Inpatient detox centres and AA meetings often get the spotlight when it comes to referring addicted patients but home-based withdrawal may be worthwhile considering as the gap between the need for services and the resourcing widens.
When individuals opted to wean themselves off drugs or alcohol at home, the proportion that said they used their problem drug most days dropped from 94% to 23% by the end of the detox, according to a study of a Perth-based withdrawal service, the Drug and Alcohol Withdrawal Network (DAWN).
It also had a knock-on effect for other drug use, with only 11.6% saying they used another drug of concern most days, down half as much as they did before treatment.
Study author Mr Cameron Wright, a research associate at Curtin University’s school of public health, said it was important for patients and their doctors to be aware that services like this existed and may be helpful in the right circumstances.
This kind of approach was particularly useful for individuals whose drug use commonly occurred at home, he said. One participant described not being tempted to drink while in rehab but having problems when returning home. “It’s handling it at home. The management of the problem can be where the triggers are.”
Over the five years of this study, researchers found out of the 1800 individuals who contacted the service, 700 completed the full detoxification and the others were triaged and referred on to other services where appropriate. In total, the entire process from phone call to completion cost an estimated $4.8 million for the study group.
Patients overwhelmingly liked the program, with 87% saying they were “extremely” satisfied with it. In particular, they trusted the nurses and appreciated the psychological and physical support they received as part of the program.
The majority of patients reported alcohol as being their primary drug of concern, but rates of people coming in for methamphetamine addiction jumped between July 2011 and June 2016, from 4% to 23%.
Given the potentially dangerous nature of withdrawal, clients at the DAWN service were vetted closely to ensure their physical and psychological safety.
Any patients referred to the service were first triaged during a phone interview and then given a follow-up face-to-face interview to assess their eligibility. Clinical nurses specialising in drug and alcohol withdrawal assessed them for potential physical risks as well as mental health concerns that might be triggered by the withdrawal process.
One of the safety features of Perth’s home-based withdrawal program was that clients had a support person with them for at least the first few days, often a partner, family member or friend. GPs were the ones to prescribe any medication needed through the withdrawal, and the support people were given instructions on how to best help them and look out for their safety.
Canberra addiction medicine specialist and GP, Dr William Huang, said home-based withdrawal was a worthy and evidence-based option for many patients with alcohol and stimulant use issues and who were at low risk for other complications.
He did caution that for some patients, asking their GP about home-based withdrawal may be a method of doctor-shopping for benzodiazepines.
“So if it is a patient or family who you know and it’s genuine, some ways that GPs can mitigate this is by prescribing [the drugs] as daily collection at a pharmacy,” he said.
Dr Huang said the traditional alcohol model of detox and rehab appeared to be even less effective for patients with amphetamine problems, given potential aggression issues and differences in their needs as they are coming down off the drugs.
If a patient was more complex, he recommended clinicians call their nearest drug and alcohol clinic for advice on management.
Aust J Prim Health 2018; online 23 July