Equating detoxification with the need for hospitalization is a mistake that continues to be made by many healthcare professionals. Managing even severe withdrawal symptoms on an outpatient basis is not only feasible but is in most situations actually preferable to inpatient detoxification. Here are three of the reasons why:
- Easier access. Because withdrawal discomfort intensifies during the initial hours and days, a person’s resolve to address their substance use problem can dissipate if help is not readily available. Some of the most dangerous symptoms, such as seizures and delirium can be entirely prevented if adequate treatment is rapidly instituted. Negotiating with overcrowded emergency departments and hospital admissions offices or managing transportation to distant residential treatment centers creates problematic delays. Getting to a nearby outpatient office can be done much more quickly and simply. Moreover, during busy times, outpatient “slots” are more readily expanded when necessary than are inpatient beds.
- More expertise. Outpatient detoxification programs have the expertise that is now rarely found in inpatient settings. Because most hospital detoxification units have been closed, the management of withdrawal is usually done on general medical wards, and occasionally on psychiatric ones. Symptom-driven medication protocols are superior to time-driven ones because they provide more rapid relief while using less total medication. The implementation of this protocol, however, requires that patients be evaluated hourly for the first several hours – a level of attention which is not available on the ordinary medical ward. In other words, the availability of medical staff in a structured outpatient detoxification facility is actually more intensive than in an inpatient facility.
- Smoother transition into follow-up treatment. The onset of physical withdrawal can provide a unique window of opportunity to engage a person with a substance use disorder in the recovery process. Because modern-day protocols can relieve withdrawal symptoms so well, this window can close very quickly. Intensive outpatient treatment programs capitalize on the effectiveness of the medication by having patients start in the rehabilitation phase of treatment on the same day that the detoxification is being done. Designing a treatment program in this way reduces the incidence of premature treatment dropouts and the “revolving door” syndrome of repeated relapses.
My hope is that a continued track record of success in outpatient detoxification will overcome any lingering unfounded skepticism.