The Coleman Institute makes every effort to ensure a safe and comfortable detox. The following outlines our process details and costs.

Initial Screening
A confidential interview is conducted when the patient calls our office to schedule a detox. Program requirements and fees are discussed. All patients will be instructed and required to schedule a consultation appointment with a substance abuse counselor of their choice. After a preliminary assessment has taken place and the counseling consultation has been scheduled, the patient is then scheduled for detoxification. Upon scheduling your detox date, a $400 deposit MUST be collected and is applied to the total costs involved. The balance will be due on the first day of detox.

Information regarding financing and hotel information will be given upon request.

Support Person
The patient must be accompanied by a drug-free responsible adult support person during his/her appointments and throughout the detox procedure. We ask that arrangements be made for the support person to stay with the patient for at least 48 hours (two days) after returning home. The role of the support person is to assist in transportation to and from the procedure, accompany the patient during his/her office visits and most importantly, to assist the patient with moral support and to help with administration of medications.

Detox Appointments
Patients will provide a complete history by telephone and speak with the physician to receive instructions on how to prepare for the pre-op exam. We request that all patients be feeling bad withdrawals the morning of the pre-op to ensure the success of the detox. If you are using heroin or a prescription narcotic, we ask your last use be 12-16 hours prior to visit. If you are using methadone, we ask your last use be 48 hours prior to visit.

What to Expect During Your Detox

Accelerated Detox with Sedation (3-day and 8-day detoxes)

• Initial Medical Visit
  Aftercare Coordinator will interview patien and possible interview their significant others to review the screening information, completea psychosocial evaluation and formulate a treatment plan. This interview may be performed over the phone when circumstances dictate. The aftercare coordinator will negotiate with the patient and significant other to agree on a treatment plan. They will then start to put that treatment plan into action. (See Aftercare Coordinator section).

• Day 1
  A physical examination will be required on the pre-op including an EKG and a pregnancy test. Consent forms will be given for signature. This visit is usually scheduled in the morning and lasts for approximately two hours. The patient is given medications on Day 1 to begin the detox. The medications sometimes precipitates withdrawal symptoms because it can actually push quite a lot of the opiates out of the brain. These symptoms usually only last one to four hours but can be quite unsettling. We frequently will ask patients to return later in the day if they’re not in sufficient withdrawal or we may give smaller doses of medications to try to decrease this. Patients usually feel fairly comfortable for the remaining duration of the detox. They frequently sleep most of the day and the evening because the medication is relieving their withdrawal symptoms.

• The first night
  Following discharge from our office, the patient is released to the care of their support person. Aside from being sleepy, they are usually somewhat agitated and confused. They are unsteady on their feet and slurring their words. They often have some abnormal movements in terms of trying to pick things up off the floor. They will usually have total amnesia for the rest of the day. This is the most dangerous part of the detox procedure for patients because in this state they cannot be relied on to make sensible decisions. It is the responsibility of the support person to make sure they are safe in terms of staying in the house, certainly not driving and being kept in an area where they can’t fall. This confusion and agitation gradually settles down. It is frequently completely gone by later that evening and almost always gone by the next morning. During this period there may be some mild nausea or even vomiting and there may be some diarrhea.

• Day 2
  The patient may be asked to stay all day or may be released to leave depending on the opiate usage and body chemistry. Narcan is introduced in regular intervals to help the process of detoxification. We carefully monitor the withdrawal symptoms, blood pressure, and adjust any medications as needed. Again, most patients sleep throughout most of this day and evening. For the 8-day Methadone detoxes, the process of Day 2 is repeated everyday until completion day which is usually on the 8th day but varies by patient.

• Completion day
  Patients and support person(s) should plan to arrive at 8:30am and expect to stay all day. During the detox the patient is kept in our office for six to eight hours in a heavily sedated state. They are not completely asleep. They are maintained in a state where they’re able to go to the bathroom if they need to, walk around the building and converse; however, most of the time they’re sleepy. As the detox proceeds and as some of the medicine builds up they usually become somewhat confused. They will usually have a period of agitation where they become quite restless. This usually settles down by the time they are ready to be discharged. They usually have total amnesia for the whole day. The patient will need to wear something comfortable. You may bring VCR tapes/movies to watch during your detox. You are also encouraged to bring a thick, warm comforter to help ease any withdrawal chills. You will be heavily sedated and numerous medications will be administered to complete detoxification. A Naltrexone implant will be given once opiate detoxification has been reached (typically by 5 pm).

Medically Supervised Detox

• Day 1
  A physical examination will be required on the pre-op. This visit will also include an EKG, pregnancy test, and detox medicines. Consent forms will be given and will be signed. This visit is usually scheduled in the morning and usually lasts for 1 hour. We request that all patients be feeling withdrawal symptoms.

• Days 2-5
  Your appointments will usually be scheduled in the morning and will last 20-30 minutes long. We will be monitoring your withdrawal symptoms, blood pressure, and adjust any medications as needed. On the final day of detox (day 5), the Naltrexone Implant will be given.

• The week following the detox
  During the next week the patient is in the sub acute withdrawal (link to Detox Program page) syndrome. They will frequently have fatigue during the day which can sometimes be profound and prevent working. They will usually have insomnia so they will feel even more tired during the day. There may be some agitation. By now the confusion, diarrhea and nausea should be gone. Patients are usually eating and drinking quite normally. During this time the patient still requires some medications, but it is best to use as little of this during the day, since they are already fatigued and use it at bedtime since that’s the time when they have trouble sleeping. We may need to prescribe other medicines to help with sleep during this period.

• The month following detox
  Over the course of the next month, the patient’s energy and sleep returns to normal. There is gradual improvement during this period in all aspects.

Most Important: To obtain the maximum and most comfortable benefit, it is important that you follow all pre-op and post-op instructions and attend all scheduled office visits. This commitment is vital so that your progress and withdrawals can be monitored and treated if necessary. Failure to follow instructions and attend scheduled office visits may limit your ability to obtain maximum benefit of your detox.

Costs of Detox Programs

The Coleman Institute is committed to making addiction treatment as widely available as possible. We work hard to keep our costs low and financing is available to those who qualify.

Please click to view Virginia Pricing , California Pricing or Kentucky Pricing.

Specific Withdrawal Problems That May Persist After the Detox

• Nausea and vomiting – This is fairly rare, but may be present for the first eight to twelve hours. If it persists, Phenergan suppositories can be quite useful.

• Diarrhea – It is reasonably common to have one or two episodes of diarrhea the first night following the detox, but then it is almost always gone. If diarrhea persists, the best treatment is anti-diarrhea medications, such as Fibercon.

• Muscle aches and pains – These are usually mild and resolve within the first eight to twenty-four hours.

• Weakness – Patients may be weak and fatigued. They rapidly regain strength and no medicines are required. If patients are active on the days after the detox, their strength and energy levels seems to improve more quickly.

• Restlessness – This can be a problem the first evening but usually resolves over 6-12 hours. It responds somewhat to Valium and sometimes we add some Zyprexa. This is almost always completely gone by the next morning.

• Insomnia – Can persist for quite some time following the detox. The first week it is frequently pretty severe and problematic. We usually use a combination of several medications to relieve this symptom. Over time this also resolves.

Long-Term Recovery
It is important to remember that what we are essentially providing is a detoxification. Our long-term goal is obviously long-term recovery. Through some modern medical techniques we now have a fairly good idea of what causes cravings and relapse and a good aftercare program must be established to avoid these.

Cravings and Relapse
Modern PET scanners can actually take pictures of the brain and the pleasure center. These studies show that cravings are related to releases of Dopamine in the brain. Dopamine is the chemical that is found in the pleasure center and all drugs of abuse cause secretion of extra amounts. When patients are in recovery and drug-free we find there are three specific things that release Dopamine in the brain, as if the patient had taken a small amount of drugs. This increase of Dopamine is associated with the patient feeling cravings for the drugs. These three things that release Dopamine in the brain and cause cravings are as follows:

• Any mood altering drug
  We know that it is absolutely essential for opiate addicts to be completely abstinent from alcohol, pot, cocaine, amphetamines and other addictive drugs. All of these drugs release Dopamine into the brain and all of them will make the brain have cravings for heroin and other opiates. It is essential that all patients pay very close attention to this and be completely abstinent from all mood-altering drugs.

• Things that were associated with the drug experience
  Any environmental stimulus that was associated with the drug experience will actually release Dopamine in the brain. This means old friends, old places where people used to use, seeing drug paraphernalia, driving down the wrong street, getting a paycheck, seeing an ATM machine, hearing a song that was associated with using drugs, etc. All of these things will actually produce cravings in addicts. Eventually these will go away, but it may take years before these stimuli do not produce releases of dopamine in the brain. It is essential that all patients pay extremely close attention to this so that the brain has the best chance of staying drug-free.

• Intense moods and emotions
  Strong feelings including sadness, grief, loneliness, depression, happiness, joy and boredom can all release Dopamine in the brain and produce cravings for drugs. It is essential that patients work with therapists and 12-step groups in order to keep themselves as stable as possible, especially in the early days of recovery.

Diet
If you have had a detox with sedation, please resume your diet carefully, starting with clear liquids and light foods such as soup or Jell-O. Advance your diet as you tolerate to resume your normal diet.

Activities
For the first 24-48 hours after detoxification do not make any important personal or business decisions or sign legal documents. Do not drive a car or operate machinery or power tools for 24 hours or as long as you are taking mood-altering medications. Do not stay alone for the first 24 hours after sedation. Rest at home and gradually increase your activities as you have been instructed.

Wound Care
For the Naltrexone Implant, keep your dressing clean and dry for 48 hours. NEVER apply a heating pad to the wound site since severe burns may occur on the skin. You must leave the bandage on for 24-hours. Do NOT soak in a bath/tub. If you shower, you must cover the wound with plastic to keep dry. After the bandage has been removed, you must wash the site gently with warm soap water and pat or air dry. You may apply a small amount of antibacterial ointment (Neosporin) for 2 days. You may take Motrin as directed for any pain associated with the implant.

Post-op
Residual withdrawals may persist after the detox including: nausea/vomiting, diarrhea, muscle aches & pains, weakness, restlessness and insomnia. Medications will be prescribed to help minimize any discomfort associated with these symptoms. Most symptoms will last for 1-2 weeks and then will start to dissipate as time goes on. Most patients are able to return to work after one week. We will continue to monitor your recovery and prescribe necessary medications for one month post-detox. At that time, we will release you to the physician that will be providing your medical care.

Long-term Recovery
It is important to remember that we are essentially providing detoxification. Our long-term goal is obviously long-term recovery. The essentials for a good recovery program include: Naltrexone maintenance for twelve months, twelve-step groups, substance abuse therapy, medical care and abstinence.

Out-of-Town Patients
After an appointment for the detox is scheduled, the patient and his/her support person will be given instructions on when to arrive and how to prepare for treatment. If the patient is traveling from out-of-town, we suggest making a reservation at a local hotel for the night before treatment. Our staff can suggest accommodations that are affordable and within easy traveling distance from our offices.