Frequently Asked Questions

Patients who need medical detox have been using one or more habit-forming substance(s) to a degree where if they attempt to stop using, they experience uncomfortable and potentially dangerous symptoms known collectively as a “withdrawal syndrome.” Substances which can lead to significant physical withdrawal include alcohol, opioids (heroin or narcotic painkillers), or sedatives (certain kinds of anxiety and sleep medications and muscle relaxants, especially benzodiazepines).

With alcohol, a general rule of thumb for average-sized adults is about a six-pack of beer per day, a bottle of wine per day, or a pint of hard liquor per day for at least 1-2 weeks without a break. Some individuals consuming these amounts do not develop significant withdrawal symptoms, as there is a wide degree of variation with the withdrawal symptoms they will experience. People who consume these amounts or more on a binge basis, such as on weekends only, in most cases do not have withdrawal symptoms.

Opioids and sedatives generally must be used in a round-the-clock fashion for at least two weeks, enough so that there is always some level of the substance in the circulation to cause withdrawal upon discontinuation. Again, binge use with skipped periods lasting days or longer usually helps to avoid withdrawal. How many doses per day of a given drug must be taken in order for withdrawal to occur would depend on the drug’s “half-life”, or how long it remains active in one’s system. The longest-acting abused opioid is methadone, which lasts approximately 24 hours and needs only be taken once daily to cause physical dependence and withdrawal symptoms. By contrast, heroin has a half-life of 6-8 hours, so users typically need to dose 3-4 times per day to stay out of withdrawal once they become dependent.

Though patients can experience physical withdrawal symptoms upon stoppage if they are heavy daily users, the withdrawal syndrome is generally not severe enough to warrant hospital-based medical management and it is not life-threatening. More problematic for these patients is difficulty fighting the impulse to use and stopping the using behavior.

At Cascade, we are well aware of the research that has repeatedly shown that detoxification alone is not an effective long-term intervention for changing from a substance-abusing lifestyle to a clean-and-sober one. For this reason we work very hard to make sure that each individual who gets admitted has an appropriate plan for formal chemical dependency treatment, whether on an inpatient or outpatient basis, at the time of their discharge.

It is best if this plan is set up prior to the admission, so the patient can simply follow through with the plan already in place. Unfortunately, we are not always able to succeed in getting a plan together before detox, and we must engage the patient and/or the family in the process of making such a plan while they are in the midst of withdrawal management. This often involves weighing issues around work and family responsibilities, level of motivation and/or denial, and financial/insurance limitations. In addition to formal treatment, we are also very quick to recommend daily sober support group meetings to patients leaving the inpatient setting and have excellent evidence backing up their effectiveness when attended regularly and actively. We offer patients a variety of free and geographically accessible options for support groups.

With both alcohol and sedative withdrawal, seizures can occur in between 1-5% of patients. Those who have had a seizure in the past are at greatest risk. For such high risk patients we use prophylactic anti-seizure medication. A certain percentage of patients (roughly 5-10%) have “delirium tremens”, a psychotic state which can occur in withdrawal where patients may experience auditory or visual hallucinations or exhibit loss of normal mental functioning. This is a temporary state but makes for a challenging course on the detox unit, as some of these patients become quite agitated, combative, and are unable to participate in treatment planning.

Opioid withdrawal is not usually associated with risk of seizure or psychosis but for some it is extremely physically uncomfortable, marked by highly intensified flu-like symptoms. Thankfully, the medications we have available for these symptoms are generally quite effective.

At Cascade, we offer the “complete package” to any patient seeking to stop an addiction. Our medical detox unit is state-of-the-art, making use of the best available medications and protocols, with a dedicated staff who find reward in working with our patients. We are part of a hospital system which values what we do, so we have rapid access to emergency services should the need arise, as well as the ability to seek out psychiatric consultation/services, physical/occupational therapy, respiratory therapy, and/or inpatient physical rehabilitation. Most importantly, our services include a short-stay inpatient chemical dependency treatment program, in which we are able to offer motivated patients the opportunity to follow-up their detoxification stay with intensive medically managed addiction treatment. This program enables stabilization of their physical symptoms, including lingering withdrawal and/or any medical issues they have, as well as providing a critical foundation for their recovery.

All patients in the inpatient addiction treatment program are strongly encouraged to build upon this foundation by pursuing ongoing outpatient addiction treatment. For patients who have been referred to our Center with a plan in place to attend another treatment program upon discharge, we make every effort to communicate regularly with the referring program to make the transition as seamless as possible.

We also offer outpatient addiction treatment at several levels of intensity, with options available to match the specific needs of the patient. Our on-campus peer support meetings for the alumni of our programs are well attended. Many program graduates continue to view Cascade as their “home base” for addiction recovery years after they first began the journey. Cascade has been providing addiction treatment services for over 35 years, so the alumni network is broad and strong, and it constantly reinforces our mission.