Outpatient detoxification has the following advantages:
- It is much less expensive than inpatient treatment.
- The patient’s life is not as disrupted as it is during inpatient treatment.
- The patient does not undergo the abrupt transition from a protected inpatient setting to the everyday home and work settings.
Outpatient detoxification usually is offered in community mental health centers, Alcohol and Other Drugs (AOD) abuse treatment clinics, and private clinics.
The emergency department (ED) often serves as a gateway to AOD detoxification services. AOD detoxification programs may rely on emergency department staff to assess and initiate treatment for patients with medical conditions or medical complications that occur during detoxification. For social model programs, EDs are often a safety net for patients who need medical treatment. For the AOD abuser who has overdosed or who is experiencing a medical complication of AOD abuse, the ED may be the initial point of contact with the health services system.
It serves as a source of case identification and referral to AOD detoxification programs. Certain illnesses treated in emergency departments may mimic, mask, or resemble symptoms of withdrawal from AODs. Urine and blood toxicology testing may assist ED staff in making the correct diagnosis.
ED staff should refer patients who enter for detoxification to a more appropriate treatment site as soon as they have been assessed and stabilized.
The ED of an acute care hospital is neither an appropriate setting for detoxification, nor is it a cost-effective one. However, because of the key role of the ED in the initial management and identification of persons in need of detoxification, ED staff should have both clinical expertise and familiarity with local AOD abuse treatment resources.
Intensive Outpatient Programs
Intensive outpatient programs offer a minimum of 9 hours a week of professionally directed evaluation and treatment in a structured environment.
Examples include day or evening programs in which patients attend a full spectrum of treatment programming but live at home or in special residences. Some programs provide medical detoxification. Many programs have established linkages through which they may refer patients to behavioral and psychosocial treatment. One strength of these programs is the daily contact between patients and staff.
Non-intensive Outpatient Programs
In non-intensive outpatient programs, patients attend regularly scheduled sessions that usually total no more than 9 hours of professionally directed evaluation and treatment per week. These programs may provide detoxification services. Treatment approaches and philosophies in staffing of outpatient programs vary considerably. Some offer only assessments; in others, counseling may continue for a year or longer.
A majority of programs provide one or two weekly patient visits and may deliver psychiatric or psychological counseling and other services, such as resource referral and management. Many combine counseling with 12-step recovery.
Methadone Maintenance (Maintenance Pharmacotherapy) Clinics
These clinics may provide medically supervised withdrawal for persons abusing heroin who do not want to enter a methadone maintenance program but instead want to use methadone for withdrawal only, as well as for people who want to withdraw from methadone maintenance.
The clinics, which must be licensed by the Food and Drug Administration, the Drug Enforcement Administration, and State regulatory agencies, are the only programs in which methadone maintenance may be conducted for opiate addicts. They may be publicly funded and/or on a fee-for-service basis, but the distinction between public and private clinics is not clearcut; for example, many private clinics have contracts with the State or county to provide detoxification services.