Detoxification and Substance Abuse Treatment
Detoxification and Substance Abuse Treatment Tip 45
Detoxification and Substance Abuse Treatment – WHY A QUICK GUIDE? This Quick Guide was developed to accompany Detoxification and Substance Abuse Treatment, Number 45 in the Treatment Improvement Protocol (TIP) series published by the Center for Substance Abuse Treatment (CSAT), Substance Abuse and Mental Health Services Administration (SAMHSA).
This Quick Guide is based entirely on TIP 45 and is designed to meet the needs of the busy clinician for concise, easily accessed “how-to” information.
The Guide is divided into nine sections (see Contents) to help readers quickly locate relevant material. For more information on the topics in this Quick Guide, readers are referred to TIP 45.
NOTE: This Quick Guide cannot substitute for clinical guidance in the management of detoxification. It is meant only as an abbreviated overview of the general features of detoxification. The details required for the clinical management of patients going through withdrawal are dealt with more fully in TIP 45.
WHAT IS A TIP?
Prior to the 1970s, public intoxication was commonly treated as a criminal offense. People arrested for it were held in “drunk tanks” where they often underwent withdrawal with no medical intervention. As society moved toward a more humanitarian view of people with substance use disorder’s, several methods of detoxification evolved.
The “medical model” of detoxification is characterized by the use of physicians and nursing staff and the administration of medication to assist people through withdrawal safely. The “social model” relies more on a supportive non-hospital environment than on medication to ease the passage through withdrawal.
Definitions
Detoxification is a set of interventions aimed at managing acute intoxication and withdrawal. It denotes a clearing of toxins from the body of the patient who is acutely intoxicated and/or dependents on substances of abuse. Detoxification seeks to minimize the physical harm caused by the abuse of substances.
Detoxification alone is not sufficient in the treatment and rehabilitation of substance use disorders.
Evaluation entails testing for the presence of substances of abuse in the bloodstream, measuring their concentration, and screening for co-occurring mental and physical conditions. Evaluation also includes a comprehensive assessment of the patient’s medical, psychological, and social situation.
Stabilization includes the medical and psychosocial process of assisting the patient through acute intoxication and withdrawal to the attainment of a medically stable, fully supported, substance-free state.
Fostering the patient’s entry into treatment involves preparing a patient for entry into treatment by stressing the importance of following through with a complete continuum of care.
Guiding Principles/Assumptions
The panel of experts who created TIP 45 agreed to the following assumptions, which served as a basis for their work:
1. Detoxification alone is not sufficient treatment for substance dependence, but it is one part of a continuum of care for substance-related disorders.
2. The detoxification process consists of the following three components:
• Evaluation
• Stabilization
• Fostering patient readiness for and entry into treatment
A detoxification process that does not incorporate all three critical components is considered incomplete and inadequate by the consensus panel.
3. Detoxification can take place in a wide variety of settings and at a number of levels of intensity within these settings. Placement should be appropriate to the patient’s needs.
4. Persons seeking detoxification should have access to the components of the detoxification process described above, no matter what the setting or the level of treatment intensity.
5. All persons requiring treatment for substance use disorders should receive treatment of the same quality and appropriate thoroughness and should be put into contact with a treatment program for substance use disorders after detoxification.
6. Ultimately, insurance coverage for the full range of detoxification and follow-up treatment services is cost-effective. If reimbursement systems do not provide payment for the complete detoxification process, patients may be released prematurely, leading to medically or socially unattended withdrawal.
7. Patients seeking detoxification services have diverse cultural and ethnic backgrounds as well as unique health needs and life situations. Organizations that provide detoxification services need to ensure that they have standard practices in place to address cultural diversity.
8. A successful detoxification process can be measured, in part, by whether an individual who is substance dependent enters, remains in, and is compliant with the treatment protocol of a substance abuse treatment/rehabilitation program after detoxification.
Overarching Principles for Care During
Detoxification Services
• Detoxification services do not offer a “cure” for substance use disorders; they are often a first step toward recovery and a “first door” through which patients pass to treatment.
• Substance use disorders are treatable and there is hope for recovery.
• Substance use disorders are brain disorders and not evidence of moral weakness.
• Patients should be treated with respect and dignity at all times.
• Patients should be treated in a nonjudgmental and supportive manner.
• Services planning should be completed in partnership with the patient and his or her social support network, including family, significant others, or employers.
• All health professionals involved in the care of the patient will maximize opportunities to promote rehabilitation and maintenance activities and to link the patient to appropriate substance abuse treatment immediately after the detoxification phase.
• Active involvement of the family and other support systems, while respecting the patient’s right to privacy and confidentiality, are to be encouraged.
• Patients should be treated with due consideration for individual background, culture, preferences, sexual orientation, disability, vulnerabilities, and strengths.
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Warmest Regards
Behavioral Health Rehabilitative Specialist & Addiction Counselor
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