Recovery from drugs and alcohol is a physical and mental process, but detox is the crucial turning point. Actually, submission to detox is the initial and critical surrender, but detox is, on a physical basis, the first step to recovery. Until the body is cleared of any substances that can affect the mind, little progress can be made. Unfortunately, detox can range from extremely uncomfortable to painful and even deadly. Addicts know this, and the addicted brain uses it as an excuse to put off any attempt at abstinence. The longer the addict uses, the more severe the detox, and thus the cycle feeds on itself and worsens.
There are cases in which medical detox is recommended. These would include times when the addiction is so deep (long-term and continuous large amount of consumption of drugs or alcohol) that a tapering strategy is untenable and possibly dangerous. Also, when complicating medical issues (co-occurring mental disorder, diabetes, coronary disease, etc.) are present, medical supervision and appropriate pharmacological intervention are appropriate.
However, many who suffer from alcohol and/or drug dependency can benefit from supervised withdrawal. Drugs are available to ameliorate the discomfort of opiate withdrawal symptoms, and titrating—a scheduled reduction in alcohol or drug intake—can be an effective strategy. The key, though, is supervision. Because the addicted brain views continued use of a substance as the solution to the problem of discomfort, it will—in the absence of supervision—give priority to finding and using the substance, and attempting abstinence or moderation will take a back seat.
In a proper treatment setting, the goal—after safety—in this first step to recovery is to minimize discomfort to the point where the addict or alcoholic can be coached through the experience, with emphasis on the fact that it is temporary and relief is on the other side. As a corollary, it is useful for the patient to be counseled that sustained effort in recovery is required in order to avoid having to repeat the experience.