K.  Assess For Appropriate Level Of Professional Monitoring For Detoxification
Address Psychosocial Barriers to Treatment Engagement

 

OBJECTIVE

 

Ensure safety during detoxification in the least restrictive environment and promote long-term successful recovery.

 

ANNOTATION

 

Determine appropriate level of care, based on:

1.        Severity of current and past withdrawal symptoms (e.g., use of CIWA-Ar for alcohol or the Short Opiate Withdrawal Scale (SOWS) or Clinical Institute Narcotics Assessment (CINA) for opioids).

2.        Severity of comorbid conditions.

3.        Patient's treatment acceptance and potential to complete detoxification.

4.        Recovery environment and other ASAM criteria (see Web site: http://www.asam.org).

 

DISCUSSION

 

This guideline endorses ASAM’s (1996) recommendation to consider the following primary patient dimensions in making a decision about appropriate level of care:

1.        Acute intoxication and/or withdrawal potential, especially history of withdrawal seizures

2.        Biomedical conditions and complications

3.        Emotional/behavioral conditions and complications including:

·         Psychiatric conditions

·         Psychological or emotional/behavioral complications of known or unknown origin

·         Poor impulse control

·         Change in mental status

·         Transient neuropsychiatric complications

4.        Treatment acceptance/resistance

5.        Relapse/continued use potential

6.        Recovery/living environment

 

Standardized assessments, such as the CIWA-Ar, SOWS, or CINA scales, may be used in addition to monitoring vital sign status and evidence of severe withdrawal by history.  The patient’s potential to complete detoxification should also be evaluated to determine the appropriate setting for stabilization.

 

EVIDENCE TABLE

 

	Recommendations	Sources of Evidence	QE		R
1	Determine appropriate level of care.	ASAM, 1996	III		A
2	Use standardized assessment of withdrawal symptoms.	Sullivan et al., 1989 Gossop, 1990 Zilm & Sellers, 1978	II		A

QE = Quality of Evidence; R = Recommendation (See Introduction)