In some cases, same-day admittance to a detox program is necessary.
For example, the following situations may necessitate same-day admittance:
In addition, there may be a reason for same-day admittance that is not related to an emergency. There may simply be a need 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 available, it should be implemented without hesitation in the above circumstances.
The Overall Structure of the Detox Process
There are three major components to the detox process. The first and second components may need to be addressed rather quickly during same-day admissions procedures:
- Evaluation: The first thing to expect is an intake assessment. A physician or nurse will evaluate the individual’s current state of intoxication and any withdrawal symptoms that are occurring as well as gather other needed information regarding the individual’s history, physical health, and mental health.
- Stabilization: This is the process of negotiating any current state of intoxication and then getting the person started with the withdrawal process. Any interventions used in this phase are based on the information gathered in the evaluation stage.
- Preparation for recovery: Detox is only the first step in the treatment process. As the person begins to stabilize, the team makes preparations for subsequent treatment. The detox process prepares the client to engage in the recovery program. The final step of the detox process is to help the individual develop a plan to address the issues that are associated with addiction and continue with ongoing treatment.
The processes of evaluation and stabilization will help to define the level of care that is appropriate for the client.
When assessing someone for a detox protocol, clinicians understand that the person has the right to fully participate in the choice of the level of care, such that it does not interfere with their civil rights or freedom to participate in other aspects of their lives (if they are able to make such a decision). This is referred to as the principle of least restrictive care. There are four aspects regarding least restrictive care:
- Clients should be treated in settings that interfere least with their civil rights and freedom to participate in other aspects of society.
- Clients are allowed to disagree with the recommendations for their care and have the right to refuse any or all care.
- Clients should be informed in all aspects of their treatment and treatment planning.
- For individuals unable to make decisions or act in their own self-interest, the treatment program needs to carefully consider all state, federal, and agency policies and statutes when developing a plan of care.
The statues regarding forced admission into a treatment program vary from state to state. The team members need to consider all aspects of the situation before forcibly admitting someone into a treatment program. There is always some debate regarding exactly what the aspects of least restrictive care really mean and how to interpret them under specific circumstances. Generally, treatment providers are required to defer to the client in decisions regarding all aspects of that client’s care. Nonetheless, it is quite clear that there are many instances in an acute care admission where the individual is not acting in their own best interest and not making an informed decision. These instances need to be weighed carefully, and there are various protocols that can be used to determine if someone is able to make informed choices.
Certainly, an individual who is suicidal, severely intoxicated to the point of being unable to understand the situation, or in an emergency life-threatening medical state due to level of intoxication will be admitted to the highest level of care available. In many cases, an individual’s ability to make an informed choice may wax and wane. In cases of drug intoxication or severe emotional stress (such as being suicidal), once the acute situation is resolved, the person’s ability to make an informed choice may be restored. Once an individual is deemed to be able to make informed decisions, the person has the right to fully participate in the treatment process. In situations where individuals are deemed to continually be unable to make informed decisions due to psychological disorders or cognitive impairment, treatment providers can rely on relatives or close friends (in some situations) to assist the person or the treatment team in making decisions that are in that person’s best interest. Of course, there are some instances where formal legal intervention is necessary and where court orders will eventually dictate who can or cannot make decisions for the individual.
According to the American Society of Addiction Medicine there are five levels of care for detoxification protocols:
Level I-D: Ambulatory Detoxification without Extended Onsite Monitoring consists of the client spending most of the detox time at home, but regularly checking in with the program at scheduled periods. Most individuals will check in daily or every other day. Typically, this is what most would consider as a standard outpatient detox program.
Level II-D: Ambulatory Detoxification with Extended Onsite Monitoring is a program where the person will spend most of the day in a residential program under the observation of staff and will return home each night. There is typically a check-in and checkout time.
Level III. 2-D: Clinically Managed Residential Detoxification is an around-the-clock treatment program in a residential facility with staff members who are not medically trained. Typically, individuals in these programs may have some complications, but they are not expected to have severe medical complications that require close medical monitoring.
Level III. 7-D: Medically Monitored Inpatient Detox is available for individuals who require 24-hour medical monitoring during the detox process. Level IV-D: 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.
Determining How to Deliver Care in DetoxThe 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.
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 these domains are assessed, the appropriate level of care can be determined. Individuals with serious emergency admissions will most likely wind up in Level IV or Level V programs. Other factors discovered during the evaluation can help to determine the level of care that is recommended for the person, such as:
- Financial issues
- Issues with traveling that make it difficult to get to an outpatient center for observation or care
- A physical disability
- Needing stricter monitoring due to legal issues, such as bond requirements, probation, etc.
- Needing special consideration because they need to care for dependents, such as children, parents, etc.
- Psychiatric or cognitive issues that call into question the individual’s ability to make informed decisions
- Being suicidal
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.
Same-day admittance to a detox program is possible under 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.