From Intake To Stabilization: Withdrawal Management Explained

Detox gets talked about like it’s a single moment, but withdrawal management is a step-by-step medical process that can change quickly and needs real support. We walk through what happens from the second someone arrives, how 24/7 admissions work, and why the first goal is stabilizing the body so recovery can actually begin.

We break down how clinicians assess substance use disorder alongside mental health and physical health needs, then decide what level of medical care is appropriate. You’ll hear how risk is evaluated based on the substances used, the amount, symptoms, and history, including what “complicated alcohol withdrawal” can look like and when hospital-based care may be the safest option. We also cover the withdrawal symptoms many people experience such as anxiety, nausea, vomiting, diarrhea, tremors, sweating, agitation, restless legs, and insomnia and how medication strategies differ for alcohol and benzodiazepines versus opioids like heroin or fentanyl, along with comfort meds that support the whole process.

Just as important, we talk about the emotional side of early recovery: what happens when the numbness wears off and hard feelings come rushing in. We share why nurses, medical staff, therapists, and certified recovery specialists with lived experience can make the difference between walking out and staying long enough to transition into the next level of addiction treatment. If this helped you understand detox in a new way, subscribe, share with someone who needs it, and leave a review so more people can find hope and practical guidance.

To learn more about GRC’s Advanced Recovery Network visit:
https://www.GatewayRehab.org
GRC’s Advanced Recovery Network 
Multiple Southwestern Pennsylvania Locations  
800-472-1177 

Transcript

Welcome And Mission

SPEAKER_00 0:03

Welcome to Recovery Roll Call, where hope has a home. Here, the experts of TRC's Advanced Recovery Network, a not-for-profit with over 50 years of experience, offer a full continuum of care with 16 locations across southwestern Pennsylvania and statewide telehealth services. TRC's Advanced Recovery Network provides individualized evidence-based treatment and family programming. Our goal is to help increase knowledge of the disease of addiction, share the many roads to recovery, and reduce stigma in our community. All right, let's take roll.

Withdrawal Management Basics

SPEAKER_02 0:48

When someone takes their first step toward recovery, the process begins long before therapy or groups. It starts with stabilizing the body. Welcome everyone. I'm Melanie Winter, co-host and producer here in the studio with Dr. Julia Diallo of GRC's Advanced Recovery Network. Dr. Diallo, how's your day going so far? Pretty good. Thanks for asking. How about you? It's good. Thank you. It's great to be here with you today. So good than thank you. To get us started, Dr. Diallo, can you walk us through what happens during withdrawal management?

SPEAKER_01 1:22

Of course. Yeah, so withdrawal management is oftentimes also known as detox. People kind of refer to it as that, just so people understand. A lot happens during during withdrawal management, to be honest. So we admit people to our withdrawal management units uh 24-7. So we do 24-7 admissions. And so depending on the time that you come, um essentially you work through a process, an intake process that is very specific to assessing needs. So we make all attempts to assess mental health needs, physical health needs, in addition to substance use disorder needs.

Assessing Risk And Medical Support

SPEAKER_02 2:38

And so, how do you determine which level of medical support a patient needs during this phase?

SPEAKER_01 2:44

Yeah, that's a great question. So a lot of times that has to do with the substances that they are using, the specific substances, the amount that they are using, and their symptoms. So, and also their history. So, for instance, if a person is drinking alcohol in excess and they have a history of what we refer to as complicated alcohol withdrawal, where they've had seizures or um they've required hospitalization or they've been really unstable or required critical care. Um, and that's rare, to be honest. Um, we we will try to filter those individuals out and then refer them to hospital-based care. Um, but um essentially what we do is we assess the specific needs based on the substances, the type of substances being used, the number of substances. So typically people use more than one substance. I mean, that's very common as well. And then we build a care plan around that, which includes medications uh specific to their needs. And um, and then we are constantly assessing them because the withdrawal process occurs over days, uh over hours and days, I would say. And so they need to be assessed frequently to see if those needs change, because sometimes someone will be admitted and um they're doing great, and then they can, you know, have um a symptom that arises that needs a different medication or an increase in a medication, sometimes a decrease in a medication, and so on and

Common Symptoms And Comfort

SPEAKER_01 4:16

so forth.

SPEAKER_02 4:16

And so what symptoms are most common and how do you help patients stay safe and comfortable?

SPEAKER_01 4:23

Yeah. Um, so I would say that it it's a little bit dependent on the substance, but generally speaking, people who exhibit withdrawal symptoms will have anxiety, um, GI upset. So a lot of times they'll have nausea, vomiting, um, andor diarrhea. Um they will oftentimes have restless legs, feel restless and unsettled. Um, they can be tremulous or have hands or their limbs are shaking. Um, they can become very sweaty and um even agitated, and uh insomnia is another big symptom. So very poor sleep is common. Um, there's really a whole multitude of symptoms, but I would say those are the most common.

Substance Specific Detox Medications

SPEAKER_02 5:07

How does withdrawal management differ then depending on the substance involved?

SPEAKER_01 5:12

Okay, so the the medications that we use can vary. I would say that's that's one of the biggest differences. So we use um a class of medications uh for alcohol withdrawal and benzodiazepine withdrawal. And we tend to use uh different classes of medications for opioid withdrawal or for those using heroin or fentanyl. Um and then we have a whole list of uh comfort medications that sort of cross over into um all substance use disorders. And then we also start managing mental health um uh symptoms and physical health needs as well on the withdrawal management unit.

Emotional Support And Peer Specialists

SPEAKER_02 5:51

And so what role does emotional support play during this early stage of care?

SPEAKER_01 5:56

Yeah, a big one because people are um, you know, a lot of times, you know, when you're using substances in excess, you are kind of numb to your life and to the dysfunction in your life and um maybe the neglect of the people that you love, or um, you know, the loss of a loved one or loss of a job or so on and so forth. And when you remove the person or you remove the substance from the person, a lot of times they will start to think, frankly, about all of those things and it becomes difficult for them and they become emotional and um and and then a lot of times they'll have different feelings, like they want to leave because they they feel like they can't do it or it's too scary or it's too hard. And so the emotional support that that occurs in withdrawal management is vital. And I would say it starts the very first moment they they arrive and the nurse greets them and it continues with nursing care. Our nurses check our patients hourly. Um, our medical staff see patients daily, and then even more than that if needed. And then we also have therapists that are on the unit. We have certified recovery specialists who are people who have lived experience, who are in recovery themselves. Um, and they are they are really incredibly vital because they know exactly how that person feels and because they've been there. Um and a lot of times they can find the words and um and sort of the support and provide the support that that person um needs in that moment.

Transitioning To Next Treatment Level

SPEAKER_02 7:36

And how do you help patients transition from withdrawal management into the next phase of treatment?

SPEAKER_01 7:43

Yeah, that's a great question. So it's there's a little bit of a bit of an art to it. Um first of all, I think one of our main focuses is is this person safe now? And are they comfortable? Because if they're not safe yet, like they need additional, you know, really higher acuity assessment and reassessment and addressing their needs on an hourly uh basis, then they're not ready for that. And they're not gonna have success probably. Um, and so we want to set them up for success. So we want to make sure that their symptoms are managed uh well or maybe just resolved in in a lot of cases. Um and we want to make sure that that they're safe. And sometimes that transition can be a little bit anxiety provoking because they're moving from more of a medical setting into more of a therapeutic setting where they're gonna start discussing all of those things that we just talked about, which are really hard to talk about. Um, but we try to provide a whole lot of um uh support and love uh during that process. You know, oftentimes we will say, you know, that we love people back into recovery because there's a lot of, there's a lot of that, you know, a lot of that that goes into it. So um, so yeah, uh that's that's that's kind of what we focus on during that transition time.

SPEAKER_02 9:06

Well, Dr. Diallo, thank you for breaking that down so clearly for us. We appreciate your insights and we look forward to seeing you next time. Thank you so much for having me.

Resources And How To Get Help

SPEAKER_00 9:20

Thanks for joining Recovery Roll Call. Remember, recovery isn't a destination, it's a journey. One day longer, one day stronger. If you're a family member or loved one of someone struggling with addiction, help is close by. Visit gatewayrehab.org. Call 800-472-1177. Or start a live chat with our team right on the website. DRC Advanced Recovery Network. Hope has a home here. We'll see you next time.