B. called to schedule an Outpatient Alcohol Detox with us earlier this week. It will be her second time coming to the Coleman Institute for Addiction Medicine for the same purpose.

J. was in last month, repeating his Accelerated Opioid Detox for the third round.

S. came back and completed his rapid detox off fentanyl two weeks ago. He was with us several months ago but didn’t complete it, admitting at that time that using the drug was just more compelling to him than getting clean.

Relapsing is not an uncommon phenomenon for people with substance use disorder.

That moment between a trigger or stimulus and one’s response is profound and powerful. This is the moment where the choice lies. How people manage that small moment—and the millions to follow—creates the trajectory, and ultimately one’s life story.

Over my many years of working in the field of addiction and substance use disorder, I have come to believe that a person who chooses to stop using an addictive substance and face life on life’s terms, fares so much more successfully if they have skills to cope with the slings and arrows that life will inevitably fling their way. It is almost cruel to take away a coping mechanism (drugs, booze, pot) until a plan is established, support systems are in order, a mentor or sponsor is lined up.

Not surprisingly, many people who come to us for a detox off alcohol or opioids (pain medications such as Dilaudid®, Oxycontin®, Percocet®, hydrocodone, methadone, buprenorphine, fentanyl or heroin for a few examples) simply want the detox. They have arrived, with great resolve. They are ready to stop and are relieved, and often elated, to have found our program which can safely, efficiently, confidentially, and fairly comfortably—get people off of addictive substances.

How Our Program Works

One of the most unique features of the Coleman Institute is that we are an outpatient program. This means our patients and their support person (or entourage) come to our office daily for treatment and return to the comfort of their own homes, a nearby hotel, or an Airbnb® as more and more of our patients are choosing to do. (If that’s your inclination and your coming to our Richmond office, consider looking in the Fan or Museum district for a place to stay. Not only is it close to our office, but it’s also in a very cool part of town). The normal time for an alcohol detox is 3 days; for opioids, it is a minimum of 3 days and up to 8 or 10 days if one is getting off higher doses of methadone or buprenorphine products).


The first day will consist of paperwork and a thorough review of the next few days, including the schedule of appointments and when and how to administer the comfort medications. The first day is also when our patients and their support people will meet with a counselor or case manager to start the all-important process of establishing an aftercare treatment program.

The interim days are usually brief. The final day of the accelerated opioid detox will be several hours. Support people will be offered lunch of their choice from nearby eateries. A naltrexone implant will be inserted in the abdominal area, and discharge instructions are reviewed. Follow up appointments are set in place. Most people return to work in 48 hours.

Why Detox Isn't Enough

Many patients believe that this is their problem: it is too difficult or dangerous to stop on their own, and if they can just get past this part, life will be different. I am the first person to say there are many ways to skin this cat, and there are people who detox with us and enter a life of recovery with no further therapy, treatment, or counseling. I suspect these people already have well-developed coping skills under their respective belts.

However, most patients and their families benefit greatly from connecting with others who can help them learn to live a life of recovery. After all, just because one gets sober doesn’t mean problems stop. Having the skills to respond intentionally to a trigger, an urge, an uncomfortable situation, from the perspective of a person choosing sobriety is the goal.

Russell Brand, British comedian, activist, and author, writes about his journey to recovery in Recovery: Freedom from Our Addictions. He describes the moment of choosing not to indulge in addictive behavior:

Now that I’m fourteen and a half years clean, one day at a time, I like to riff on this concept like I’m Charlie Parker or Foucault. When I feel like I want to act out sexually, I surrender it, I don’t act out. Then the next day, or even an hour later I think, "Imagine I had done that? It would be over now anyway and I'd detonated my family."

Brand, like thousands in recovery from addictive substances and behaviors, has turned the presence of triggers into a practice of responding in a chosen manner.

Although our patients who relapse may call us with some feelings of shame or embarrassment, there is no judgment on our end. We know it is a normal part of the process for many people, and I am gratified to see that patients felt so well-treated on round one (or two), that they are choosing to return to us.

We are here to help you start your journey to a lifetime of making choices in the service of what you personally value. Please call us at 877-773-3869 for information on our programs.

Joan R. Shepherd, FNP