# Presentation: 223064

## Module 3: An Overview of Psychological and Biomedical Issues During Detoxification

## Module 3 Objectives

- Identify overarching principles for patient care during detox
- Describe strategies for evaluating/addressing psychosocial/medical issues for detoxing patients
- Identify at least two considerations in each of the following for detoxing patients: adolescents, parents with dependent children, domestic violence victims, and culturally diverse patients
- Describe strategies for engaging/retaining detox patients
- Identify effective referral techniques promoting initiation of substance abuse treatment

## Biomedical Evaluation Domains

- General health history
- Mental status
- Physical assessment
- Use and patterns of substance abuse
- Past treatments for substance abuse

## Psychosocial Evaluation Domains

- Demographics
- Living conditions
- Violence/suicide risk
- Transportation availability
- Financial situation
- Dependent children
- Legal status
- Physical, sensory, or cognitive abilities

## Conditions Requiring Immediate Medical Attention

- Change in mental status
- Increase in anxiety and panic
- Hallucinations
- High body temperature
- Increase/decrease in blood pressure
- Insomnia
- Abdominal pain
- Upper/lower gastrointestinal bleeding
- Changes in responsiveness of pupils

## Conditions Requiring Immediate Psychiatric Attention

- Suicide risk
- Anger
- De-escalating aggressive behaviors
- Co-occurring mental disorders

## Nutritional Considerations During Detoxification

- Malnutrition can interfere with detox process
- Stress of detox requires additional nutrients
- Nutritional evaluation is necessary for detox
- New routines for mealtime and diet are crucial
- Important to manage gastrointestinal symptoms during detox
- Nutrition therapy may be required

## Detoxification Considerations for Adolescents

- Binge drinking is common
- Can cause escalating blood alcohol levels
- Some drugs taken are not identifiable
- Routinely screen for illicit drugs
- Nondisclosure of drug use
- Multiple substances may have been taken with alcohol
- Establish rapport
- Obtain thorough substance use history
- Screen for suicide potential

## Detox Consideration for Parents with Dependent Children

- Barriers to treatment:
- Parents, especially mothers, fear for the safety of their children
- Some children experience distress while parent is in treatment
- Ensure children have a safe place to stay
- Social services may need to be involved

## Detox Consideration for Domestic Violence Victims

- Both men and women may be victims
- Increased risk for female drug abusers to be victims
- Develop safety plan when violence is disclosed
- Avoid communications between abused and abuser during detox
- Victims may need help with parenting skills
- Know local childcare resources

## Detox Consideration for Culturally Diverse Patients

- Patients’ expectations of detox may vary
- Patients’ experience in health care system may vary
- Patients cannot be defined by their culture/ethnicity
- Use open-ended questions to gain understanding
- Important to have bilingual staff to avoid language barriers

## Detox Consideration for Chronic Relapsers

- Relapser may feel hopeless and vulnerable
- Acknowledge progress made before relapse
- Reassure that gains from prior progress have not been lost
- Reinforce the importance of recovery

## Strategies to Engage and Retain Patients in Detoxification

- Offer hope
- Provide an atmosphere with comfort, relaxation, cleanliness, and security
- Educate patients on the withdrawal process
- Utilize support systems
- Maintain a drug-free environment
- Consider alternative approaches
- Enhance patient motivation
- Foster a therapeutic alliance

## Enhancing Patient Motivation

- Focus on strengths
- Show respect for autonomy
- Avoid confrontation
- Provide individualized treatment
- Avoid using labels
- Use empathy
- Recognize small steps toward achieving goals
- Raise awareness of discrepancies
- Use reflective listening

## Stages of Change

- Precontemplation
- No consideration for change
- Unaware of problem
- Contemplation
- Some awareness of problem
- Willing to consider change, but ambivalent
- Preparation
- Aware of problem
- Decision made to commit to change
- Goal setting
- Action—takes steps to achieve goals to change
- Maintenance—works to maintain changes made

## Fostering a Therapeutic Alliance

- Be supportive and empathic
- Refer when patient cannot be engaged
- Establish rapport with all patients
- Discuss confidentiality issues
- Be cognizant of patient challenges ahead
- Be consistent, trustworthy, reliable
- Be calm and cool
- Show confidence and humility
- Be able to set limits without a power struggle
- Be cognizant of patient’s progress
- Encourage patient’s self-expression

## Common Barriers to Referral After Detox

- Patients may believe they are “cured” once eliminating substance
- After detox patients may feel they no longer need help
- Insurance may only provide partial or no coverage
- Paperwork for insurance coverage may be overwhelming
- Patients have difficulty navigating the insurance system to determine coverage

## Evaluating Rehabilitation Needs

- Psychosocial needs
- Special needs may limit access to rehab
- Limitations or conditions may limit suitable treatment settings
- Support system may influence referral
- Dependent children may impact needs
- May be need for gender-specific treatment

## Areas for Assessment

- Medical conditions and complications
- Motivation/readiness to change
- Physical, sensory, or mobility limitations
- Relapse history and potential
- Substance abuse/ dependence
- Developmental and cognitive issues

- Family and social support
- Co-occurring disorders
- Dependent children
- Trauma and violence
- Treatment history
- Cultural background
- Strengths and resources
- Language

## Treatment Settings

- Inpatient programs
- Residential treatment programs
- Therapeutic communities
- Transitional residential and halfway houses

- Partial hospital and day treatment programs
- Intensive outpatient programs
- Traditional outpatient services
- Recovery maintenance activities

## Following Through with Treatment Referral

- Patients will more likely initiate treatment if they:
- Believe they will be helped
- Are employed
- Are motivated beyond precontemplation stage
- Have family and social support
- Have co-occurring psychiatric conditions

## Strategies to Promote Initiation of Treatment After Detox

- Assess degree of urgency
- Reduce wait time to appointment
- Call to reschedule missed appointments
- Provide information to show expectations
- Offer tangible incentives
- Engage the support of family members
- Introduce the patient to the counselor who will deliver rehabilitation services
- Offer services and referrals to address other needed services
- Minimize access to treatment barriers
- Maintain motivation during waiting list period
- Facilitate coordination of treatment for any co-occurring disorders
- Ensure all necessary medical appointments are being made
- Some patients may require something other than a traditional treatment approach