Drug and Alcohol Detox: Detoxification Programs for Veterans

Alcohol and substance use disorders are extremely prevalent among our nation’s military veterans, with 11% of veterans who meet the criteria for substance use disorder seeking first-time care at the local VA hospital.¹ Alcohol use disorders and heavy drinking are common amongst military personnel. Problematic patterns of alcohol consumption may go hand in hand with inconsistent policy enforcement and a culture of heavy alcohol consumption for recreation, stress relief, and socializing.¹ Additionally, the number of opioid prescriptions given in the VA healthcare system has also increased, which parallels a trend of increasingly prevalent misuse of prescription opioids amongst veterans.¹

With problematic substance use being so commonplace, the need for treatment remains high. Oftentimes, veterans who are seeking treatment for substance abuse will have to first undergo detoxification, or detox. Undergoing detox from alcohol and other drugs can be difficult. Some veterans may not utilize VA services, which could additionally limit both detox and treatment options. If you are a veteran seeking detox for the first time, it’s important to understand the process, what insurances will cover detox, and how to access detox through the VA.

What is Drug Detoxification?

Drug detoxification is a set of interventions aimed at managing the acute phase of withdrawal that arises at the point of quitting drugs or alcohol.³ If done under supervision with various medical interventions available, detoxification can help prevent life-threatening complications that might appear if the patient were left untreated. For many, drug detox is also the first step taken toward recovery, and is then commonly followed by additional rehabilitation or longer-term treatment.³

It is important to remember that detox doesn’t represent the entirety of substance abuse treatment. Detox is generally just a first step to stabilize and prepare patients for more intensive treatments. The detox process will often involve several stages, beginning with an evaluation of a patient’s condition. Once this has been determined, detox treatment can begin, often with the goal of stabilizing a patient so they can move on to different medical treatment tracks.³

Detox can take place in either an inpatient or outpatient setting, depending on your needs. Medications may be used, depending on a person’s needs and the services offered at the given treatment center, to alleviate potential withdrawal symptoms associated with some types of substances.

The decision to detox with help from a treatment center sets you up for success in long-term recovery. The relapse rate for people who do not seek help for their substance abuse and do not enroll in detox is 60% — much higher than for those who seek treatment.⁴

What Medications Are Used for Drug Detox?

Many detox programs will work to meet you where you are by offering unique programs. For veterans, this could involve taking into account any co-occurring mental health disorders, like post-traumatic stress disorder (PTSD) or anxiety. Some detox centers also offer medication-assisted treatment (MAT), which can help lessen the withdrawal symptoms commonly experienced during detox. MAT may continue at the point that withdrawal has successfully been managed during detox, with the goal of maintaining someone in long-term recovery.⁵ This may include the use of FDA-approved medications that can help treat alcohol and opioid use disorders, including:⁵

• Used in the treatment of opioid use disorder for both detoxification and maintenance treatment after a medical detox.
• Can also be used in the treatment of opioid use disorder for both detoxification and maintenance programs.
• Used in treating both opioid and alcohol use disorder after the initial detox period. It blocks opioid receptors, reduces cravings, and diminishes the rewarding effects of alcohol and opioids.
• Used in the treatment of alcohol use disorder to help in the maintenance of alcohol abstinence.
• Used in the treatment of alcohol use disorder as a deterrent to continued drinking. It causes severe physical reactions when taken with alcohol.

What is the Detoxification Process?

The detoxification process is essentially the management of withdrawal symptoms that a person may experience when they stop using a drug or alcohol.⁵ symptoms vary in intensity and duration based on the specific type of substance being used as well as factors such as how long a person used the substance and their overall health. Professional detox is a process that is methodical and medically supervised. It includes a series of steps that may be done concurrently or in a series:³

• Evaluation, where the person is tested for the presence of the abused substance in the blood or urine and screened for co-occurring mental health conditions.
• Stabilization, which includes helping the person medically and emotionally through withdrawal, usually with the assistance of medications. This can also include the involvement of family members so that the patient and their family can learn about the process of recovery.
• Fostering entry into treatment, the final step, involving complete substance abuse treatment and education about the lifelong process of recovery.

What Are the Benefits of Drug Detox?

Problematic drug and alcohol use is associated with significant health issues. While treatment can help people put a stop to compulsive substance use as a means of improving their health and wellbeing, the thought of an imminent and often-uncomfortable withdrawal process presents a hurdle to many people from seeking help to begin with. One of the main benefits of professional detox with medical withdrawal management is that it can keep you as safe and comfortable during this early recovery period.

Additionally, drug detox is often considered the first step toward recovery. As a veteran, you have the resources of the Department of Veterans Affairs (VA). The VA  can help you enroll in a medical management detoxification program so you can start your recovery with a strong foundation.⁶ Other substance abuse treatment services offered by the VA may include:⁶

• Counseling groups.
• Residential live-in care.
• Outpatient treatment (both intensive and short-term)
• Continuing care and relapse prevention.
• Marriage and family counseling.
• Self-help groups.

In addition to the safety and comfort afforded by withdrawal management interventions, becoming medically stable to better access and participate in these potentially life-changing programs is another indispensable benefit of drug detox.

What is Withdrawal like During Detox?

People may experience a variety of withdrawal symptoms while undergoing detox. The term substance withdrawal syndrome refers to a set of symptoms that may occur when someone with significant physiological dependence on drugs and/or alcohol suddenly stops using or quits drinking. Some substances, such as opioids, alcohol, benzodiazepines, and other central nervous system depressants are associated with significant, and potentially dangerous or fatal withdrawal symptoms. Withdrawal symptoms of other substances, such as marijuana and stimulants, are less commonly associated with severe physical withdrawal or withdrawal complications .⁵ While the character, severity, and length of withdrawal varies according to the substance being used in addition to a number of other factors, many withdrawal syndromes are relatively short—lasting less than a week before symptoms largely resolve.⁵

When detoxing from alcohol, timeframes for when one might experience withdrawal symptoms varies widely depending upon how much that individual was drinking. Generally, one can expect alcohol withdrawal symptoms to begin within eight hours after the last drink. Symptoms and certain withdrawal risks may peak in severity within one to three days, though they can last for weeks. Alcohol withdrawal symptoms may include. :^7,10

• Anxiety or nervousness.
• Insomnia (sleeping difficulty).
• Depression, mood swings, or irritability.
• Sweating, clammy skin.
• Rapid heart rate.
• Nausea and vomiting.
• Tremor of the hands or other body parts.
• Seizures.

Delirium tremens is a particularly severe form of alcohol withdrawal. It can be fatal if left untreated. Symptoms may include:⁷

• Agitation.
• Elevated body temperature.
• Hallucinations.
• Seizures.
• Severe confusion.

Symptoms of opioid withdrawal may start within twelve hours of last use. They may include some of the symptoms of alcohol withdrawal along with:⁸

• Anxiety.
• Dysphoria.
• Goosebumps.
• Sweating, runny nose, teary eyes.
• Yawning.
• Dilated pupils.
• Abdominal cramping, diarrhea, nausea, and vomiting.

How Long Does it Take to Detox?

The duration of detox will depend on the individual. Remember that the length of time you spend in detox will depend on what substance you’ve been using, for how long, and in what quantities. It’s best to speak with a medical professional to determine what detox may entail.

Does the VA or Insurance Cover Detox for Veterans?

Many veterans struggle with substance use disorders. The VA health network offers a wide variety of services to help veterans tackle substance abuse. These services may range from addressing unhealthy alcohol use to intensive medical treatment for substance abuse disorder.⁶ These services may also be offered internally at the VA, or through a third-party Community Care partner.

The VA will provide the most up-to-date medical services for all eligible veterans, no matter where they come for services. By getting care in the VA, your provider will know that substance use disorders are frequently part of co-occurring mental health conditions. Common co-occurring health disorders affecting veterans range from posttraumatic stress disorder (PTSD) and depression to chronic pain, disturbed sleep, or relationship problems.⁶

The VA offers several options for those seeking treatment for substance use problems. These options include therapy, either alone with the therapist or in a group, as well as medications that can help reduce their use of alcohol and drugs.

If you are a veteran and have TRICARE insurance, your insurance may cover inpatient services that require detox, intensive outpatient programs for recovery, medication assistant treatment, mental health therapeutic services, office-based opioid treatment, partial hospitalization programs, and residential substance use disorder treatments.⁹ TRICARE will not cover aversion therapy or unproven treatments.⁹

How Do I Know I Need Detox Instead of Other Types of Treatment?

Detox is often the first step in achieving recovery, but recognizing when you need detox may not be easy. Depending on where you are in the recovery journey, your level of care, seeing of care (inpatient or outpatient), and treatment track may vary greatly.⁵ Many of these programs and therapies are best accessed after one is medically stable and able to fully focus on addressing the underlying causes of their substance abuse.

Rapid and At-Home Detox: Are They Safe?

The goal of medically managed withdrawal or detox treatment is to reduce withdrawal symptoms, minimize the risk for and manage any complications that can arise (for instance, seizures during alcohol withdrawal), and get you into treatment to begin your path to sobriety.⁷ Trying to detox at home can be dangerous in the event that withdrawal symptoms become severe or other withdrawal complications develop.

Detoxing at home or otherwise without the support of a treatment team could also increase the likelihood of immediate relapse in an attempt to avoid or diminish the unpleasantness of unmanaged withdrawal symptoms.¹⁰

What Happens After Detox?

If you are ready to get help and seek medically supervised detox, then the next step will be to get into treatment by calling your local VA or another treatment program. After detox, it will be pivotal that your treatment includes a combination of behavioral treatment, support groups, and possibly medications to help or reduce cravings or wean you off your drug of choice and prevent relapse.¹¹ Remember to look for treatment programs that have veterans-specific treatment tracks, offer personalized treatment plans, and offer treatment for co-occurring disorders.

Remember that overcoming alcohol and substance abuse disorder is an ongoing process that will require long-term care and work. For veterans transitioning from military to civilian life, connection is the antidote to addiction. If you are ready to stop drinking or using drugs, the American Addiction Centers is ready to help. Our 24/7 confidential phone line is available to assist you.

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