Ask an Expert: Are There Differences in Detox?

By Lance Dodes 02/19/15

Today's question is on if it matters where you go for detox.


Are there differences in detox?  My wife has been in and out of treatment for serious alcoholism for several years and then relapses very badly every two or three years. Her physical craving seems to become overwhelming. Over and above insurance I have spent a fortune on this. Also, I am sorry to say, I don't help the situation sometimes by showing my frustration. Recently I have been reading there are a number of forms of detox. I am looking for recommendations about the most effective, maybe something even out of the box, so we can compare it to past detox experiences she has had which have not stopped the physical craving in its tracks. Yes, she is in therapy as well.- Arthur.


Lance Dodes: Arthur, you stated your question as if it is about detox, not rehabilitation facilities, which makes a big difference.  Detoxification from drugs on an inpatient basis is a medical procedure which is basically the same everywhere.  It is not related to the relapses you describe, since once the detoxification is completed (usually no more than a matter of days), there is no more physical addiction. For that reason, your wife's relapses much later are not due to "physical craving." Relapse urges are driven by emotional factors for which drug use is an attempted solution.  The appropriate treatment is to figure out the factors that repeatedly precipitate these urges (I describe this in detail in my book, Breaking Addiction).

If what you are asking about is not detoxification itself, but inpatient rehabilitation programs, then you should understand that the rehab industry is unregulated, so rehabs may offer any kind of unproven treatments and claim any wonderful results they want, without evidence. There is also no reason to think that paying more will get you better treatment. Indeed, the most expensive and well-known facilities charge for such irrelevant "treatments" as horse therapy, "ocean therapy" (a trip on a yacht), aerobic exercise, and more. If you are considering an inpatient rehabilitation stay, 

I would look for a shorter (no more than 2 weeks) and less expensive facility that offers zero horses and does not insist that everyone buy into whatever is their standard program. Ask if most treatment is done in groups or whether there is truly individual therapy, and ask about the academic qualifications of the "therapists." Avoid places that are "12-step-based" unless your wife is in the 5-10% who do well with that approach. Finally, if your wife has had extensive periods of abstinence and not benefitted from longer hospitalization beyond physical detoxification, I would obtain a careful review of her situation before embarking on another inpatient stay.



Lance Dodes, MD, has been Director of the substance abuse treatment unit of Harvard’s McLean Hospital, Director of the alcoholism treatment unit at Spaulding Rehabilitation Hospital and Director of the Boston Center for Problem Gambling. His books, The Heart of Addiction, Breaking Addiction: A 7-Step Handbook for Ending Any Addiction and The Sober Truth, have been described as revolutionary advances in understanding how addictions work.   Full Bio.

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