The First 72 Hours

The federal treatment protocol describes detoxification as three things, not one: evaluation, stabilization, and getting you into ongoing treatment afterward. In practice that means the first hours are mostly questions and tests, the middle is the hard part with medical staff watching it, and the end is a conversation about what comes next. How long the hard part lasts depends on what you have been using, and this page only states timings that a federal source states.

The shape of it

• The first hour or two Questions, and a lot of them

  This is the part SAMHSA calls evaluation: testing for substances in your blood, measuring how much, and screening for other physical and mental health conditions. It also includes a broader look at your medical and psychological situation and your circumstances at home, because that is what decides what level of care you are pointed at afterward.

  It feels like an interrogation and it is not one. The protocol is explicit that the evaluation is the basis for your treatment plan later. Answering it straight, including the amounts, is the single most useful thing you can do in the first hour — the medication decisions come off those numbers.

• Hours 0 to 24 Withdrawal starts on its own schedule

  Alcohol. The federal protocol says the signs and symptoms of acute alcohol withdrawal generally start 6 to 24 hours after the last drink, and can begin while there is still significant alcohol in the blood. MedlinePlus puts the usual onset within 8 hours of the last drink, and notes it can start days later instead.

  Opioids. MedlinePlus says symptoms usually start within 12 hours of the last heroin use, and within 30 hours of the last methadone exposure. The early ones are agitation, anxiety, muscle aches, watering eyes, insomnia, runny nose, sweating and yawning.

  Stimulants. Different in kind, not just degree — see the question below on whether withdrawal can kill you.

• Hours 24 to 48 Usually the worst of it, and the most watched

  This is stabilization: the protocol defines it as the medical and psychosocial work of getting you through acute intoxication and withdrawal to a medically stable, fully supported, substance-free state. It says this is often done with the help of medication, though some approaches use none.

  For alcohol this window is why detox is supervised at all. The protocol reports that most alcohol withdrawal seizures happen within the first 48 hours after stopping or cutting down, with the peak around 24 hours. MedlinePlus says alcohol withdrawal symptoms tend to peak by 24 to 72 hours.

  For opioids the late symptoms — abdominal cramping, diarrhoea, dilated pupils, goosebumps, nausea, vomiting — tend to arrive in this stretch. MedlinePlus describes them as very uncomfortable but not life threatening.

• Hours 48 to 72 It starts costing less to be awake

  Stabilization also covers something that sounds soft and is not: the protocol says it includes familiarising you with what to expect in treatment and what your part in it is, and that this is when staff try to involve family, employers and other significant people — with a release of confidentiality, meaning only if you sign for it.

  MedlinePlus is honest that alcohol withdrawal symptoms “may go on for weeks,” so 72 hours is not a finish line. It is the point at which most people can hold a conversation about what happens next.

• After that The third part, and the one people skip

  The protocol’s third component is fostering your entry into treatment — preparing you to actually follow through into the treatment that comes after. It notes that for people who have repeatedly completed detox and then not engaged with treatment, some programs use a written, voluntary, not legally binding contract to encourage it.

  That component exists because the alternative is common. Detox is not treatment. The next section is about why that distinction matters more than anything else on this page.

Detox is not treatment, and the people who wrote the protocol say so

This is the single most important thing on this page, so it gets stated flatly. The federal TIP 45 protocol quotes the Washington Circle Group’s point that “a detoxification program is not designed to resolve the longstanding psychological, social, and behavioral problems associated with alcohol and drug abuse,” and its own consensus panel then goes further, taking “special care to note that detoxification is not substance abuse treatment and rehabilitation.”

Detox manages withdrawal. That is the job it is designed for, and it does it. What happens after it is a different question with a different answer, and it is worth having that answer before the 72 hours are up. Our side-by-side of detox, inpatient, outpatient and MAT is built for exactly that decision.

The questions people are actually afraid to ask

Keep going

• What to bring to detox — the checklist for before you go
• Detox, inpatient, outpatient or MAT — which one is me?
• Which level of care applies?
• Naloxone and opioid overdose response
• Browse treatment facilities by state