Detox and rehab: what's the difference?

What detox is

Detox, which health services usually call withdrawal management, is the period when the body adjusts to going without a substance it has become dependent on. Depending on the substance, how much and how long someone has been using, and their health, withdrawal can range from uncomfortable to medically serious.

Withdrawal management is medical care. It may happen in a hospital, in a specialist withdrawal unit, or at home with close supervision from a GP or a community drug and alcohol service. A doctor decides which setting is safe. Medication is sometimes used to ease symptoms and reduce risks, and the person is monitored so that problems are picked up early.

Withdrawal management typically lasts days rather than weeks. It is an important first step, but on its own it does not change the reasons someone started drinking or using, or the patterns that keep it going.

Why stopping suddenly can be dangerous

• Alcohol. For people who are physically dependent, stopping suddenly can cause severe withdrawal, which can include seizures and a dangerous state of confusion called delirium tremens. This is a medical emergency.
• Benzodiazepines (such as diazepam or alprazolam). Stopping suddenly after regular use can also cause seizures. Doctors usually reduce the dose slowly over time.
• Opioids. Withdrawal is very unpleasant, though less often life-threatening in itself. The bigger risk comes after: tolerance drops quickly, so going back to a previous dose can cause an overdose.
• Mixing substances, or having other health conditions, makes withdrawal harder to predict.

If someone is having a seizure, is very confused, can't stay awake, or is having trouble breathing, call 000.

What rehab is

Rehabilitation is the longer work that follows. In a residential program, people live on site for a set period, often 30 to 90 days, and follow a structured day of individual counselling, group work, practical skills and time to rest and recover. The focus moves from getting through withdrawal to understanding what drives the drinking or using, treating co-occurring mental health concerns, repairing relationships and building routines for life afterwards.

Rehab can also be done as an outpatient program, living at home and attending sessions. Which suits a person depends on how settled their home life is, their health and their goals.

Why detox usually comes first

Most residential programs, including ours, need guests to be through the acute stage of withdrawal before they arrive. There are good reasons for this:

• Withdrawal can need medical monitoring and medication that a rehab home is not set up to provide.
• It is hard to take part in therapy while your body is in withdrawal.
• The days straight after detox are a vulnerable time. Moving directly into a structured program, with a bed date already confirmed, avoids a gap where it is easy to slip back.

Not everyone needs a formal detox. Some people are not physically dependent, or have already stopped. A doctor can tell you.

Detox and Sapphire

Sapphire Recovery does not provide medical detox on site. If an assessment shows someone needs withdrawal management first, we help arrange it with an appropriate service, and plan the admission date around it so the move from one to the other is as smooth as possible. If the timing is linked to a court matter, our guide to rehab and bail explains how this affects the bed date.

When to see a GP

A GP is a good first stop, and you don't need to have a plan before you go. Book an appointment if:

• you want to cut down or stop and aren't sure if it is safe to do on your own
• you have had shakes, sweats, nausea or anxiety when you go without
• you take prescribed medication, including benzodiazepines or opioids, and want to reduce it
• you have other health conditions, or you are pregnant
• you want a referral to a withdrawal service, a psychologist or a rehab program.

You can also call Adis 24/7 Alcohol and Drug Support, Queensland's free, confidential phone service, on 1800 177 833, any time of day or night. They can talk through options and point you to withdrawal services near you.