Detox centers concentrate on treating the withdrawal syndrome associated with the use of alcohol or certain drugs. The term medical detox is no longer used by major organizations like the World Health Organization (WHO), the American Psychiatric Association (APA), and the American Society of Addiction Medicine (ASAM). Instead, these organizations refer to the process as withdrawal management.
Detox or withdrawal management programs help clients control withdrawal symptoms as they attempt to remain abstinent from drugs or alcohol; initiate formal substance use disorder treatment, such as therapy, support group participation, and other forms of support; and provide medical management for any other co-occurring issues, such as depression. For many individuals, placement in a detox center is often a result of convenience; they simply attend the closest facility to them or the one recommended by a referring treatment provider. There are, however, numerous factors one should consider before choosing a facility that is designed to help with withdrawal.
What to Look For
The initial consideration should be whether or not one should enter the facility as an inpatient or attempt to receive treatment as an outpatient. Often, this will depend on the extent of insurance coverage the individual has, and insurance companies will often approve the use of inpatient withdrawal management programs if the referring physician can demonstrate the medical necessity of inpatient treatment compared to outpatient treatment.
Medical necessity refers to the notion that the proposed treatment is necessary and better suited to the needs of the individual than some alternative intervention.
Medical necessity is often established by physicians who wish to place individuals into inpatient withdrawal management programs by explaining that the withdrawal process can result in significant physical or emotional harm if the person is not monitored around the clock or that placement in some other outpatient program will most likely lead to relapse. Other co-occurring issues, such as a severe psychiatric disorder, suicidality, a severe abusive environment, etc., can also determine the need for inpatient treatment. An individual who has undergone numerous attempts at recovery followed by relapses would also be a strong candidate for inpatient detox.
On the other hand, some individuals may find that they would prefer an outpatient detox program. These individuals may wish to maintain active participation in their employment or family life, or the withdrawal syndrome they are expected to experience is not deemed to be potentially dangerous. Anyone considering inpatient versus outpatient withdrawal management should discuss the situation thoroughly with their physician and other treatment providers to determine the option that best fits their needs.
An individual contemplating admission to a withdrawal management or medical detox program cannot realistically determine if a particular program meets their needs if they have not outlined their situation and their needs and expectations of treatment. Again, this is an issue that should be discussed with one’s treatment providers. The first step in finding a detox program that satisfies one’s needs is to actually identify the major areas that one wishes to have addressed during this phase of the treatment.
After defining treatment goals and expectations, it is time to find an appropriate facility. Some of the following considerations can help one determine if the particular program will be sufficient to help them meet their goals:
Only consider facilities that are accredited and licensed. The best treatment occurs in facilities that have been thoroughly examined by agents from the state to allow licensing. These facilities also allow themselves to be examined by organizations that offer accreditations. Programs that are unaccredited or have licensing issues typically complain that qualifications for accreditation and licensing vary from state to state and use this as a reason to excuse their lack of accreditation, but this is not a valid excuse. Instead, the highest quality treatment programs are licensed by the state and have accreditation from one or more national organizations, such as the Joint Commission in Accreditation of Healthcare Organizations (JCAHO). Often, certain insurance providers will not cover treatment by an organization that does not have the proper qualifications (e.g., licensing, accreditation, etc.).
Only consider facilities that have licensed and fully accredited staff members. Physicians, nurses, therapists, and other professional healthcare workers should be licensed by the state in which they practice and also have appropriate accreditation. Non-therapy and nonmedical staff, such as kitchen staff, janitorial staff, maintenance staff, etc., will not be licensed, but should be at least 18 years old. Some facilities operate as teaching facilities; some of the therapists or physicians may have limited licenses or accreditation, but these individuals should be supervised by fully licensed individuals. Any facility that attempts to excuse a lack of licensed and accredited treatment providers should be avoided. Most states require that there be a 1:1 ratio of fully licensed staff and interns and others with limited licenses. There is no excuse for offering professional treatment from unlicensed staff.
Make sure there is enough staff to cover the needs of the clients in the facility. There should be a relatively small ratio between clients to nurses, clients to physicians, and clients to therapists. A staff that consists of one physician, one nurse, and one therapist that accommodates 30 inpatients is obviously understaffed. In addition, find out if the facility is able to increase staff with appropriate personnel if there is an emergency situation.
Empirically validated treatment approaches should be used. Facilities that habitually offer treatment interventions that do not have sufficient empirical evidence to warrant their use (research evidence) should not be considered. The major reason for this is that approaches that lack empirical validation are often ineffective (except perhaps for placebo effects). Another major reason for not considering facilities that use unqualified interventions, such as rapid detox procedures, is that insurance companies will often not approve payment for these services.
Make sure the facility has access to emergency care. Whether a person is in an inpatient or outpatient treatment program, the program should have immediate access to emergency care in case there is an emergency situation. This access should be available around the clock.
Inquire about the treatment philosophy of the program. Discuss the overall treatment philosophy with the intake personnel or do some research on the facility to ensure that the overall treatment philosophy of the program fits with the needs of the client. For instance, a program that is highly focused on religious activities may not be suitable for everyone. A program that is focused on treating clients with co-occurring disorders (a substance use disorder and some other psychological disorder) may not be appropriate for someone who only requires withdrawal management.
Ensure the facility has access to aftercare treatment programs. Simply completing a medical detox program is not sufficient for long-term recovery success. The program should be able to place a person in an aftercare program once they complete medical detox.
The program should communicate progress to the client’s loved ones, if desired. Secretive programs that do not communicate the person’s progress in treatment to concerned family members (who have received permission from the individual to get this information) should be avoided. Family members and close friends should be an active part of the person’s recovery if they wish to be involved. Withholding information about the client’s progress from such individuals, unless the client requests it or does not sign a waiver, is counterproductive.
Ensure the program has readily scheduled visiting hours. Clients in inpatient programs should be able to have visits with family members and friends during treatment. The program should offer regularly scheduled visiting hours to allow the client to receive social support.