Pharmacologic therapies are utilized in drug detox to prevent life-threatening withdrawal complications such as seizures, delirium tremens, heart attacks and suicidal ideation. Medical detox also increases compliance with psychosocial forms of addiction treatment in rehab. Medication management of withdrawal symptoms and recovery is based on the type, duration, timing and dosage of abused drugs as well as an individual\u2019s overall health. People who choose to detox \u201ccold turkey\u201d on their own without medically assisted detox often suffer unimaginable physical and psychological pain and many relapse due to extreme withdrawal symptoms.1 One can find anecdotal, first-person stories online about cold turkey withdrawal, although few scientific studies have been conducted specifically on this subject. A growing number of reports have been published on newly incarcerated prisoners suffering and dying from drug withdrawal because they were refused medical treatment. These stories provide a glimpse of what can happen when individuals go through withdrawal without medical intervention. David Stojcevski died in a Michigan jail cell after spending more than two weeks in acute withdrawal from benzodiazepines and methadone. The 32-year-old lost 50 pounds in just 16 days because Macomb County Jail officials repeatedly refused to give him medications he had been legally prescribed before entering the facility to serve a 30-day sentence for reckless driving. An estimated two-thirds of inmates entering jail have a diagnosable substance use disorder, yet few jails provide the medical standard of care for withdrawal. The Stojcevski case is not an anomaly \u2013 in the past five years, families in at least six states have been awarded nearly $11 million in compensation for loved ones who died because they were denied routine detox care at local jails.2 While a person undergoing medical detox can experience the following symptoms, prompt intervention at inpatient facilities alleviates severe reactions and helps prevent unnecessary tragedies. \tSeizures: Seizures are characterized by tremors, spasms and other involuntary movements of the body. Alcohol, benzodiazepines and hallucinogens can cause seizures, which can be life-threatening in the absence of professionally supervised medical detox. Generalized tonic-clonic seizures are a dangerous component of alcohol withdrawal syndrome. The risk of grand mal seizures from benzo withdrawal is higher than with alcohol withdrawal. While a withdrawal seizure itself is typically not fatal, it could lead to death if it occurs while someone is driving, in a bathtub or pool or falls and suffers a traumatic brain injury.3,4 \tDelirium tremens: Alcohol is one of the few chemical substances (by itself) associated with deadly withdrawal symptoms, most of which are linked to a condition called delirium tremens (DTs). DTs causes an altered mental status and autonomic hyperactivity, which can progress to cardiovascular collapse. The most common DTs symptoms leading to death are respiratory failure and cardiac arrhythmias. Only 5% of individuals withdrawing from alcohol progress to DTs, although the lifetime risk in chronic alcoholics is 5% to 10%. The current DTs mortality rate ranges from 5% to15%, although it was as high as 35% prior to the era of intensive care and advanced pharmacotherapy.5 \tSevere gastrointestinal (GI) distress: Vomiting, abdominal pain, diarrhea, constipation and loss of appetite are common symptoms of alcohol and opioid withdrawal. The main concerns with diarrhea and vomiting are dehydration and electrolyte loss, which can be fatal in extreme cases. Over time, opioids can slow the bowel, causing opiate bowel dysfunction and opioid-induced constipation. In addition, about 5% to 10% of individuals experience sensitized nerves in the GI tract and worsening abdominal pain, a condition known as narcotic bowel syndrome (NBS). Drug withdrawal already exacerbates the GI tract, although medically managed detox can alleviate these sypmtoms.6,7 \tMental and cognitive symptoms: Alcohol, many illicit drugs and abused prescription drugs can cause a wide range of mental and cognitive withdrawal symptoms. Some individuals experience excruciating side effects mirroring those of full-blown psychiatric disorders, such as anxiety, depression, panic attacks, obsessive-compulsive behaviors, sudden mood swings, delusions, aggression and paranoia. Cognitive issues include a lack of motivation, inability to concentrate, general cognitive impairment, memory loss, difficulty solving problems, disorientation, clouded thinking and obsessive thoughts.8 \tSuicidal ideation: The relationship between suicide attempts and psychiatric disorders including substance use disorders is common. A 12-month study on 868 substance-using individuals indicated suicidal incidence (SI) and suicide attempt (SA) rates of 25.9% and 7.1%, respectively. This was considerably higher than estimated one-year incidence rates for people in the general U.S. population (SI: 3.7%; SA: 0.5%). These findings are consistent with research indicating substance use is a substantial risk factor for suicidality.9 SI and SA withdrawal side effects are associated primarily with opioids, cocaine and methamphetamine, although the high incidence of untreated polysubstance use and coexisting psychiatric disorders compounds this issue. \tIntense drug craving: Illicit drugs like cocaine, meth and heroin affect the way the brain processes neurotransmitters (neurochemicals) such as dopamine, serotonin, glutamate, acetylcholine and dozens of others scientists have identified to date. When a person stops taking addictive drugs, the brain attempts to compensate for decreased levels of these chemicals, which prompts intense drug cravings. Mu opioid receptors in the frontal and temporal regions of the cortex appear to impact the intensity of drug craving for cocaine during the first few months of abstinence.10 \tRelapse: Drug cravings and relapse are strongly correlated. Recent drug relapse statistics indicate more than 85% of individuals relapse and return to drug use within a year following treatment, with two-thirds in recovery relapsing within weeks to months of beginning addiction treatment. Specific medications can help re-establish normal brain function, decrease symptoms and thereby reduce cravings and the likelihood of relapse.11 A meta-analysis evaluating 26 Relapse Prevention (RP) treatment outcome studies with 9,504 participants indicated RP was generally successful in reducing substance use and improving psychosocial functioning. It was most effective for reducing alcohol and polysubstance use and even more so when delivered in conjunction with pharmacotherapy.12 \tDeath: Quitting cold turkey can lead to fatalities, in particular for individuals withdrawing from long-time misuse of alcohol, benzodiazepines or methadone at high doses. Moreover, quitting cold turkey results in the body losing its tolerance for the previously abused substances. Relapse is more common when someone tries detoxing themselves, which leads to repeated abuse. When these drugs are reintroduced at the level of prior consumption, there is a high risk of overdose, which can be fatal. A 2010 study published in the journal Alcohol analyzed individuals hospitalized due to abrupt cessation of alcohol intake. An estimated 6.6% of the individuals admitted to the hospital for alcohol withdrawal syndrome died due to various effects of their symptoms.4 The significant physical psychological effects of drug withdrawal can be torturous for a chemically dependent person. Undergoing medically supervised detox at a high-quality inpatient facility can make a tremendous difference in an addict\u2019s chance of recovery. Around-the-clock care during the most dangerous stages of detox can alleviate many withdrawal symptoms and reduce the chance of relapse. Moreover, if seizures, DTs or any other potentially fatal symptoms occur, appropriate medical intervention can be administered immediately.13 \tHow Improperly Detoxing Can Kill You. Rehabs website. http:\/\/www.rehabs.com\/how-improperly-detoxing-can-kill-you\/ Published April 26, 2013. Accessed May 22, 2017. \tDeath by detox. Aljazeera America website. http:\/\/america.aljazeera.com\/opinions\/2015\/10\/death-by-detox.html Published October 26, 2015. Accessed May 22, 2017. \tRogawski MA. Update on the Neurobiology of Alcohol Withdrawal Seizures. Epilepsy Curr. 2005;5(6):225-230. doi:10.1111\/j.1535-7511.2005.00071.x. \tCan Heroin, Benzo or Alcohol Withdrawal Cause Death? American Addiction Centers website. http:\/\/americanaddictioncenters.org\/withdrawal-timelines-treatments\/risk-of-death\/ Accessed May 22, 2017. \tDelirium Tremens (DTs). Medscape website. http:\/\/emedicine.medscape.com\/article\/166032-overview Updated: March 7, 2017. Accessed May 22, 2017. \tTips to Cope With Diarrhea During Drug Withdrawal. Very Well website. https:\/\/www.verywell.com\/diarrhea-stomach-pain-treatment-during-drug-withdrawal-22372 Updated May 5, 2016. Accessed May 22, 2017. \tNarcotic Bowel Syndrome. International Foundation for Functional Gastrointestinal Disorders website. https:\/\/www.iffgd.org\/other-disorders\/narcotic-bowel-syndrome.html Updated May 22. 2016. Accessed May 22, 2017. \tSymptoms of Drug Withdrawal. Narconon website. http:\/\/www.narconon.org\/blog\/drug-addiction\/withdrawal-symptoms\/ Accessed May 22, 2017. \tHallgren KA, Ries RK, Atkins DC, Bumgardner K, Roy-Byrne P. Prediction of Suicide Ideation and Attempt Among Substance-Using Patients in Primary Care. J Am Board Fam Med. 2017 Mar-Apr;30(2):150-160. doi: 10.3122\/jabfm.2017.02.160264. \tImpacts of Drugs on Neurotransmission. National Institute on Drug Abuse. https:\/\/www.drugabuse.gov\/news-events\/nida-notes\/2017\/03\/impacts-drugs-neurotransmission Published March 9, 2017. Accessed May 22, 2017. \tDrug Relapse. Drug Abuse website. http:\/\/drugabuse.com\/library\/drug-relapse\/ Accessed May 22, 2017. \tHendershot CS, Witkiewitz K, George WH, Marlatt GA. Relapse prevention for addictive behaviors. Subst Abuse Treat Prev Policy. 2011;6:17. doi:10.1186\/1747-597X-6-17. \tGuide to Drug Detox. Dual Diagnosis website. http:\/\/www.dualdiagnosis.org\/guide-drug-detox\/ Accessed May 22, 2017.