Melissa Killeen
Alcoholics are not receiving the care they need for detox. As a recovery coach, I have seen a disturbing practice develop within the medical community involving detoxing an individual in extreme alcohol withdrawal. Not everyone who walks into an emergency room in withdrawal from an addiction is transferred to an inpatient detox environment. Detoxing from drugs will last as long as it might take for a person to safely withdraw from a specific substance, often at least 5 days. Drug detoxification can take place in inpatient settings, and according to the National Survey of Substance Abuse Treatment Facilities, about 6.5 percent of inpatient treatment facilities and 4.8 percent of hospitals provide this kind of care. At an inpatient detox treatment program, people have around-the-clock medical supervision that can help them to avoid serious complications caused by withdrawal, and people also have a safe and sober place in which to recover from their addictions, so they aren’t tempted to relapse.
Alcoholics are not treated in the same manner. Alcohol detox could take the same 5 days during which patients may experience a wide range of symptoms depending on the severity of their alcohol dependence. Symptoms experienced during detox may be as mild as a headache and nausea or as severe as delirium tremens (DTs), marked by seizures and/or hallucinations. Emergency Room’s expect alcohol detox to take 24 hours for the physical withdrawal symptoms to disappear, aided by intravenous dosages of phenobarbital. But the mental withdrawal takes much longer.
Most alcoholics are sent home by hospital emergency room physicians, with a script for Diazepam (Valium), lorazepam (Ativan), or chlordiazepoxide (Librium), and asked to return to their family practitioner for a follow-up in two days. Sending an alcoholic client to detox at home is a cop-out on the part of the medical and hospital community.
ERs and the behavioral health departments in most major-market hospitals are not equipped, nor do they have the beds, to house clients that are in withdrawal or detox from alcohol. Many of these hospitals have closed their detox centers. A cost cutting practice called “reducing the length of stay” mandates that the ER discharges a client to go home, as it costs too much for them to stay in the hospital, waiting for an bed to become available at a detox center. The client is sent home to make their own plans to enter a detox and/or treatment center.
To complicate matters further, there are very few free or low-cost detox facilities. For example, in the state of New Jersey, only two hospitals can provide Medicaid-covered detox treatment: in Paramus, Bergen County, the Bergen Regional Medical Center http://www.bergenregional.com/Evergreen/index.html ) and in Atlantic City, the AtlantiCare Regional Hospital (http://www.atlanticare.org/index.php/mission-health-care ). In the private for-profit detox centers, there will be a Medicaid or charity-care bed or two, but these beds have a long waiting list, giving the individual only one option: to detox at home.
Individuals who need help with withdrawing from their alcohol addiction don’t have the time to wait—they are withdrawing now! It is generally assumed by the ER staff that alcoholics will be able to detox at home, with minimal health risks. Detoxing at home poses a significant problem: the maximum likelihood that the client in withdrawal will pick up a drink in their home environment.
This is where a recovery coach can help.
As long as these individuals have a recovery coach with them at all times, a coach who can step up and step in if something goes wrong, and to help plan for admission to a treatment center, this can be a safe strategy to follow.
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