Q. When is someone a candidate for inpatient detox for alcohol and benzodiazepines?
A. The first question is whether a patient has physical dependence on these substances. The decision between outpatient and inpatient detox can also depend on the severity of symptoms. For alcohol and benzodiazepines, symptoms can range from anxiety and mild tremor to seizures and delirium. At Princeton House, we evaluate candidates through a comprehensive clinical assessment. We pair this with the Clinical Institute Withdrawal Assessment for Alcohol–Revised (CIWA-Ar) questionnaire, which enables us to quantify the level of withdrawal. History of past withdrawal attempts is also important to consider.
Q. Why is medically supervised detox particularly important for these substances?
A. Withdrawal from alcohol and benzodiazepines can deteriorate to a life-threatening situation when not managed effectively. While the length of time in detox may differ between the two, both involve medical management using careful adjustments of medications.
Q. What happens during inpatient detox?
A. Each patient is unique, so an individualized care plan is established after completing a thorough medical history and physical and reviewing labwork. We ensure appropriate nutrition, hydration, and vitamin supplementation. Throughout each day, we assess withdrawal symptoms and carefully adjust medications.
Education is also a critical component of detox. At Princeton House, patients participate in individual and group therapy, including allied clinical therapies. Peer support can be validating; when patients listen to stories of others with similar challenges, they recognize that they are not alone and identify potential relapse triggers.
Q. Why is an inpatient setting beneficial?
A. A supportive environment conducive to abstinence is beneficial, which means removing patients from the environment where they were using. Detox is most effective when overseen by a multidisciplinary team of physicians, nurses, social workers, dietitians, and therapists who communicate daily about patient progress. With this approach, we work to prevent medical complications, minimize discomfort, and manage co-occurring conditions. Detox is the first step in a comprehensive care plan, and determining the appropriate level of aftercare is crucial.
Tips for Referral from Telehealth
When outpatient therapy is conducted via telehealth, it can be more challenging to know when a patient is having a substance use crisis that requires detox, according to Nicole Orro, LPC, LCADC, Director of Addiction Services at Princeton House. In this case, gaining rapport is even more important so patients are able to better trust and understand how a higher level of care can help them. When possible, check-ins with primary care providers and family members can also help providers gain a broader view of needs. To refer a patient for assessment, call 888.437.1610.
Article as seen in the Winter 2021 issue of Princeton House Behavioral Health Today.