-acute medical detox, and it’s recommended for anyone who has been through detox before.

The American Society of Addiction Medicine has identified five levels of care for detox, with sub-acute detox comprising the fourth level:1

Level I-D:Ambulatory Detoxification Without Extended Onsite Monitoring. Also known as outpatient detox, this is the least restrictive level of care and involves detoxing at home but making regular visits to an outpatient clinic for monitoring.

Level II-D: Ambulatory Detoxification With Extended Onsite Monitoring. Clients at this level are monitored by licensed nurses during the day and return home at night.

Level III.2-D: Clinically Managed Residential Detoxification. Detox at the third level takes place at an inpatient detox facility, where staff and peers offer around-the-clock support. Medications are not provided at this level.

Level III.7-D: Medically Monitored Inpatient Detoxification. This level is sub-acute medical detox. It takes place at a stand-alone residential detox center or through a comprehensive inpatient treatment program. Sub-acute medical detox is monitored by medical and mental health professionals. It may involve medications that are provided as needed to reduce the severity of symptoms and treat any medical emergencies that arise during withdrawal.

Level IV-D: Medically Managed Intensive Inpatient Detoxification. Sometimes known as acute detox, this is the highest level of care. It involves hospitalization and intense, around-the-clock medical attention to reduce severe symptoms and prevent or treat dangerous complications during withdrawal.

An initial intake assessment helps healthcare providers determine the best detox setting for an individual’s needs. As a rule, providers strive to place people in the least restrictive environment possible.

Withdrawal in Detox

When you quit using substances, normal brain function quickly returns. This sudden and powerful shift in chemical function produces physical withdrawal symptoms.

Withdrawal symptoms depend on which neurotransmitters the drug acts on. Not everyone will experience all of the possible withdrawal symptoms associated with a certain drug, and symptoms can range from mild to severe. Withdrawal can last anywhere from a few days to a few weeks, and in severe cases, symptoms can last a month or longer.

How severe your symptoms are and how long they last depend on a number of factors:

  • Your age
  • The amount of drugs or alcohol in your body at the time detox begins
  • Your general state of mental and physical health
  • Your unique genetic makeup and biology

Sub-acute medical detox treats symptoms and reduces the amount of time it takes to detox.

Lifesaving Medical Detox for Withdrawal

Withdrawal from some substances, like alcohol and prescription drugs like Xanax and valium, can produce dangerous and even fatal complications. Medical detox during withdrawal from these substances is essential for safety.

While withdrawal from opioids and stimulants isn’t particularly dangerous, it can be excruciating. Opioid withdrawal is characterized by flulike symptoms, including body aches, nausea, vomiting, abdominal cramps and diarrhea. Dehydration is a serious concern during opioid withdrawal. Stimulants, such as cocaine, meth and the prescription drug Adderall, can produce deep depression during withdrawal. Stimulant withdrawal may also cause anxiety, restlessness, irritability and insomnia.

In many cases, withdrawal symptoms, including cravings, are so uncomfortable that relapse may occur simply to end the discomfort. The medications used in sub-acute medical detox reduce the severity of withdrawal symptoms to dramatically improve comfort and increase the chances of staying off drugs or alcohol.

Sub-Acute Medical Detox vs. Medical Detox and MAT

Sub-acute medical detox is different from both medical detox and MAT. Medical detox is the most restrictive and intensive level of detox and takes place in a hospital setting, while sub-acute medical detox takes place in a facility that offers more freedom and a variety of therapies and interventions to improve comfort and wellbeing. In many cases, however, the term “medical detox” is used to describe both acute and sub-acute medical detox.

Medication-Assisted Treatment

Medical detox is different from medication-assisted treatment, or MAT. Medication-assisted treatment for opioid dependence involves medications that, in most cases, prevent withdrawal, reduce cravings and block the effects of opioids. The medications approved for use with MAT are methadone, buprenorphine, and naltrexone. MAT can occur in an outpatient situation, whereas Medical Detox typically occurs in a facility.

Medication is just one component of MAT. The other component is counseling, which addresses the addiction and helps people in recovery develop the mindset, skills, and tools they need to recover for the long-term. MAT is available for alcohol use disorders, and it’s the gold standard of treatment for opioid use disorders, according to the Substance Abuse and Mental Health Services Administration.2

Three Components of Medical Detox

During sub-acute medical detox, there is the freedom to take strolls outside, watch TV or play games with fellow detoxers or enjoy solo periods of rest and relaxation. But a variety of therapies and assessments also to help you get the most out of detox. High quality detox programs have three components: Evaluation, stabilization and fostering readiness for treatment.

Evaluation

During the evaluation phase of sub-acute medical detox, you’ll undergo a variety of assessments that identify the types and amounts of substances in your bloodstream and determine whether you have a co-occurring mental illness like anxiety or depression. You’ll undergo a comprehensive medical and mental health evaluation and an assessment of your social situation to help care providers identify the areas in your life where you need help.

Stabilization

During the stabilization phase of detox, medical and mental health professionals help you move through the period of withdrawal into a medically stable state where you’re drug-free. This is the phase where medications are provided and during which staff and peers provide a high level of emotional support. A variety of complementary therapies are offered in high-quality detox programs, including acupuncture, massage therapy, and restorative yoga, which reduce stress, ease withdrawal symptoms and promote feelings of calm and wellbeing.

Fostering Entry Into Treatment

Detox treats dependence, but it has very little effect on addiction, which is characterized by compulsive drug abuse despite negative consequences. Research shows that if addiction treatment doesn’t follow detox, the risk of relapse is very high.

One study, published in the Irish Medical Journal, found that 91 percent of people in an opioid medical detox program relapsed following discharge, with 59 percent relapsing within a week.3 However, those who completed a six-week treatment program either didn’t relapse or had a significantly delayed relapse.

Treatment should follow detox for the best chances at successful recovery. During the fostering phase of detox, care providers work to prepare clients to enter addiction treatment. This occurs through individual and group therapy and psychoeducational sessions that impart the importance of treatment for ending an addiction for the long-term. Motivational interviewing is a therapy that helps clients identify their own, intrinsic reasons for wanting to recover and build motivation to change

What Happens After Detox?

The assessments taken during sub-acute medical detox guide the development of a comprehensive and highly individualized treatment plan that addresses the addiction, which is far more complex than dependence. Your treatment plan will address all of your needs and issues and will include a variety of traditional and complementary therapies that help you create an enjoyable, sober lifestyle. Treatment works for most people who stay in a program for an appropriate period of time. According to the National Institute on Drug Abuse, treatment lasting less than 90 days is of limited effectiveness.4

Recovery is a process of change, and it comes with challenges. Detox is the first challenge, but a high-quality detox program can make an enormous difference in comfort and safety. 

Following detox with a treatment program dramatically improves your chances of successful long-term recovery.

Treatment helps you develop the mindset, skills, strategies, and tools you need to make real and meaningful changes in your life and cope with triggers like cravings, negative emotions, and stress. Treatment works, and it can help you find purpose, meaning and authentic happiness in a life without drugs or alcohol.


Resources

  1. https://www.ncbi.nlm.nih.gov/books/NBK64109/
  2. https://www.samhsa.gov/medication-assisted-treatment/treatment
  3. https://www.ncbi.nlm.nih.gov/pubmed/20669601
  4. https://www.drugabuse.gov/publications/principles-drug-addiction-treatment-research-based-guide-third-edition/frequently-asked-questions/how-long-does-drug-addiction-treatment