Substance Abuse Treatment Modalities: Literature Review

Detoxification

The main objective of a detoxification service is to help people while their bodies get rid of alcohol and/or drugs and adapt to a drug-free state. Detoxification centres provide a safe environment for clients who experience intoxication or withdrawal from alcohol and/or other drugs. Generally, withdrawal symptoms are in the opposite direction to the original drug effects (e.g. withdrawal symptoms from depressant drugs, such as alcohol, usually involve high levels of arousal).

Detoxification is the process whereby clients achieve a minimal level of acceptable physical, psychological and social functioning. These services may be provided with or without medical supervision. Medical treatments only last for a few days and are intended to avoid the adverse side of effects experienced through withdrawal. Nonmedical detoxification, sometimes called the "social model", involves monitoring the individual during withdrawal without the use of prescription drugs over a brief time frame.

The short term goal of detoxification is immediate stabilization of a client while the long term goal is usually directed towards referring clients to ongoing treatment services. The duration of detoxification varies from client to client and setting to setting, but an average of three to five days is usually required for treatment. Detoxification settings vary from rural to urban locations but generally include residential, outpatient, and home treatment.

The research evidence suggests that detoxification centres are often successful in helping individuals withdraw from alcohol and drugs in the short term. Detoxification is usually only the first step in treatment intended to produce long-term behaviour change. Unfortunately, detox centres are often unsuccessful in linking patients to future treatment that may produce long-term behaviour change. There are two reasons why detox centres have generally not been successful in creating linkages to additional treatment. First, many of the individuals who go to detox centres simply want to detoxify; they do not want to stop drinking or using drugs. Heroin addicts, for example, are well known for detoxifying in order to bring down their tolerance to heroin so that they don't need to spend so much money to obtain an adequate supply. The second reason for the poor linkages is that many detox centres have a slim budget and poorly paid staff and do not have the capacity to make an effective referral.

Ross and Lightfoot (1985) point out that the key goals for detoxification are not rehabilitative but rather are social and economic ones: getting intoxicated people off the street; providing them with medical care; redefining drunkenness as a medical/social welfare problem rather than as a criminal justice problem; and reducing criminal justice costs. However, critics argue that detoxification without rehabilitation and follow-up services offers little more than a comparable period in jail and often lead to the "revolving-door" situation (Addiction Research Foundation: 1994).

References for Detoxification:

Addiction Research Foundation, Alcohol and Drug Treatment in Ontario, Toronto: 1994.

Hamilton, J.R., "Evaluation of detoxification service for habitual drunken offenders", British Journal of Psychiatry, 135, 28-34, 1979.

Ross, R.R. and Lightfoot, L. (1985), Treatment of the Alcohol Abusing Offender, Springfield: Charles Thomas Publisher