No matter what the illness, medical professionals realize that no two patients are alike and, thus, must tailor treatment accordingly. For example, some heart patients may respond well to a modified diet while others may need special medication to achieve the same result.
The same holds true for alcoholism and the alcohol detox process. For many patients, a medically supervised alcohol detox process will serve two purposes. First, it will provide medications which are designed to reduce the painful cravings and withdrawal symptoms associated with alcohol detox. However, enrolling in an inpatient detox program will also make it physically impossible for the patient to give in to the urge to drink; enrolling in an outpatient program will make it more likely for relapses to be identified and handled quickly. In sum, alcohol detox interrupts compulsive drinking while reducing the severity of withdrawal symptoms. At the same time, a good alcohol detox program will prepare the patient for prolonged substance abuse treatment and foster commitment to sobriety.
Intake personnel must screen potential alcohol detox patients to determine the proper location and intensity of the detox program. At the same time, patients should be offered treatment in the least restrictive and most cost-effective manner that is appropriate for his or her level of addiction.
Due to the nature of addiction, a person who is attempting to detox from alcohol will likely experience strong cravings for another drink. These cravings are hard to keep in check and, if left to detox at home on their own, many patients would likely give in to the urge to drink and terminate the detox process. Thus, the best detox program for any particular patient will be the one that offers her choice of care and respects her civil rights while restricting physical freedom as much as necessary to cut off immediate access to alcohol.
When determining which alcohol detox is right for a particular patient, clinicians are not without guidance. The American Society of Addiction Medicine (ASAM) has created placement criteria so that patients can be matched with the appropriate level of alcohol detox. When deciding placement, clinicians must evaluate the level of current intoxication, the potential for withdrawal symptoms, any co-occurring medical or mental health issues, willingness to enter recovery, potential for relapse, and the discharge environment. For adults, the ASAM has developed five potential levels of care, labeled I through IV with increasing levels of intensity.
The first level of alcohol detox is offered on an outpatient basis and can happen in an office, treatment facility or in the patient’s home. The treatment will be administered by trained clinical professionals who will evaluate the patient, administer the detox program, and refer the patient to post-detox follow-up services. First level detox is typically administered in scheduled sessions and should only be used when there is a strong support system at home for the patient to rely on when not in session. The second level is also conducted on an outpatient basis, but includes the option for daily monitoring of the alcohol detox process by a trained nurse, sometimes for several hours.
In both outpatient models, the availability of doctors and nurses trained to handle addiction and detoxification is a core component. Although their presence will be required during actual sessions, it is also important for trained professionals to be on hand for emergencies, as traditional urgent care centers and emergency rooms are often ill-equipped to handle emergencies that occur during alcohol detox. Training for alcohol detox treatment includes learning to interpret alcohol intoxication and withdrawal signs and symptoms, identify appropriate treatment and monitor progress, and facilitate the patient’s progression from active detox to addiction treatment.
The other three levels of alcohol detox typically occur on an inpatient basis and provide for 24-hour supervision. Level three, or “clinically” managed detox, has only a minimal amount of oversight by medical professionals. Instead, the physician-planned detoxification is carried out by staff who distribute medicine and monitor vital signs; doctors and nurses only get involved if and when problems arise. Conversely, levels four and five are medically monitored inpatient detox programs where doctors and nurses routinely monitor the patient. In level four, doctors plan the treatment, clinicians carry it out, and both doctors and nurses follow up with treatment progress. In level five, there is near complete access to doctors and nurses for unexpected problems and emergencies.
Unfortunately, many alcohol detox programs are not large enough to offer all conceivable levels of care for the entire population of potential alcohol detox patients. Instead, they must find the combination that best fits the patient’s situation or refer the patient elsewhere for treatment. Other alcohol detox programs find themselves constrained by the admission criteria of third-party payors, such as insurance companies, which often balk at paying for ideal level of care. Still others are faced with patients who are in critical need of services, but lack the resources to pay for them.
Although various mental health parity laws have recently been implemented to ensure that private insurers actually give patients the coverage that they need, the statues have done nothing to aid people who lack the resources to even have private insurance. With cuts to government-sponsored mental health treatment funding happening across the United States, the shortage of appropriate alcohol detox programs is likely to get worse over the coming years.