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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.
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