Newport Harbor Recovery
Affordable, Effective Alcohol and Drug Treatment
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Detox Information
As defined by the Substance Abuse and Mental Health Services Admisistration, detoxification should be viewed as the gateway to ongoing treatment. In Chapter 1 of the Treatment Improvement Protocol (TIP), providing a safe withdrawal is the first goal of detoxification, and another is to prepare the client for appropriate followup treatment. Staff members in all detoxification settings, from the least restrictive to the most intensive, must facilitate this goal.
Considerable variation exists in the levels of care provided by Alcohol and Drug abuse treatment programs. Inpatient programs generally have fairly extensive onsite capabilities for providing medical care to patients or are affiliated with a nearby medical center or physician. Some residential treatment programs are loosely affiliated with a medical center. Intensive outpatient treatment programs may be located within or closely affiliated with a hospital or medical center. Therapeutic communities are residential and have minimal, if any, onsite medical capabilities. They tend to rely on outside sources of medical care. Detoxification services generally are available under a medical model or a social model.
Medical Model Programs
Medical model programs are directed by a physician and staffed by other health care personnel. They range from hospital-based inpatient programs to free-standing medically based residential programs in hospitals or in community facilities that can draw on various medical resources.
Social Model Programs
Social model alcohol or other drug abuse treatment programs concentrate on providing psychosocial services. Social workers and other clinicians provide services such as individual and family counseling and coordination of care. Patients who need a physician's care may be referred to a nearby emergency department, which is not a cost-effective source of detoxification services. Some programs that provide detoxification services have a physician on call who can prescribe detoxification medications.
Social model programs use a variety of approaches to detoxification, but the emphasis is most often on nonpharmacological management of withdrawal. Usually, counselors do not have prescribing privileges and cannot legally administer medications from stock bottles to patients. In some programs, counselors can assist patients in taking detoxification medications. The patient's medication supply must be in a container that is labeled with the patient's name and that includes instructions for taking the medication. Counselors observe the patient take the medication, and they maintain a log. Counselors can also monitor patients' symptoms and call physicians or nurse practitioners if patients become ill.
Social model programs should not provide detoxification for people who have severe dependence on alcohol or other sedative-hypnotics, as withdrawal can be life threatening in these cases. Patients must be properly medically evaluated when they enter a social model program.
Inpatient and Outpatient Detoxification Settings
Detoxification may occur either in an inpatient or an outpatient setting. Both types of settings initiate recovery programs that may include referrals for problems such as medical, legal, psychiatric, and family issues.