Detoxification inpatient

In addition to providing a controlled environment for detoxification, inpatient treatment is helpful in cases where there is a risk that patients might harm themselves or others or if there is another physical or mental illness that requires a doctor s observation and care. 

Increasingly, detoxification is being done on an ambulatory basis, which is much less costly than inpatient detoxification (Hayashida et al. 1989). Inpatient detoxification is indicated for patients with serious medical or surgical illness and for those with a past history of adverse withdrawal reactions or with current evidence of more serious withdrawal reactions (e.g., dehrium tremens) (Feldman et al. 1975). 

Patients requiring detoxification from high or supratherapeutic dosages of benzodiazepines constitute a smaller number of patients, but they are at greater risk for life-threatening discontinuation symptoms, such as seizures, delirium, and psychoses. There has been more experience with inpatient detoxification in this group, but outpatient detoxification is possible if conducted slowly (5% reduction in dose per week), with frequent contact, and in the context of a therapeutic alliance with the patient. Often, such an alliance proves unworkable because the patient s impoverished control results in supplementation from outside sources or early exhaustion of prescribed supplies meant to be tapered. In these cases, as in the cases of patients with a history of seizures, delirium, or psychoses during previous detoxification attempts, inpatient detoxification is indicated. 

Reasons for inpatient stays include full detoxification, stabilization, and management of complications... 

Exactly what constitutes success is contentious in any drug misuse treatment, but one point is brought into particularly sharp focus in relation to the inpatient and residential options. This is the question of success at detoxification - do we mean just that, or are we by implication taking into account whether an individual actually stays off drugs afterwards The purist view is well stated by Wodak (1994) ... 

The strongest traditions of inpatient detoxification relate mainly to alcohol misuse, in which the withdrawal syndrome is inherently more dangerous than that from opiates, and the avoidance of withdrawal complications in standard treatment may be the prime consideration in selecting admission. (In drug misuse, as we shall see in subsequent chapters, indications for admission increasingly relate to new developments, such as rapid... 

A methadone detoxification is more often completed if it is done as an inpatient than as an outpatient (Gossop et al. 1986), but many individuals are reluctant to be admitted, and various other limitations of inpatient treatment were indicated in the Introduction. In attempting to provide the most useful combination of treatments in a community setting, we have no problem with offering methadone detoxification as an option, basically in cases where there are not the features favourable for the quicker methods. However, we do not expect it to proceed in a simple manner, and some of the more important practical management considerations are discussed below. 

As indicated, buprenorphine can offer a quicker option than methadone, with a three-day course reported to be effective for withdrawal from heroin (Cheskin et al. 1994). The side-effects of clonidine which render it unsuitable for community treatment can be manageable in the inpatient setting, although the drug is being superseded by lofexidine where that is available. Controlled studies have found clonidine and lofexidine to be equally effective in alleviating withdrawal symptoms in inpatient detoxification from heroin (Lin et al. 1997) and from methadone (Khan et al. 1997), with lofexidine resulting in less hypotension and fewer adverse effects. Another double-blind controlled study found lofexidine to be broadly as effective as a ten-day methadone detoxification in inpatient opiate withdrawal (Bearn et al. 1996). 

Backmund M, Meyer K, Eichenlaub D Schiitz CG (2001). Predictors for completing an inpatient detoxification program among intravenous heroin users, methadone substituted and codeine substituted patients. Drug and Alcohol Dependence, 64, 173-80... 

Gossop M, Bradley M Philips G (1987). An investigation of withdrawal symptoms shown hy opiate addicts during and subsequent to a 21-day inpatient methadone detoxification. Addictive Behaviours, 12, 1-6... 

After detoxification, psychosocial therapy either in intensive inpatient or in outpatient rehabilitation programs serves as the primary treatment for alcohol dependence. Other psychiatric problems, most commonly depressive or anxiety disorders, often coexist with alcoholism and, if untreated, can contribute to the tendency of detoxified alcoholics to relapse. Treatment for these associated disorders with counseling and drugs can help decrease the rate of relapse for alcoholic patients. 

For amphetamine addicts and drug abusers, the controlled, therapeutic environment of residential rehab provides a safe place to learn new behaviors and explore the emotional issues behind their drug use. And for patients experiencing amphetamine or other drug withdrawal symptoms, an inpatient facility is the best option for a safe and gradual detoxification from the drug. 

Dmg rehabilitation programs may be either inpatient or outpatient. Inpatient, or residential, drug programs require a patient to live at the hospital or rehab facility for a period of several weeks to several months. Outpatient programs allow patients to spend part of their day at the treatment facility, and return home at night. Nitrous oxide is rapidly eliminated from the body, and abuse of NzO alone is not associated with withdrawal. This means that a lengthy detoxification period (removal of the drug from the body) is typically not required. 

The activities that an inpatient drug program incorporates are usually medical detoxification plus individual and group counseling. 

---