They tried to make me go to rehab

I get a lot of calls from people who want to go to detox, or who want their family members to go to detox. Often they are legitimate candidates for immediate, do-not-pass-go-do-not-collect-$200 detox. For example, they've decided to go cold turkey from alcohol and now are tremulous and sweating. Or they've been quadrupling their Xanax and their psychiatrist won't write another prescription. Withdrawal from alcohol or benzodiazepines can be fatal; and detox is a medical procedure which (hopefully) keeps the withdrawal process safe. I can't begin to count the number of alcohol- or benzo-dependent people I've had to convince to go to the hospital immediately... not tomorrow, not the next day, not next week when they already have time off from work. I've found "Withdrawal can kill you" to be a fairly effective tactic.

Opiate detox is another story. Opiate withdrawal is highly unpleasant, to say the least; but it is not necessarily dangerous. Managed care does not always cover opiate detox, especially of the inpatient sort. I have no idea why. But if I get a call from someone who wants to detox from Vicodin, I tell them to go to the hospital immediately. Some will ask whether withdrawal will kill them. I reply, "At the very least, if you try to do it yourself, it will be extraordinarily uncomfortable."

But then I have some people who want to detox from cocaine. There is no medical detox procedure for cocaine. Cocaine is rapidly eliminated from the body; so even if there were a way to do cocaine detox, it would have to be done very quickly. When people ask me for cocaine detox referrals, I tell them to go to the ER right away if they have any unpleasant physical symptoms or pre-existing cardiac problems. But unless they are suicidal, homicidal, or using alcohol or benzos with their cocaine, they can most likely wait until the next day for an assessment for some other level of care.

My favorite callers, though, are the parents who want their teenagers to go to marijuana detox. (Oddly, no one ever seems to call for detox for their own pot habit.) Again, there is no medical detox for marijuana. Marijuana hangs out in the body for a while, but there's really nothing to do about it--and no real need to do anything, either. I am often tempted to tell these folks that marijuana detox is a home procedure involving a couple bags of potato chips administered over the course of a few hours. But I don't, as this would be poor customer service.