What makes concierge home detox better than going to an inpatient detox program?
Do you have to check into a facility to get off of opioids, or to quit drinking? Do you have to hand over your phone, sleep next to a stranger, and tell your story to a circle of people you have never met? In many cases, you do not.
Concierge home detox means that one doctor treats you directly, by telemedicine, while you stay in your own home. I am an osteopathic physician, and I treat opioid and alcohol dependence this way, for patients in Florida. I believe that, for many people, it works better than a week or two in a facility.
There is one exception that you should know about from the start. If you drink heavily every day, do not stop drinking suddenly on your own, because alcohol withdrawal can cause seizures. So, what is detox, and why would it go better at home?
What does detox really mean?
Detox, as they call it in the drug treatment industry, is short for detoxification. The word suggests that drugs are toxins, and that once they are flushed out of your body, you are well. Unfortunately, that is not what is happening in your body.
When you take an opioid or drink alcohol every day, your nervous system adapts to having it there. This is known as physical dependence. When the drug is taken away, the nervous system reacts, and that reaction is withdrawal.
Physical dependence is not addiction. Dependence is a change in the body, addiction is a pattern of behavior, and a person can have one without the other.
People ask whether they should detox at home or go to a medical detox, as if staying home meant being on your own. Yet, when a doctor is managing your withdrawal, a home detox is a medical detox.
Is it possible to count on a private experience in rehab or detox?
If you go to detox or rehab, you expect the facility to observe the privacy laws. In most cases, the staff will do their best. Addiction treatment records even carry extra protection under federal law.
Unfortunately, a law can only do so much. Rehab admissions of celebrities have been leaked to the tabloids more than once, and it only takes one staff member with a phone. And, while the law protects your chart, it does not bind the other patients in the room.
While detox and rehab programs are medical programs, they are also typically based on the 12-step model. Patients meet in groups throughout the day, with an assurance that what is said in the group stays in the group, yet no one can enforce it.
Imagine that you are sitting in a group, and you disclose that you once drove drunk, or that you bought pills on the street. Then, you look up and look around at the faces of your fellow patients and you recognize a familiar face. You see a cop who pulled you over once, sitting in the group.
What if you are a lawyer, and you see a competing lawyer in the group? What if you are a doctor or a nurse, and a member of the medical board is sitting across from you? Is your secret safe? Do you really want to have to worry about it?
There are secrets that must be kept.
If you have a secret, the fewer people who know it, the more likely it is to stay a secret. In recovery, they sometimes say that you are only as sick as your secrets. Yet, the stigma against people in recovery is deep rooted in society, and it will probably not go away in our lifetimes.
I have seen what can happen when a person in recovery shares that history at work, hoping to inspire someone else to get help. From then on, any conflict in the office has a quiet explanation, spoken behind that person’s back. Maybe they are drinking again.
Careers have been destroyed by word of an addiction getting out to the wrong people.
When you are treated at home by one doctor, there is no waiting room, no group, and no roommate. While a large telemedicine company may pass your information through many hands, much as a large rehab does, a concierge doctor typically works alone, or with one or two trusted staff members.
Concierge home detox gives you full access to your doctor at all times.
One of the great benefits of concierge medicine is being able to contact your doctor directly, without going through a protective wall of staff members. Many patients describe the same experience at a busy office. They leave a message about an important problem, they are promised a call back, and the call comes just before closing, if it comes at all.
With a concierge doctor, you send a message, and the doctor answers it. When the pharmacy does not have your medication in stock, it is a simple administrative problem, easily solved.
While it is not easy to get through withdrawal in a facility or at home, it is much nicer to be in the privacy of your home, with your doctor an easy phone call away. Of course, a doctor on the phone is not an ambulance, and an emergency is still a reason to call 911.
What would the fanciest rehab give you that your own home cannot?
There are beautiful facilities in the Blue Ridge Mountains of North Carolina, and in quiet seaside towns of New England. You can sip coffee or tea in the luxurious common areas with your fellow residents, at a very high price.
Yet, these fancy rehabs will likely still put you in a small room with a roommate. Who will you be sleeping next to every night for the next month? Is this evidence-based treatment, to put you in a room with a stranger in the darkness of the night? It is not.
Do you want to play, or get work done, with your phone or your computer? At home, no one is going to confiscate your devices and put you on a strict schedule of meetings and group therapy every day. If meetings help you, you can still go to them, and you keep your job, your family, and your own bed.
Is concierge home detox as effective as inpatient detox?
I believe that it is often more effective, especially in supporting long-term success. How is it possible that an expensive inpatient program, where you are confined and monitored for a week or two, is not as effective as a doctor calling you at home?
The answer is in the protocol. Many inpatient programs are designed to get you to a medication-free state by the day of discharge, and the day of discharge is often set by what the insurance will cover. Your nervous system has not read the insurance policy.
Relapse after a short detox is common. Do the detox programs take responsibility for this? Of course not. Relapse is always blamed on the patient.
While a facility can get a person safely through the first days of withdrawal, it is what happens after discharge that decides how things turn out. In most cases, it is the protocol that failed, and not the patient.
Why does a short buprenorphine detox so often end in relapse?
Many opioid detox facilities use buprenorphine, the main ingredient in Suboxone, for a fast taper. The patient is brought down to nothing in a week or two, and then discharged.
Buprenorphine attaches to the opioid receptors in the brain and holds on. When enough receptors are occupied, the withdrawal sickness and the cravings quiet down. When the dose is cut to zero in a matter of days, the receptors may empty faster than the nervous system can adjust.
So, the patient walks out the door in withdrawal, with cravings, and with less tolerance than before. That last part is deadly. A person who goes back to the old amount after a detox can overdose, because the body is no longer used to it. An overdose is an emergency, so call 911.
One thing that we can all agree upon is that the wrong way to land an airplane is by flying straight down, into the ground. A pilot brings the plane down gradually, and the descent gets gentler as the ground gets closer. No one on board complains that the landing took too long.
While this is not a perfect analogy, a two-week detox is a steep dive, and the passenger is expected to walk away from it.
What works better than a fast detox?
Fortunately, there is a better way, and it is not complicated. Long-term treatment works better. Medication-assisted treatment (MAT) with buprenorphine is the gold standard for opioid dependence, and it should continue for as long as it is helping.
At home, medically supervised withdrawal does not have a discharge day to race toward. You start the medication with your doctor guiding you, the dose is adjusted until you feel normal, and you go on with your life.
If you decide, later on, that you want to come off of buprenorphine, that is your decision. The way down is a slow taper, known as hyperbolic tapering, in which the steps get smaller as the dose gets lower. The taper is planned with your prescriber, at a pace that you set.
Unfortunately, many residential programs still stop buprenorphine before discharge, and some do not offer it at all, which can lead to relapse. Ask before you are admitted.
Finding a doctor on your own may take persistence. Lists of buprenorphine prescribers can be out of date, and may include doctors who are no longer practicing. Call the office before you count on a name from a list.
What about alcohol? Can you detox from alcohol at home?
Alcohol is a different story. While opioid withdrawal is miserable, it is rarely dangerous by itself, and alcohol withdrawal can be deadly.
If you drink heavily every day and you stop suddenly, there is a risk of seizures. There is also a risk of delirium tremens, or DTs, a medical emergency that involves confusion, shaking, fever, and hallucinations. DTs most often begin two to four days after the last drink, so feeling well on the first day proves nothing.
Heavy drinking can also drain the body of thiamine, or vitamin B1. Without it, a person can develop Wernicke-Korsakoff syndrome, which can cause permanent brain damage.
So, never stop drinking abruptly without medical supervision. If you are a heavy, daily drinker, if you have ever had a withdrawal seizure or DTs, or if you have serious medical problems, you may do best to check into a hospital or a medical detox facility.
Not everyone who wants to quit drinking needs a facility. A gray area drinker, who drinks heavily on occasion but not every day, may be able to stay at home. That is a decision to make with a doctor, before the drinking stops.
Call 911 or go to the nearest emergency room if you, or someone you are with, has cut back or stopped drinking and:
- has a seizure.
- becomes confused, or sees or hears things that are not there.
- has a fever, a racing heartbeat, or severe shaking and sweating.
- cannot keep fluids down.
If you are in crisis, or having thoughts of suicide, call or text 988, the Suicide and Crisis Lifeline, at any hour.
Is it possible to taper with alcohol?
I have heard of people trying it on their own, with a set number of beers or glasses of wine for the day, and willpower to hold the line. While that is a risky plan for a heavy, daily drinker to carry out alone, a controlled taper from alcohol is possible with medical supervision.
With the Sinclair Method, or TSM, the patient takes naltrexone, a medication that blocks opioid receptors, one hour before drinking. With the reward blocked, the brain gradually unlearns the habit, and the desire to drink can fade over time. This is known as pharmacological extinction.
The drinking comes down gradually, with your doctor watching for withdrawal along the way, and you do not have to quit before you start. Naltrexone is not for anyone who takes opioids, including buprenorphine, because it blocks them and can bring on sudden withdrawal.
This is where the alcohol detox at many facilities falls short. The patient is brought safely through a week or two of withdrawal, and then discharged without naltrexone, and without ever hearing about TSM. The withdrawal was treated, yet the drinking was not.
At home, with one doctor, you can ask about these alternatives, and an open-minded doctor will take the time to listen.
What if the drug is a medication that your doctor prescribed?
The same principle holds for any prescribed medication that causes physical dependence. The way off is a gradual taper, never cold turkey, and a taper done properly can take many months. It will not fit inside a two-week stay.
This matters most for people who take benzodiazepines as prescribed. Taking a medication as directed is not addiction. They are physically dependent, and a fast taper with a discharge date can do real harm.
One warning stands above everything else: never stop a benzodiazepine suddenly, and never let a taper turn into an abrupt stop. Sudden discontinuation can trigger seizures and can be life-threatening. However a taper is shaped, it should be gradual and medically supervised.
Who should consider concierge home detox to help quit alcohol or opioids?
Executives, people in the public eye, and professionals with a license to protect will appreciate the privacy and confidentiality. So will a parent who cannot disappear for a month. Yet, anyone who values their privacy may find that concierge detox works best for them.
Concierge home care sounds expensive and exclusive, but keep in mind that detox and rehab establishments are often outrageously expensive, and their success is often overpromised. Do not believe a program that claims near 100% success rates. And, ask that they provide a clear definition of what they are calling success.
There is no one-size-fits-all answer. A person facing a dangerous alcohol withdrawal, or a person with no safe place to stay, may need a facility first. For many others, treatment can begin at home, with a doctor who knows them. You do not always have to go away to get better.
How do I treat opioid and alcohol dependence at home?
My practice is a concierge practice, and care is by telemedicine for patients throughout Florida. Patients work directly with me at every visit. For opioid dependence, I prescribe buprenorphine by telemedicine, with the first doses taken at home and phone support along the way, and a low-dose start when fentanyl is involved. For alcohol use disorder, I prescribe naltrexone with the Sinclair Method.
There are no mandatory group meetings, and patients can text me with urgent questions between visits. The patient decides whether the goal is long-term treatment or a gradual taper.
To ask about an appointment, use the contact form.
This article is educational. It is not medical advice, and reading it does not create a doctor-patient relationship. Decisions about starting, continuing, or tapering any medication should be made with your own physician.
