Same Day Admittance to a Detox Program

Last Updated: August 16, 2019

When medical withdrawal management is urgently needed, same-day admission to a detox program may be imperative and could be lifesaving.

Potential situations requiring immediate, intensive detox care:

  • Patient is acutely intoxicated
  • Patient is experiencing or is at risk of experiencing relatively severe acute alcohol withdrawal (in cases of significantly severe physical alcohol dependence and associated withdrawal risks)
  • Acute sedative-hypnotic withdrawal (similar to the above, only for benzos, prescription sleep medications, etc.)
  • Combination withdrawal syndromes (alcohol + opioid dependence, alcohol + benzo dependence, etc.)
  • Severe acute opioid withdrawal (the symptoms of which might otherwise compel relapse if not managed immediately)

In addition, there may be other circumstances—those not related to a medical emergency or the potential for withdrawal complications—in which an immediate, or same-day admission would be ideal or highly desirable. For example, there may simply be a strong desire to get the person into detox immediately. For example, for someone with a history of chronic addiction who has finally decided to address the issue, prompt action may be required. In some instances, families may worry that their loved ones may change their minds regarding treatment if they have to wait several days for an appointment.

If same-day admission to a detox program is necessitated, and a specific detox center equipped to manage potentially emergent situations, it should be implemented without hesitation.

The Overall Structure of the Detox Process

From start to finish, there are three primary components to the detox process. The steps taken in connection with the first and second components may need to occur rather quickly for individuals in need of urgent withdrawal management:

  • Evaluation: The first thing to expect is an intake assessment. A physician or nurse will evaluate the individual for active intoxication as well as for any signs of withdrawal. Additional information will be gathered regarding the individual’s history, physical health, and mental health.
  • StabilizationThis may entail negotiating any current state of intoxication and actively managing withdrawal via various medical and psychosocial interventions, as needed. Any interventions used in this phase are based on the information gathered in the evaluation stage.
  • Fostering the patient’s entry into treatment: This component involves preparing a patient to enter into continued treatment and helping them understand the importance of such longer-term recovery efforts. Patients with a history of repeated detoxes but failure to engage with post-detox substance abuse treatment may be more encouraged to do so by signing a treatment contract prior to detox completion.

The findings during the evaluation phase as well as the observations and progress made during the stabilization phase will help to define the level of ongoing care that is appropriate for the client.

Levels of Care

According to the American Society of Addiction Medicine there are five levels of care for detoxification protocols; the two most intensive levels of care include:

  • Medically Monitored Inpatient Detox: is available for individuals who require 24-hour medical monitoring during the detox process.
  • Medically Managed Intensive Inpatient Detox: is the most intensive level of detox where patients with the most complicated cases spend their time in an acute care hospital with intense supervision and monitoring. As clients are stabilized, they can be transferred to a less acute level.

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Determining How to Deliver Care in Detox

calling-for-treatmentThe first thing to expect when being admitted on the same day to a detox program is the intake evaluation. Intake professionals, such as intake specialists, nurses, addiction counselors, and/or physicians, will assess the following domains:

The person’s current level of intoxication: It must first be determined if the person is under the influence of any drugs. This can be done both with physical testing, such as looking at blood alcohol content (BAC), other physical tests, and behavioral signs. An individual entering a detox program with a high BAC that indicates severe alcohol intoxication would require a different approach than someone entering without such a level of intoxication. The same is true for signs of any other drug intoxication occurring in the person.

Determining potential withdrawal symptoms and their severity: Based on the information given to the team by the client regarding the type of drug use, amounts, frequency, etc., the team can determine the general effects of any withdrawal symptoms and their severity. The team can also determine if the individual is experiencing any withdrawal symptoms. This information can help prepare the detox protocol.

Understanding the history of any health problems or medical issues: A person who presents with a complicated medical history can alter the program of detox. For instance, someone with a history of stroke or extremely high blood pressure will be treated differently than someone without these issues. An individual with a condition that requires medical monitoring, such as diabetes, will need to be considered for a different level of care that an individual who has no such issue.

Determining the presence of any emotional or cognitive issues: Co-occurring mental health issues, such as depression, bipolar disorder, etc., may require integrated treatment approaches and other special considerations. In addition, many times these conditions affect the individual’s ability to go through the detox process, and special approaches to these conditions need to be considered. Individuals with developmental disorders that affect their ability to make decisions require a different approach.

Assessing the person’s readiness to change behavior: Understanding how the person views the substance abuse and what is expected from detox is important in structuring the middle and later phases of the detox program. Understanding the individual’s history regarding relapse is also important. Many individuals enter a detox program thinking that going through detox is all that is required of them in order to recover from the substance use disorder. Understanding where the person is at regarding readiness to change can help prepare the overall treatment protocol.

Relapse issues and substance abuse history: Obviously, the nature of the person’s substance use disorder should be taken into consideration when deciding on a treatment plan for that individual.

Assessing the person’s current living situation: The middle and later phases of the detox process can address these issues; however, people who have extremely unstable living situations, such as being homeless or having abusive family members, often require a different approach. In addition, some individuals with extreme living situations may require full residential care to help them get through the detox process.

Once placed into an appropriate level of care, instructions, education, continued assessment, and continued monitoring will be given. The initial level of care a person is admitted into can be altered depending on the situation and the needs of the individual.

Conclusions

Doctor hands writing on a clipboard.Immediate or same-day admittance to a detox program may be required in a number of different circumstances. Individuals can expect to be evaluated as thoroughly as the situation allows, to be placed in a specific level of care, and to begin treatment based on their specific circumstances. As the person continues to negotiate the detox program, adjustments can be made to assist the person in transitioning through the stages of detox more smoothly. People who are able to make informed decisions regarding their treatment plan have the right to refuse any or all treatments. The ultimate goal of a detox program is to prepare the person for long-term recovery.
Last Updated on August 16, 2019
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