This TIP, Detoxification From Alcohol and Other Drugs, describes detoxification care in a number of settings. Detoxification and patient matching are discussed. The TIP provides clinical guidelines for detoxification from specific classes of drugs such as sedative-hypnotics, stimulants, and opiates. Detoxification needs of special populations are addressed. The TIP also includes information helpful to planners and policymakers about costs, quality improvement, outcome criteria, health care reform, and linking detoxification -- often the gateway to ongoing treatment -- to the larger continuum of care in the substance abuse treatment system. Legal and ethical issues of concern to detoxification programs are also examined.

Contents

• What Is a TIP?
• Consensus Panel
• Foreword
• Chapter 1—Introduction
  • Goals of Detoxification
  • Repeated Detoxification
  • Issues in Postdetoxification Treatment
  • Effects of AOD Exposure and Withdrawal
  • Forces Affecting AOD Detoxification and Treatment
  • Contents of This Treatment Improvement Protocol
• Chapter 2—Detoxification Settings and Patient Matching
  • Medical Model and Social Model Programs
  • Inpatient and Outpatient Detoxification Settings
  • A Proposed Modified Medical Model of Detoxification
  • The Role of Patient Matching Criteria
• Chapter 3—Clinical Detoxification Protocols
  • Principles of Detoxification
  • Alcohol Detoxification
  • Withdrawal From Opiates
  • Withdrawal From Benzodiazepines and Other Sedative-Hypnotics
  • Withdrawal From Stimulants (Cocaine, Crack Cocaine, Amphetamines, and Methamphetamine)
  • Withdrawal From Other Drugs
• Chapter 4—Special Populations
  • Incarcerated Persons
  • Women
  • Pregnant and Nursing Women
  • Adolescents
  • Elderly Persons
  • Patients Who Are HIV-Positive
  • Other Medical Conditions
  • Persons With Psychiatric Comorbidity
  • The Importance of Cultural Competence of Staff
• Chapter 5—Improving Quality and Measuring Outcomes of AOD Detoxification Services
  • Quality Improvement
  • Outcomes Measurement
• Chapter 6—Costs and Current Payment Mechanisms for AOD Detoxification
  • Current Sources of Funding for AOD Services
  • Toward a Model AOD Detoxification Services and Benefits System
  • A Model for Estimating the Cost of AOD Abuse Treatment
  • Estimated Costs Based on Field Review Data
• Appendix A -- Bibliography
• Appendix B—Glossary
• Appendix C—Resource List
• Appendix D—Acronyms
• Appendix E - Legal and Ethical Issues for Detoxification Programs
• Appendix F—Federal Resource Panel
• Appendix G—Field Reviewers

This publication is part of the Substance Abuse Prevention and Treatment Block Grant technical assistance program. This publication was written under contract number ADM 270-91-0007 from the Center for Substance Abuse Treatment of the Substance Abuse and Mental Health Services Administration (SAMHSA). Sandra Clunies, MS, served as the CSAT Government project officer. Dorynne Czechowicz, MD, served as the Government content advisor. Carolyn Davis, Betsy Earp, Jo Lane Gregory-Thomas, Linda Harteker, Lise Markl, and Gail Martin served as writers.

The opinions expressed herein are the views of the consensus panel members and do not reflect the official position of CSAT or any other part of the U.S. Department of Health and Human Services (DHHS). No official support or endorsement of CSAT or DHHS for these opinions or for particular instruments or software that may be described in this document is intended or should be inferred. The guidelines proffered in this document should not be considered as substitutes for individualized patient care and treatment decisions.