June 19th, 2014

Many people still equate detoxification with hospitalization, and even some addiction specialists are not aware of what a broad range of patients can be detoxified on an ambulatory basis. We are going to explore the types of detoxification.

When I began to develop my outpatient rehabilitation program 35 years ago, I had access to an excellent detoxification unit at the Adventist Hospital in Takoma Park. I got privileges there and later became head of this unit.

My plan for those of my patients who needed detox was to start them off in the hospital and then move them into my outpatient rehab program in Silver Spring. Some of the time this worked effectively, but I began to encounter two types of situations where it did not work.

In the first situation, I would successfully detoxify patients, but then find that when they felt better, they had no interest in further treatment and would not enter the rehab program. Studies consistently show that more than 90 percent of patients who are successfully detoxified, but who do not receive follow up treatment, will relapse.

In the other situation, patients who needed detoxification were not willing to be admitted to the hospital. Rather than just refuse to treat these patients, I began to try and see if I could manage their withdrawal symptoms on an outpatient basis instead of at the hospital. Because I was working in a psychiatric day hospital, I could have the patients stay in the facility for up to 10 hours during which time I could observe and medicate them. I would send them home with a limited amount of medication and then they would come back the next day. I realized there needed to be other types of detoxification.

Initially I noticed that with this approach, I could manage their withdrawal symptoms safely and comfortably. Because I thought that they were too toxic to benefit from the rehab program, I would not have them attend this part of treatment for a few days. They would get bored, however, just sitting around in a room alone, so I began to have them sit in on the rehab groups.

I found that even though they did not comprehend everything that was occurring, very important connections would be formed with the other patients. On the one hand, the other patients were there to support and comfort them through their discomfort. On the other hand, weeks later when the patient was feeling and looking better and might be inclined to minimize the severity of their problem, the other patients would have had their firsthand earlier experience to look back on to counter this.

After 40 years of refining this approach and looking at other types of detoxification, we are now able to smoothly transition most of our withdrawal patients into rehabilitation sessions within one to two hours of when they first come to our office. The result is a dramatically improved follow through into continued treatment as well as a safe and comfortable withdrawal experience.

Editor’s Note: Professionals in the addiction field are now trying to change the language we use and refer to “withdrawal management,” which is a clinical intervention, rather than “detoxification,” which is what is done by the body.

Contact us to learn more about different types of detoxification.

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