Detox is withdrawal done with a clinician involved, not a facility you disappear into. It starts with an assessment of about an hour, you are given a keyworker, and for some substances there is medication. Alcohol and benzodiazepines are the two where coming off without a prescriber is genuinely dangerous. Opioids need the plan for afterwards, because that is where the deaths are.
Which substances need a prescriber
This is the part people most need and most rarely get straight, and blurring it does real harm. Someone comes off heroin, finds it survivable, and concludes the alcohol warnings were overblown. They were not.
| What you are stopping | Does stopping suddenly need medical support? | What to ask for | |---|---|---| | Alcohol | Yes. UK guidelines warn that stopping suddenly or reducing too quickly "can lead to severe complications and can even be fatal" | A medically assisted withdrawal. Do not attempt a cold stop first | | Benzodiazepines, and other medicines linked to dependence | Yes. NICE is explicit that a medicine should not be stopped abruptly | A written, dated reduction plan with a prescriber | | Heroin, methadone, other opioids | The withdrawal itself is usually not life-threatening. The danger is afterwards | Substitute prescribing, and naloxone before you start | | Cocaine, crack, cannabis, ketamine and most stimulants | Not dangerous in the same way, though mood can drop hard after stopping stimulants | Ask what support is offered, and tell someone if your mood drops badly |
On opioids the WHO is plain: ["opioid withdrawal is not usually life-threatening"](https://www.ncbi.nlm.nih.gov/books/NBK310652/). That reads like good news and it is not, because the same guidance says everyone who has withdrawn from opioids is at increased risk of overdose from reduced tolerance. The NHS says it in one line: ["Detox lowers your tolerance to heroin. This means your risk of overdosing is higher if you take heroin or other drugs, such as benzodiazapines, after detoxing."](https://www.nhs.uk/live-well/addiction-support/heroin-get-help/)
If you drink heavily alongside your drug use, the alcohol is the urgent part. It is the one that can go wrong fastest.
What actually happens when you ask
Far less dramatic than the word suggests.
**The assessment.** Roughly an hour of questions: what you use, how much, how often, how long, what else is going on, your physical health, your housing, your mental health. Answer with real numbers. Understating it is the single most common way people end up with a plan that does not fit them.
**A keyworker.** The NHS is specific: "you'll also be given a keyworker, who will support you throughout your treatment." One named person who knows your case and who you can ring. For many people this turns out to be the most useful part of the whole thing.
**A plan, agreed with you.** Not handed down. It sets out whether medication is involved, how often you are seen, and what happens if it goes wrong. Ask for it in writing, with dates.
**Where it happens.** Most drug treatment in the UK is community-based, meaning you live at home and attend appointments. Residential detox exists and suits particular situations, and it is a decision made with a clinician after an assessment rather than before one. If someone is selling you a private bed before anybody has assessed you, ring a free service for a second opinion.
Medication, plainly
**Opioids.** The NHS: "if you're dependent on heroin or another opioid, you may be offered a substitute medicine, such as methadone or buprenorphine." This is standard practice, not a lesser option. The US National Institute on Drug Abuse states that ["treatment with methadone, buprenorphine, or naltrexone is standard of care for opioid use disorder"](https://nida.nih.gov/publications/drugfacts/treatment-approaches-drug-addiction). If anyone in a meeting tells you a prescription means you are not really in recovery, they are stating an opinion, not a clinical fact.
**Alcohol.** ["Benzodiazepine reducing regimens are the standard pharmacological treatment to manage withdrawal from alcohol"](https://www.gov.uk/guidance/clinical-guidelines-for-alcohol-treatment/10-pharmacological-interventions), stepped down over days, with thiamine given to everyone undergoing assisted withdrawal to guard against a serious vitamin B1 deficiency. Acamprosate and naltrexone are named as first-line options for staying stopped afterwards.
**Prescribed medicines you have become dependent on.** NICE tells prescribers to "suggest a slow, stepwise rate of reduction proportionate to the existing dose, so that decrements become smaller as the dose is lowered." Smaller steps as you go down, not bigger. If your reduction is being halved every fortnight and you are struggling, that guidance is yours to point at.
**Stimulants and cannabis.** Ask what is offered rather than assuming. The support here is usually built around appointments, structure and psychosocial work rather than a detox prescription, and the honest thing to say is that it is a different kind of help rather than no help.
The bit that decides whether it worked
Detox is the beginning. Coming off is a matter of days or weeks. Staying off is the actual project, and a detox with nothing arranged for the fortnight afterwards is the classic way this fails.
Before you start, have three things in place.
- **Naloxone in the house**, if opioids are anywhere in the picture, and somebody who knows where it is. [Naloxone and keeping yourself alive](/guides/drugs/naloxone-and-keeping-yourself-alive) covers how to get a kit free.
- **The supply closed.** Numbers, chats, money, route. [Cutting off the supply](/guides/drugs/cutting-off-your-dealer-and-your-supply) is a twenty-minute job.
- **The empty hours filled.** Meetings, a keyworker appointment, someone to ring. Week two is when the boredom lands, and an open fortnight is not a plan.
How to ask for it
Two routes, both free, and neither requires you to have stopped first.
**A GP.** The NHS says "a GP may be a good place to start. They can discuss your problems with you and help get you into treatment." Say the real amounts and the real frequency. "I'm using and I want help stopping" is enough of an opening.
**A local service, directly.** [We Are With You](https://www.wearewithyou.org.uk/help-and-advice/) lists free drug and alcohol services across England and Scotland and runs a webchat staffed by trained recovery workers. FRANK is 0300 123 6600, 24 hours. Samaritans is 116 123 at any hour.
Two sentences worth having ready when you ring, because they change what you are offered: what you use daily, and whether you have ever had a seizure or a bad withdrawal before.
What to ask them
Take these in with you.
- Am I physically dependent, and does that change how I should stop?
- Is medication part of this, and what exactly?
- Community or residential, and why that one for me?
- What happens if I use during the reduction? (There should be a plan. If the answer is that you are discharged, ask what the actual policy is.)
- Who do I ring at eight in the evening?
- What is arranged for the month after I finish?
Common questions
**How long does drug detox take?** It depends entirely on the substance and the plan. An opioid reduction can run over weeks or months. A supervised alcohol withdrawal is usually days, with NHS guidance putting alcohol withdrawal symptoms at 3 to 7 days. Ask for the timetable in writing at the start rather than guessing.
**Can I detox at home?** For some substances and some people, yes, with a prescriber involved and someone around. For alcohol at higher levels, and for anyone with a history of withdrawal seizures, home is not the right setting. That decision belongs with a clinician after an assessment, not to a page.
**Does the NHS pay for detox?** NHS and community drug treatment in the UK is free, including assessment, keyworker support and prescribing. Residential placements are a separate question with local funding processes, which is exactly the sort of thing a keyworker exists to explain.
**Is methadone just swapping one addiction for another?** It is a prescribed medicine given at a controlled dose as a recognised treatment. The NHS offers substitute medicines to people dependent on opioids, and NIDA describes methadone, buprenorphine and naltrexone as standard of care. People will still tell you otherwise. That is opinion.
**What if I use during my detox?** Tell your keyworker the same day rather than dropping out of contact, and be aware that your tolerance has already fallen, which makes going back to your old amount genuinely dangerous. Services plan for this happening.
Sources
- [NHS, Drug addiction: getting help](https://www.nhs.uk/live-well/addiction-support/drug-addiction-getting-help/), for the GP route, keyworkers and substitute prescribing.
- [WHO, clinical guidelines for withdrawal management](https://www.ncbi.nlm.nih.gov/books/NBK310652/), for opioid withdrawal not usually being life-threatening and the raised overdose risk afterwards.
- [GOV.UK, UK clinical guidelines for alcohol treatment, pharmacological interventions](https://www.gov.uk/guidance/clinical-guidelines-for-alcohol-treatment/10-pharmacological-interventions), for benzodiazepine reducing regimens, thiamine and first-line relapse prevention medication.
- [NICE NG215, medicines associated with dependence](https://www.ncbi.nlm.nih.gov/books/NBK580680/), for no abrupt stops and stepwise reductions with smaller decrements.
