Medical detox is the first stage of treatment for physical dependence on alcohol, opioids, benzodiazepines, and some other substances. It is not treatment for the underlying addiction , it is medical stabilization. The goal is to get you through withdrawal safely, with medications and monitoring that prevent serious complications, so that your body can begin to clear the substance and you can move into actual treatment.
Knowing what is coming makes it less frightening. This page gives you the day-by-day picture for the most common types of detox, so you know what to expect before you go in.
Alcohol withdrawal and benzodiazepine withdrawal can cause seizures and, in some cases, a life-threatening condition called delirium tremens. If you are physically dependent on alcohol or benzodiazepines, do not stop suddenly without speaking to a medical provider first. Medical detox provides the medications and monitoring that prevent these complications. This is not a caution to delay getting help , it is a reason to get medical help rather than attempt withdrawal alone.
What happens medically in detox
When you arrive at a medical detox facility, the clinical team conducts a thorough assessment: your substance use history, how much and how long you have been using, your physical health, any current medications, and any history of prior withdrawals or complications. This information determines the withdrawal protocol and medications.
Throughout detox, the clinical team monitors vital signs , blood pressure, heart rate, temperature, and respiratory rate , at regular intervals. For alcohol withdrawal, most facilities use standardized assessment tools like the CIWA-Ar (Clinical Institute Withdrawal Assessment for Alcohol) to measure withdrawal severity and adjust medications accordingly. For opioid withdrawal, the COWS (Clinical Opiate Withdrawal Scale) serves the same function.
Medications are adjusted in response to your withdrawal symptoms, not on a fixed schedule. The goal is to keep you comfortable enough to stay in detox and to prevent medically serious complications.
Alcohol detox: days 1 through 7
Alcohol withdrawal follows a predictable progression. The timeline varies based on how long and how heavily you have been drinking, and whether you have had prior withdrawals.
First symptoms appear
Within 6 to 12 hours of the last drink, most people begin experiencing anxiety, tremor (shakiness), sweating, nausea, and increased heart rate. These are the first signs of the central nervous system beginning to recalibrate without alcohol present. The clinical team begins monitoring and typically initiates medication at this stage.
Peak seizure risk
The period between 12 and 24 hours after the last drink is when alcohol withdrawal seizures are most likely in people with significant physical dependence. This is the primary reason medical supervision is essential. Medications , typically benzodiazepines given in controlled doses , substantially reduce seizure risk. Most people who have medically managed detox do not have seizures.
Peak withdrawal intensity
Day 2 is typically the most uncomfortable day. Symptoms include significant anxiety, sweating, tremor, elevated heart rate and blood pressure, and often severe insomnia. Some people experience hallucinations , visual, auditory, or tactile , which are distinct from delirium tremens and generally resolve without additional intervention. Medications are adjusted to manage symptoms as they peak.
Delirium tremens risk period
Between 48 and 96 hours after the last drink, a small percentage of people with severe alcohol dependence develop delirium tremens , a serious condition involving confusion, severe agitation, fever, and autonomic instability. Delirium tremens is the reason medical detox exists. With proper monitoring and medication, it is manageable. Untreated, it can be fatal. This window is why medical supervision is not optional for heavy drinkers.
Symptoms begin resolving
For most people, the acute withdrawal symptoms begin to improve noticeably by days 5 through 7. Tremor, sweating, and autonomic symptoms diminish. Sleep improves somewhat, though insomnia often persists for weeks after acute detox. Appetite begins to return. The clinical team typically begins tapering withdrawal medications. Many people complete alcohol detox and discharge to the next level of care around day 7.
A subset of people experience prolonged withdrawal symptoms , anxiety, sleep disturbance, and mood changes , that can persist for weeks or months after acute detox. This is called protracted withdrawal syndrome and is a significant factor in relapse risk during early recovery. The next level of treatment addresses this period.
Opioid detox: days 1 through 10
Opioid withdrawal is not typically life-threatening, but it is intensely uncomfortable and is the leading cause of leaving treatment against medical advice. Medication dramatically changes the experience of opioid withdrawal.
Short-acting opioids: early onset
For short-acting opioids (heroin, oxycodone, hydrocodone), withdrawal symptoms begin 8 to 24 hours after the last use. Early symptoms include anxiety, restlessness, yawning, sweating, and muscle aches. For long-acting opioids (methadone, extended-release formulations), onset is delayed by 36 to 48 hours but often more prolonged.
Peak withdrawal symptoms
Days 2 and 3 are typically the most difficult. Symptoms include severe muscle cramps and pain, nausea and vomiting, diarrhea, chills and goosebumps, insomnia, extreme restlessness, and intense drug craving. Without medication, this period is the most common point for leaving treatment. With buprenorphine or methadone, symptoms are substantially reduced , many people describe a night-and-day difference.
Physical symptoms begin easing
Physical withdrawal symptoms , vomiting, diarrhea, muscle cramps , begin to diminish. Restlessness and insomnia persist. Mood is often low or dysphoric at this stage. Craving for opioids often peaks as the physical symptoms begin to resolve. This is a vulnerable period for impulsive decisions to use.
Acute withdrawal resolving
Most acute physical symptoms have resolved by days 6 to 10 for short-acting opioids. Sleep remains disrupted. Anxiety, low mood, and intense craving often persist for weeks, particularly for people who have been using opioids for years. Continuing onto the next level of care , residential or IOP , provides structure and support during this period when craving is high and motivation can fluctuate.
Withdrawal timelines by substance
Acute withdrawal: 5 to 7 days. Serious complications (seizures, DTs) possible in heavy, long-term drinkers. Medical supervision required. Medications: benzodiazepines, thiamine.
Acute withdrawal: 7 to 10 days. Not typically life-threatening but extremely uncomfortable. Buprenorphine significantly reduces symptoms. Continued MAT recommended after detox.
Acute withdrawal: 14 to 21 days for methadone. Onset delayed but more prolonged. Typically managed with methadone taper or buprenorphine transition at a specialty program.
Acute withdrawal: 1 to 4 weeks depending on half-life. Seizure risk similar to alcohol. Requires a controlled medical taper , never stop abruptly. Medical supervision required.
Stimulant withdrawal does not cause physical seizures. The primary symptoms are fatigue, depression, hypersomnia, and intense craving. Not medically dangerous but significant psychiatric monitoring may be needed.
Cannabis withdrawal syndrome: irritability, anxiety, insomnia, decreased appetite, restlessness. Not medically dangerous but uncomfortable for heavy daily users. Typically managed with supportive care.
Medications used in medical detox
| Medication | Used for | Purpose in detox |
|---|---|---|
| Diazepam / Lorazepam (benzodiazepines) | Alcohol and benzo withdrawal | Prevent seizures and delirium tremens. Tapered gradually under clinical monitoring. The cornerstone of alcohol detox medical management. |
| Buprenorphine (Suboxone) | Opioid withdrawal | Significantly reduces opioid withdrawal symptoms and craving. Can be continued after detox as medication-assisted treatment. TRICARE-covered with prior authorization. |
| Methadone | Opioid withdrawal (specialty programs) | Used in opioid treatment programs (OTPs) for both detox and ongoing MAT. Requires daily dosing at a licensed OTP, at least initially. |
| Clonidine | Opioid, alcohol withdrawal | Reduces autonomic withdrawal symptoms , sweating, elevated heart rate, anxiety. Often used alongside buprenorphine in opioid detox. Not a substitute for buprenorphine or methadone. |
| Naltrexone | Alcohol use disorder (sometimes started in detox) | Reduces the rewarding effects of alcohol. Sometimes initiated near the end of detox as a bridge to medication-assisted treatment for alcohol use disorder. |
| Thiamine (Vitamin B1) | All alcohol detox | Prevents Wernicke’s encephalopathy, a serious neurological complication of alcohol use. Given routinely to all patients in alcohol detox. |
| Ondansetron / Promethazine | Nausea management | Controls nausea and vomiting during withdrawal, particularly opioid withdrawal, to improve comfort and reduce dehydration risk. |
The specific medications and doses used depend on your individual clinical situation, withdrawal severity, and the facility’s protocols. All medications are administered and monitored by licensed clinical staff.
Is TRICARE-covered detox available in San Antonio?
Yes. Medical detox is a covered TRICARE benefit with prior authorization. Active-duty service members pay nothing; TRICARE Select retirees and dependents pay standard inpatient cost-sharing.
In San Antonio, the process differs by beneficiary type. Active-duty service members contact their branch substance abuse program , Army ASAP at Fort Sam Houston, Air Force ADAPT at Lackland or Randolph , which coordinates medical detox through the military health system or a TRICARE-contracted civilian facility.
For TRICARE Select and other non-active-duty beneficiaries, call TriWest at 1-888-874-9378 before entering any detox program. They will verify that the facility is in-network and initiate the prior authorization process. Do not enter a facility without confirming network status and authorization first.
Our cost estimator can show you realistic out-of-pocket costs for detox by plan type. Our treatment centers directory lists San Antonio area facilities that work with TRICARE beneficiaries.
What happens after detox
Medical detox gets the substance out of your system and stabilizes you physically. It is not, by itself, treatment for addiction. Completing detox without entering the next level of care is associated with very high rates of relapse , often within days.
The level of care recommended after detox depends on your clinical situation, your history, and the nature of your substance use. The typical sequence is detox, followed by residential treatment (28 to 90 days), then partial hospitalization (PHP), then intensive outpatient (IOP), then standard outpatient. Not every person needs every level, and movement between levels is based on clinical progress.
TRICARE covers all of these levels. The clinical team at your detox facility can provide a recommendation and help coordinate the next level of care before you discharge. Accept that recommendation and enter the next level of treatment rather than leaving and returning home after detox alone.
See our guide on levels of care explained for a full breakdown of what each level involves and how they differ.
Common questions
Ready to take the first step?
If you or a family member needs help accessing medically supervised detox in San Antonio, the Veterans Crisis Line is available around the clock. For TRICARE coverage questions, call TriWest at 1-888-874-9378.
988, press 1 , Veterans Crisis Line