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Nurturing approach

Mitch recalled how new patients used to be greeted in detox with a barrage of accusations.

Patients were told they were addicts, that they were hurting people, she said. Counselors would get information from families about how much alcohol they drank in a week, how much money they spent on drugs or examples of run-ins with the law and present this information to them in group counseling sessions.

“The counselors were rough,” she said. “They didn’t let people worm out of it or make excuses.”

In recent years, the approach has become much less confrontational and much more nurturing, she said. “It’s more respectful to the patients and it seems better for them.”

At Scripps McDonald Center in La Jolla, Calif., manager Sandra Boller, RN, pushed hard to separate detox from residential rehabilitation. Before, when the center used a medical model, detoxing patients were mixed in with people who were two or three weeks into recovery. The sick detox patients became understandably agitated when someone told them, “You’re just an addict, admit it,” Boller said. “Why all the stress and drama?” It made more sense to wait until they felt well enough to start group counseling sessions.

“I’ve always had a strong belief that you’re more open to something when you feel good,” she said.

At Sierra Tucson, Power also has worked to separate the detox and assessment area from the residential area to reduce the amount of traffic, noise and other disturbances that could easily get on the nerves of on-edge patients. She has set up soft lighting and meditative music. Nurses take newly admitted patients to private areas to take vital signs and information.

At Grapevine Valley Hope in the Dallas/Fort Worth area, patients in detox are encouraged to start group counseling sessions after a day or two if they want to, said Sandi DeLusque, RN. But they are not forced out of bed if they say they feel too sick to get up. “We’ll tell them, ‘You’re right, you don’t feel well. I’ll get you that washcloth.’ ”

As it has in almost every aspect of health care, managed care has forced certain changes on chemical dependency units. When she first began working in the field, Mitch said, patients stayed under medical supervision for up to 60 days. Even then, she wondered if that was enough time for some patients.

“I watched the numbers get cut and cut and cut,” she said. “Now, there’s no inpatient [medical] treatment anymore.” Most hospital-based programs detox patients, then refer them to outpatient treatment centers or move them into a residential program that does not have direct medical supervision.

This residential “social model”—which combines group and family therapy, individual counseling, 12-step programs and medications—has its advantages, Boller said. Patients can learn from each other and support each other and participate in their care. It makes more sense to separate the detox patients who require costly medical supervision from residential rehabilitation patients who mostly don’t, she said.