How to Get Into Detox in New Hampshire: A Step-by-Step Guide

Deciding to stop is a big step. If you drink heavily or use opioids or benzodiazepines every day, the next step is often a safe withdrawal with medical care, which most people call detox. This guide covers how to tell whether you need it, how to find a detox program in New Hampshire, what to have ready when you call, what to do if no bed is open today, and why the days right after detox matter so much.

When to call 911 first

Withdrawal can turn into a medical emergency. Call 911 or go to the nearest emergency room if someone in alcohol withdrawal has a seizure, a fever, severe confusion, hallucinations or an irregular heartbeat (MedlinePlus). Benzodiazepine withdrawal can bring seizures and delirium as well (joint benzodiazepine guideline). Call 911 for a suspected overdose too, and give naloxone if opioids may be involved.

New Hampshire's health department sums up the split this way: for a medical emergency, call 911, and for a substance use or addiction-related crisis, call 2-1-1 (NH DHHS). If you are having thoughts of suicide, call or text 988.

What detox is

Clinicians now call detox withdrawal management. The American Society of Addiction Medicine (ASAM) defines it as the medical and psychological care of people who have withdrawal symptoms after stopping or cutting back a substance (ASAM guideline). A detox program keeps you safe and as comfortable as possible while your body adjusts, and it gives you a starting point for treatment.

Detox can happen in more than one kind of setting. ASAM groups them into two broad types: ambulatory withdrawal management, where you go home between visits, and inpatient withdrawal management, where you stay on site around the clock in a hospital or residential program (ASAM). New Hampshire's treatment locator lets you search for both "Withdrawal Management" and "Withdrawal Management (Outpatient)" (NH DHHS).

Do you need medically supervised detox?

A clinician makes this call, based on what you use, how much, for how long, and your health. ASAM's alcohol withdrawal guideline says the decision should rest on three things: your current symptoms, your risk of severe or complicated withdrawal, and your circumstances, such as support at home. Alcohol withdrawal can usually be managed safely as an outpatient when risk factors are few. People with little support or an unsafe home may need a more intensive setting than their symptoms alone would suggest (ASAM).

ASAM lists factors that raise the risk of a complicated alcohol withdrawal, including these (ASAM):

• a past withdrawal seizure or withdrawal delirium (formerly called delirium tremens, or DTs)
• many past episodes of withdrawal
• another medical or surgical illness, especially a traumatic brain injury
• being older than 65
• a long history of heavy, regular drinking
• a seizure during the current withdrawal
• physical dependence on benzodiazepines or barbiturates

MedlinePlus, the National Library of Medicine's health site, describes the same split in plain terms. People with mild to moderate alcohol withdrawal can often be treated as outpatients, with someone staying with them and daily visits to a provider until they are stable. People with moderate to severe symptoms may need care in a hospital or a facility that treats alcohol withdrawal (MedlinePlus).

When you call a program or a clinician, describe your use plainly, including amounts. Programs use that information to judge your risk and choose a safe setting.

Alcohol

Alcohol withdrawal symptoms usually start within 8 hours of the last drink, though they can begin days later, and they tend to peak between 24 and 72 hours (MedlinePlus). Common symptoms include shakiness, sweating, anxiety, nausea, trouble sleeping and a rapid heart rate (MedlinePlus). ASAM names seizures, delirium and death as the most severe consequences (ASAM), which is why alcohol withdrawal calls for a clinician's judgment. Treatment works. ASAM describes benzodiazepines as the first-line medication for people at risk of severe withdrawal because they reduce withdrawal symptoms and the chance of seizures and delirium (ASAM).

Benzodiazepines

Benzodiazepines include medications such as alprazolam (Xanax), clonazepam (Klonopin), diazepam (Valium) and lorazepam (Ativan). A 2025 guideline from ASAM and nine other medical organizations warns that after regular use, stopping suddenly or cutting the dose too fast can cause serious and potentially life-threatening withdrawal, including seizures and delirium. It recommends a gradual taper rather than an abrupt stop for anyone likely to be physically dependent (joint benzodiazepine guideline).

The same guideline says most people can taper as outpatients. Inpatient care is generally indicated for someone who is having, or is expected to have, severe or complicated withdrawal, and a history of moderate to severe alcohol withdrawal may make benzodiazepine withdrawal more severe (joint benzodiazepine guideline). If you take a benzodiazepine every day, prescribed or not, talk with a clinician before you stop.

Opioids, including fentanyl

Opioid withdrawal brings muscle aches, anxiety, sweating, a runny nose, stomach cramps, nausea, vomiting and diarrhea. MedlinePlus describes it as very uncomfortable but usually not life-threatening, though vomiting and diarrhea can cause dehydration. Going through it alone can be very hard and may be dangerous. Buprenorphine and methadone ease withdrawal and can also be continued as long-term treatment (MedlinePlus). Our guide to what Suboxone is and how it works explains buprenorphine in more detail.

The larger danger with opioids comes after withdrawal. Withdrawal lowers tolerance, so a much smaller dose than a person used to take can cause an overdose (MedlinePlus). SAMHSA's treatment protocol on medications for opioid use disorder states that people who complete medically supervised withdrawal are at risk of opioid overdose. Its expert panel does not recommend short-term withdrawal on its own, because rates of return to opioid use afterward are high (SAMHSA TIP 63). That is why it matters to ask any detox program about starting medication and how you would keep taking it after you leave.

Cocaine

Cocaine withdrawal often has no visible physical symptoms like the shaking and vomiting of alcohol or opioid withdrawal. Instead there is a crash: exhaustion, low mood, strong cravings, and sometimes agitation or paranoia. The depression can be serious, and some people have suicidal thoughts. MedlinePlus advises starting treatment with the least restrictive option and notes that outpatient care is as effective as inpatient care for most people (MedlinePlus).

For a fuller picture of what withdrawal feels like, substance by substance, see our guide to symptoms of detoxing the body.

How to find a detox program in New Hampshire

You can use more than one of these routes at the same time.

Dial 2-1-1 for The Doorway

The Doorway is New Hampshire's access point for substance use help. Dialing 2-1-1 connects you to a Doorway 24 hours a day, and the state says the regional Doorways keep help less than an hour away (The Doorway). The Doorways help people access every level of treatment and connect them to screening and evaluation, treatment including medication-assisted treatment, naloxone and peer recovery support (The Doorway).

There are nine Doorways, which the state places at community hospitals (The Doorway), in Berlin, Concord, Dover, Keene, Laconia, Lebanon, Littleton, Manchester and Nashua. For southern New Hampshire, the closest are The Doorway of Greater Manchester at 300 Hanover Street and The Doorway of Greater Nashua at 268 Main Street (Doorway locations).

Search the state and federal locators

The NH Drug & Alcohol Treatment Locator, run by the New Hampshire Department of Health and Human Services, lists agencies and practitioners offering substance use services. Filter by "Withdrawal Management" or "Withdrawal Management (Outpatient)" and search by town or zip code.

FindTreatment.gov, run by SAMHSA, is a confidential and anonymous treatment locator with a "Detoxification" filter. If you would rather talk to someone, SAMHSA's National Helpline at 1-800-662-4357 is free, confidential and open 24 hours a day, every day of the year, in English and Spanish, and gives referrals to local treatment facilities (SAMHSA).

Call your insurance plan

Call the member services number on your insurance card and ask which detox programs your plan covers and whether the stay needs approval first. New Hampshire's health department lists withdrawal management among the state's levels of care and notes that many of these services are paid for by public or private insurance, along with state funding that helps people get into treatment (NH DHHS). Whether a particular detox stay is covered depends on your plan, so ask before you are admitted. The detox program confirms what your plan covers for the stay itself. If you have New Hampshire Medicaid, our page explains how the state's Medicaid health plans handle outpatient care afterward.

Ask your doctor or an emergency department

If you have a primary care provider, call the office. MedlinePlus advises contacting your provider right away, or going to an emergency room, if you think you might be in alcohol withdrawal, especially if you drank often and recently stopped (MedlinePlus). For opioid use, SAMHSA notes that almost all healthcare settings are appropriate for assessing opioid use disorder and offering medication on site or by referral (SAMHSA TIP 63).

Call Clear Steps admissions

Clear Steps Recovery is an outpatient program and doesn't provide detox itself. When you call (603) 769-8981, any time, admissions talks through detox programs that fit your needs and your insurance, and helps you contact the one you choose, or contacts it with you. You choose where to go. You can call The Doorway, call us, or both. Our page on getting into detox in New Hampshire explains how that works.

What to have ready when you call

Detox programs need a clear picture to decide whether they are the right setting for you. It helps to have these details ready:

• what you use, how much, how often, and when you last used
• any past withdrawal, especially seizures, delirium or hallucinations
• every medication you take, including prescribed benzodiazepines, sleep medications, buprenorphine or methadone
• medical and mental health conditions, and whether you are pregnant
• your insurance card and a photo ID
• a phone number where the program can reach you, and someone they may contact with your permission

Before you go, ask the program what to bring and what to leave at home, including whether you can keep your phone and how it handles medications you already take.

Questions to ask a detox program

• Do you have a bed today? If not, when should I call back, and what days and hours do you admit?
• Do you take my insurance, and does my plan need to approve the stay first?
• What medications do you use for withdrawal?
• Can you start medication for alcohol or opioid use disorder while I am here, and who will prescribe it after I leave?
• Will you help set up my next step in treatment before I am discharged?

The question about medication is worth asking directly. ASAM recommends starting treatment for alcohol use disorder during withdrawal management when feasible, including offering medication when appropriate (ASAM). For opioids, SAMHSA warns that people who don't take a medication for opioid use disorder after withdrawal are at high risk of returning to opioid use, which can be fatal because tolerance is lost (SAMHSA TIP 63).

If there is no bed today

Hearing "we have no bed" after you have finally decided to stop is discouraging, and there are still things you can do. Bed openings, insurance approval and admission days and hours are up to each detox program, so how fast you get in can vary.

• Ask when to call back. Find out what time of day beds usually open and whether the program can call you.
• Keep more than one line open. Dial 2-1-1, check the locators again, and call your plan or Clear Steps admissions at the same time.
• Ask about outpatient withdrawal management. For people at lower risk, ASAM says alcohol withdrawal can usually be managed safely as an outpatient (ASAM), and New Hampshire's locator lists outpatient withdrawal management programs.
• Get medical advice before stopping alcohol or benzodiazepines on your own. If you drink heavily or take benzodiazepines every day, withdrawal from either can become dangerous (MedlinePlus, joint benzodiazepine guideline).
• Know when to go to the emergency room. If withdrawal starts while you wait and brings confusion, hallucinations, a fever, an irregular heartbeat or a seizure, go to an emergency room or call 911.
• If you use opioids, keep naloxone close. In 2023 the FDA approved Narcan nasal spray, a naloxone product, for sale without a prescription (FDA), and The Doorway can help you get naloxone as well. SAMHSA's overdose prevention advice includes not using alone and making sure others know where your naloxone is and how to use it (SAMHSA TIP 63).

Why the step after detox matters

The days right after detox are when treatment can take hold, and also when many people slip through the gaps between programs. Research on what happens after detox points the same way:

• Using state treatment records from five states, researchers found in several of those states that people who started substance use treatment within 14 days of leaving detox were less likely to be readmitted to detox (Lee and colleagues, 2014).
• In a national Veterans Health Administration study of 25,354 people who went through alcohol or opioid detox, those who had an outpatient follow-up visit within 7 days had 53.3% lower odds of dying over the next two years. The researchers adjusted for differences between the groups. Like any observational study, it shows an association and cannot prove cause (Schmidt and colleagues, 2017).
• The handoff can fall through. In one Massachusetts study of 4,236 people admitted to detox between 2013 and 2015, all covered through a single behavioral health plan, 42% received any substance use treatment within 14 days of leaving (Lee and colleagues, 2020).

A common next step is outpatient treatment at the level a clinician recommends. New Hampshire's health department says intensive outpatient programs (IOP) serve several groups, including people stepping down from inpatient, residential and withdrawal management settings, with at least 9 hours of treatment a week for adults. A partial hospitalization program (PHP) is a more intensive day program, with ASAM criteria recommending at least 20 hours a week (NH DHHS).

At Clear Steps Recovery in Londonderry, people coming out of detox start at the level a clinician recommends: PHP (Day Treatment) on weekdays with no overnight stays, IOP, or Evening IOP Monday through Thursday from 6 to 9 pm for people going back to work. Buprenorphine or naltrexone started in detox can continue with our medical team without a gap. Where you go after detox is your choice, and our Londonderry center page has directions and details.

If you live in Massachusetts, the routes there are different. See our page on help getting into detox in Massachusetts.