Ch. 3: Detoxification and Stabilization

One place where addiction treatment might be supported with medication is in the immediate detoxification process (detox). Detox is considered a stabilization process. You are going to be reading segment excerpted from a Treatment Improvement Protocol (TIP #45) produced by the Substance Abuse and Mental Health Services Administration (SAMHSA, 2015), titled Detoxification and Substance Abuse Treatment. You will read about:

• Detox as part of a continuum of care
• The goals of the detox process
• Features of withdrawal associated with 4 specific types of substances

Keep in mind that you are reading only 6 pages of a 257 page manual. One thing that might be a bit confusing if you are not used to the jargon is the levels of care in the detox protocol. They are listed in your reading from least to most intensive: Level I being “ambulatory” to Level IV being intensive inpatient care.

The other thing that it is very important to keep in mind as you read this material is that detox or stabilization is part of a continuum of care to treat individuals experiencing a substance use disorder or addiction. A stabilization program may consist of specific stages or phases with different aims at each point in the process.

1. First, the goal is to monitor the acute medical situation or crisis, ensuring safety as the misused substances leave the body (withdrawal). Administering medications to support the person medically could take place during this phase, but only if the medical team knows what drugs the person has taken—a polydrug use crisis might leave the team unwilling to risk administering medications. The initial detox stabilization phase might last a matter of hours.
2. The second phase of stabilization involves a more extended detoxification treatment plan (measured in days) to manage the next phase of the early withdrawal period and to support the person in obtaining ongoing treatment for the substance use disorder. This might involve starting a medication assisted treatment (MAT) plan.
3. The next phase of a stabilization plan might continue for days to weeks with the goal of making a successful transition to long-term treatment, often involving counseling, supportive “recovery” housing, and MAT.

Finally, in this chapter you are asked to read a brief news article about the recent death of another star: Nelsan Ellis. This news article has us considering what might happen to a person who abruptly stops taking a substance like alcohol to which an addiction has developed. Abrupt cessation does not cause death from acute withdrawal for all substances, but death could be a result when the addiction involves alcohol or barbiturates. (article retrieved from Washington Post is Nelsan Ellis died of alcohol withdrawal. Family hopes his death will be a ‘cautionary tale.’)