The First 72 Hours of Treatment

You want a script for the first three days, and programs do not share one national script. What federal guidance describes is the job of those days: find out what the person needs, get them medically stable, and connect them to care that continues after withdrawal. SAMHSA's TIP 45 says a detoxification process that skips any of those pieces is incomplete.

If someone is having a seizure, cannot be woken, is severely confused, or is struggling to breathe, call 911. For a mental health crisis, call or text 988.

Three jobs, not a tour

TIP 45 says detoxification by itself is not substance use treatment. It is one part of a continuum. The process has three components.

Evaluation means testing for substances, noting how much is present, and screening for other medical and mental health conditions. It also means a broader look at the person's medical, psychological, and social situation, because that look is what should drive the plan after withdrawal.

Stabilization is the medical and psychosocial work of getting through intoxication and withdrawal to a medically stable state. This is often done with medication, and some approaches do not use medication. It includes telling the person what the setting expects of them. Family or an employer is involved only when that is appropriate and confidentiality is released.

The third component is fostering entry into ongoing treatment. Staff are supposed to stress follow-through, not treat discharge from detox as the end. NIDA's research-based guide says the same thing in plainer words: medically assisted detoxification is only the first stage of addiction treatment. How detox and ongoing care differ is the detox-versus-rehab guide.

None of that is a promise that a particular building will feel a certain way at hour six. Ask which clinician is responsible for the evaluation, and what "stable" means before anyone talks about the next placement. The morning you arrive is the day-one guide.

Alcohol in this window

Signs and symptoms of acute alcohol withdrawal generally start 6 to 24 hours after the last drink. They can start while a significant amount of alcohol is still in the blood. The list includes tremor, sweating, nausea, anxiety, and, in more severe cases, seizures and delirium. The picture is highly variable. A clock is not a way to decide that someone is safe at home.

Seizures usually occur within the first 48 hours after drinking stops or drops, with a peak around 24 hours. A seizure raises the risk of progressing to delirium tremens. Death and disability may result from delirium tremens or seizures without medical care. Predicting who will have a seizure cannot be done with any great certainty. That is why a history of severe withdrawal, seizures, or delirium belongs in a medical setting. Who is a poor candidate for nonmedical withdrawal care is the detox guide.

Benzodiazepines remain the medication of choice for alcohol withdrawal, and early recognition matters. Which medicine, and how it is given, is a clinician's decision in the room. Do not try to copy a hospital protocol at home. What you carry to the door is the packing guide.

Benzodiazepines are in the same danger group

The FDA boxed warning says abrupt discontinuation or rapid dose reduction of benzodiazepines can cause serious withdrawal reactions, including seizures. That warning is not limited to the first day of rehab. If benzodiazepines are part of the history, say so at intake, including medicines that were not prescribed to you. TIP 45 treats withdrawal from benzodiazepines and other sedatives as potentially life-threatening, especially when they are mixed with alcohol.

Stopping on the airplane, or in a car on the way to admission, is not a head start. It is an unmonitored withdrawal.

Opioids: miserable, and a different risk

Uncomplicated opioid withdrawal is not life-threatening, which is different from alcohol and sedative withdrawal. Complications can still need fast medical care, and trying to manage significant opioid withdrawal without effective medication can cause needless suffering.

NIDA identifies methadone, buprenorphine, and naltrexone as FDA-approved medicines that help people stop or reduce opioid use. People treated with methadone or buprenorphine are less likely to die or to have an overdose than people who do not receive those treatments. Whether one of those medicines is started, continued, or held in the first three days is a clinical decision. What each medicine is, and what it is not, is the medication FAQ.

After a period without opioids, tolerance drops, so a return to use raises overdose risk. If opioids are the reason for admission, ask where naloxone is kept. How to recognize an opioid overdose is the overdose guide.

What a good first conversation covers

You can ask plain questions without the clinical vocabulary.

• Which substances and which health problems is the evaluation checking?
• Who monitors during these days, and how often?
• If alcohol or benzodiazepines are involved, where would a seizure be treated?
• If opioids are involved, will a medication for opioid use disorder be offered or continued, and who prescribes it?
• What level of care is being considered after stabilization, and why?
• What happens if you want to leave? Voluntary admission and a court order are not the same thing. Rules depend on the order and on state law. A lawyer can read a specific order. Leaving in the middle of alcohol or benzodiazepine withdrawal can be medically dangerous. Tell the clinician before you walk out.

Belongings, phones, and visiting hours are house rules. They are not set by SAMHSA. Ask the admitting program before you pack. Whether a clinician has cleared the admission is the medical-clearance guide.

Privacy on day one

Programs covered by federal confidentiality rules generally need consent before they share substance use disorder records, with narrow exceptions such as a medical emergency. What a subpoena does not do is in the privacy guide. Tell the intake staff who may be called if you become ill. Do not assume a family member will be updated.

If you are pregnant, the first 72 hours are not a time to stop opioids in order to tough out withdrawal for the sake of the baby. CDC says quickly stopping opioids in pregnancy is not recommended. Read the pregnancy guide and tell the clinician about the pregnancy at once.

After hour 72

Stabilization is supposed to produce a next step, not a certificate. That next step might be residential care, intensive outpatient care, an opioid treatment program, or office-based buprenorphine. NIDA says matching the setting to the person matters more than a single model. That choice is the comparison guide.

FindTreatment.gov lists facilities you can compare.

Call or text (800) 653-9376 if you want help asking which level of care fits.

Additional Resources

Sources cited on this page:

• SAMHSA TIP 45 quick guide: Detoxification and Substance Abuse Treatment
• NIDA: Principles of Drug Addiction Treatment (Research-Based Guide, Third Edition)
• NIDA: Medications for Opioid Use Disorder
• FDA: Boxed warning on benzodiazepines
• eCFR: 42 CFR Part 2, Confidentiality of Substance Use Disorder Patient Records
• CDC: Treatment of opioid use disorder before, during, and after pregnancy
• SAMHSA FindTreatment.gov
• 988 Suicide & Crisis Lifeline

Common Questions