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Detoxification

Detoxification occurs when addictive substances are naturally eliminated from the body after ceasing drug use. It requires physical and medical support. Detoxification requests may come from the health care worker, doctor or client. Drug users may initiate detoxification themselves, but may need help when withdrawal symptoms intensify.

Indications for urgent detoxification are a profound decrease in the normal level of mental and physical functioning as a result of persistent and heavy drug use. Medical assessment will rule out other possible causes such as pneumonia or head injury. Detoxification may be residential or community based.

In severe cases of alcohol or drug addiction, 'residential' detoxification allows for withdrawal in a supportive and supervised environment away from the person's usual place of residence, and should be considered if one or more of the following indications are present:

• A risk of severe withdrawal symptoms, such as epileptic fits or extreme agitation.
• Deficiencies in the home environment, such as inadequate support or the influence of other drug users.
• Homelessness.
• Person is currently residing in a crisis shelter.
• Failed 'community detoxification'.

Residential detoxification can be medical or non-medical. Indications for residential medical detoxification include a history of severe withdrawal fits, coexisting medical problems such as heart disease, multiple drug and alcohol dependencies, or failed non-medical residential detoxification. Residential medical detoxification services are reducing and emphasis on community detoxification is increasing. Designated public hospitals are now opening small numbers of detoxification beds (see Table 3). Tranquillising medications and other treatments such as methadone are available in medical detoxification centres.

Non-medical residential detoxification is similar to medical detoxification, but achieves a drug-free state without significant medication use. Basic medication such as vitamins may be given. This occurs under supervision in a supportive environment like that provided in De Paul House in Fitzroy (see Table 3). It is generally easier to access non-medical than medical residential detoxification.

Community detoxification. In the less severe cases of dependency, and if the person is sufficiently motivated, 'nonresidential' or 'community based' detoxification may be trialled. Current government emphasis is on encouraging greater use of such services. See the 'drug and alcohol problems/medical assistance' section for advice on community detoxification.