Lives are not completely transformed in a substance use detox unit with an average stay of under a week. But the quality of the interactions that take place there have a huge bearing on patients' prospects for longer-term success.
At Mountainside Treatment Center in Canaan, Conn., one challenge consistently occupying its detox staff involves responding to conditions that might result in a patient leaving the facility early against medical advice (AMA). “Especially with male patients, we do find that those with opioid addiction have a higher risk of AMA, especially in detox,” Mountainside clinician Devon Hawes tells Addiction Professional.
Hawes, who has worked exclusively in Mountainside's 19-bed detox unit since shortly after its mid-2014 opening, says accurate assessment and individualized support can be crucial to averting crisis in these cases. Patients' professional and home lives may be falling apart at this time, and these issues are just coming clear to someone who is emerging from regular use of substances. Operators of the unit seek to ensure that the patient will meet with his primary clinician within 24 hours of admission, Hawes says.
(Hawes adds that while illicit opioids including fentanyl are commonly found in the region where Mountainside operates, the detox unit still tends to see a majority of its admissions associated with alcohol.)
Individual counseling sessions may be scheduled daily during detox. Most of the facility's patients are covered under either out-of-network insurance benefits or self-pay arrangements. Around two-thirds of patients in the unit will eventually be transferred into Mountainside's 30-day residential program, says Hawes, adding that the current AMA rate is only a little over 3%.
Acupuncture widely available
Another tool that the Mountainside detox unit uses to the greatest extent possible is acupuncture, a practice with a long history of successful application in detox. Licensed practitioners are housed at the facility five days a week, says Hawes.
Patients interested in receiving acupuncture may be set up for an appointment within the first day of their detox stay. Group sessions of auricular acupuncture take place in the morning and afternoon, and full-body sessions can be scheduled as well. A patient conceivably could participate in anywhere from one to three acupuncture sessions during a detox stay, Hawes says.
For patients with opioid addiction and at high risk of relapse, a medication taper followed by initiation on the injectable formulations of naltrexone (Vivitrol) or buprenorphine (Sublocade) will be an important component of treatment. “We look at [medication-assisted treatment] as the standard,” says Hawes, himself a certified MAT specialist.
Hawes says that more than 70% of Mountainside's overall patient population begins receiving MAT prior to discharge. He sees that patients have grown increasingly receptive to MAT as part of their care, especially given the dangers of overdose associated with fentanyl
The pace of working in a detox unit is fast and the patient need is great, but Hawes says he derives great satisfaction in seeing the progress that patients can make both medically and psychologically. "There can be a changed perspective in the course of five days," he says.