Medically monitored detox
From Drug Rehab Wiki
According to the ASAM’s criteria levels of care, there are five different types of detoxification strategies that may be administered to patients with alcohol or substance abuse disorders. Two of these strategies involve medically monitored detoxification for the more intense cases of withdrawal: Level III.7-D and Level IV-D.
Level III.7-D
Level III.7-D is medically monitored inpatient detoxification and is used to treat severe cases of withdrawal. Patients assigned to this level of treatment require 24-hour nursing care and physician supervision, evaluation, withdrawal management, and visitation when necessary. Without this process of medical monitoring, these patients are not likely to complete detoxification on their own. These individuals may come from a situation that inhibits their ability to successfully complete detoxification, such as having a co-existing psychological illness, physical condition, or other substance abuse disorder that can intensify withdrawal and thereby further complicate detoxification.
Level III.7-D detoxification usually takes place within a licensed health care facility, rehabilitation facility, or a freestanding detoxification center. A physician is present on a daily basis to oversee the administration of the patient’s care and prescribe any necessary medication or evaluations, and is on-call 24 hours a day. A nursing staff is employed at all times and administers the patient’s medication. The staff monitors the patient’s progress throughout the entire process.
If the patient experiences no complications after 2 to 3 days at Level III.7-D, then the staff may place the patient in a lower level of detoxification, such as Level III.5-D, which involves a therapeutic community. Community therapy offers the patient a safe place to recover when the patient’s own home does not encourage recovery or is not safe, or if the patient is homeless It also provides continued support during withdrawal, structural support during potential risk of relapse, suppresses compulsions and urges, and reinforces commitment to the program. On the other hand, if the patient has a safe home environment with a supportive family that will encourage recovery and help monitor cravings, then the patient could potentially be discharged from inpatient services and instead be treated at a partial hospital or intensive outpatient facility.
Level IV-D
Level IV-D is medically managed intensive inpatient detoxification and is used to treat severe and unstable cases of withdrawal. These patients require 24-hour nursing care and physician visitation on a daily basis to moderate detoxification regimen and supervise medical instability. This level of care is similar to the medical setting provided in Level III.7-D to treat addiction severity, but patients at Level IV-D require primary medical and nursing care services. Treatment may take place in a psychiatric hospital, general care hospital, or a chemical dependency specialty care facility with a complete medical and nursing staff and life-support equipment available. The 24-hour nursing staff manages observation, administers care, and monitors regimen intake (or intervention if necessary) more frequently than an hourly basis. A physician is on call at all times and supervises all care. This level of care is to help alleviate biomedical distress and emotional and behavioral disturbances. A patient undergoing such intense withdrawal may undergo physical and psychiatric alterations that are considered to be medical emergencies, and should only be treated by medical professionals to guarantee safe and successful recovery.
Other scenarios such as head trauma, infection, or a co-existing illness may require a patient to be monitored under Level IV-D. Other factors may place a patient at this level of severity such as overdose, loss of consciousness, pregnancy, or life-threatening acute biomedical conditions that can induce cardiovascular stress or failure and dysfunction of vital organs.
Once a professional medical staff has evaluated a patient’s withdrawal symptoms, the proper level of care can be assigned that is least restrictive to the patient’s recovery. Symptoms of withdrawal can vary and may include: agitated arousal, irritability, restlessness, anger, anxiety, depression, headache, fatigue, fever, nausea, vomiting, perspiration, palpitations, arrhythmia, hypertension, loss of concentration, loss of appetite, insomnia, delusions, hallucinations, tremors, delirium tremens, and grand mal seizures.
Once the assigned medically monitored detoxification has been completed, the medical staff will refer addiction support groups and recovery resources to these patients. It is important that the patient continues to monitor his or her adherence to recovery, risk of relapse, and physical and psychiatric state, which is most successfully done through support groups, counseling, a supportive family, and changes to lifestyle.
