Principles of Detoxification
Detoxification alone is rarely adequate treatment for alcohol and other drug (AOD) dependencies. The provision of detoxification services without followup to an appropriate level of care is less than optimum use of limited resources. The appropriate level of care following detoxification must be a clinical decision based on the individual needs of the patient.
When using medication regimens or other detoxification procedures, only protocols of established safety and efficacy should be used in routine clinical practice.
Providers must advise patients when procedures are used that have not been established as safe and effective. Such procedures are considered investigatory and should be carried out under an approved research protocol.
During detoxification, providers should control patients’ access to medication to the greatest extent possible. Patients who are AOD dependent generally cannot be relied on to take their medication as prescribed. Overdose with either the prescribed medication or other drugs is always a possibility. Because of this, treatment staff should administer as many of the patient’s detoxification medications as possible. When it is not possible for the treatment staff to do so, another responsible person should assist the patient in taking the prescribed detoxification medication.
Initiation of withdrawal should be individualized. Many persons come to treatment during times of personal crisis. To initiate withdrawal immediately may intensify their distress. In some cases, treatment staff may prefer to stabilize the patient on medication (e.g., a patient using heroin may be stabilized on methadone) to resolve the immediate crisis before initiating withdrawal.
Whenever possible, clinicians should substitute a long-acting medication for short-acting drugs of addiction. For example, when detoxifying a patient from alcohol, clinicians usually prescribe a slowly metabolized benzodiazepine such as diazepam (Valium) or chlordiazepoxide (Librium). This type of medication provides a gradual decline in blood level and a more controlled reversal of neuroadaptation.
The intensity of withdrawal cannot always be predicted accurately. To assign patients to the appropriate level of care, it would be desirable to have empirically validated predictors of withdrawal severity. Unfortunately, no validated objective measures exist that would enable providers to predict with confidence a particular patient’s intensity of withdrawal symptoms. Clinical guidelines used to assess probable withdrawal severity include the amount and duration of patients’ AOD use, the severity of their prior withdrawals (if any), and the presence of medical or psychiatric comorbidity. Clinicians should take into account the patient’s medical history but should also be aware that it cannot be considered totally reliable.
Every means possible should be used to ameliorate the patient’s signs and symptoms of AOD withdrawal. Medication should not be the only component of treatment. Psychological support is extremely important in reducing patients’ distress during detoxification. Also, to the extent that it is medically safe, patents should be physically active.
Patients should begin participating as soon as possible in followup support therapy such as peer group therapy, family therapy, individual counseling or therapy, 12-step recovery meetings, and AOD recovery educational programs. Such services provide much-needed emotional support and provide alternative methods of coping with stresses that trigger AOD abuse. They provide general information about AOD dependence and goals for recovery. Overall health also can be addressed. Counseling on sexual health may include information on sexually transmitted diseases, human immunodeficiency virus (HIV) testing and education, and guidance on safer sexual practices. For injecting drug users, a drug-recovery educational program might include a discussion of the Centers for Disease Control and Prevention recommendations on needle exchange and disinfection.
DRUG ADDICTION TREATMENT TYPES
These type of treatments are primarily used for heroin addiciton, opiate addiction, and in general those addictions that produce the most severe withdrawal symptoms.