Home Detox: 21st Century Rehabilitation

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A presentation of Dr. Mike McPhillips, the medical director of the world's first and only addiction treatment and mental health clinic, The Causeway Retreat.

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  • Home Detox: 21st Century Rehabilitation

    1. 2. Thinking outside the box 21 st Century Rehabilitation <ul><li> Dr. Mike McPhillips </li></ul><ul><li>Consultant Psychiatrist </li></ul><ul><li>Addictions Specialist </li></ul>
    2. 3. What did that NICE young man say? <ul><li>Drug misuse, Psychosocial interventions </li></ul><ul><li>National Clinical Practice Guideline Number 51 </li></ul><ul><li>National Collaborating Centre for Mental Health </li></ul><ul><li>Commissioned by the National Institute for Health and Clinical Excellence, 2007 </li></ul>
    3. 4. Nice findings <ul><li>“ There is consistent evidence that 12-step attendance </li></ul><ul><li>mediates better substance misuse outcomes” (p181). </li></ul><ul><li>“ A large-scale prospective cohort study (n = 3,018) </li></ul><ul><li>conducted by Moos and colleagues (1999) revealed that </li></ul><ul><li>people receiving 12-step-based treatment for drug </li></ul><ul><li>and/or alcohol misuse had superior abstinence </li></ul><ul><li>outcomes compared with those in CBT or eclectic (based on </li></ul><ul><li>a combination of 12-step and CBT principles) treatment </li></ul><ul><li>groups”. </li></ul>
    4. 5. NICE recommendations <ul><li>“ Staff should routinely provide people who misuse </li></ul><ul><li>Drugs with information about self-help groups...based </li></ul><ul><li>on 12-step principles” </li></ul><ul><li>“ If a person who misuses drugs has expressed an </li></ul><ul><li>interest in attending a 12-step self-help group, staff </li></ul><ul><li>should consider facilitating the person’s initial contact </li></ul><ul><li>with the group, for example by making the </li></ul><ul><li>appointment, arranging transport, accompanying him </li></ul><ul><li>or her to the first session…” </li></ul>
    5. 6. “ Rehab.” ‏ <ul><li>Modern era </li></ul><ul><ul><li>Began at Hazelden, Minnesota, 1949 </li></ul></ul><ul><ul><li>Now worldwide </li></ul></ul><ul><ul><li>In UK since 1974 </li></ul></ul><ul><li>Elements </li></ul><ul><ul><ul><li>Medical Care, including detoxification </li></ul></ul></ul><ul><ul><ul><li>Group Therapy-based </li></ul></ul></ul><ul><ul><ul><li>Education </li></ul></ul></ul><ul><ul><ul><li>Spiritual Renewal </li></ul></ul></ul><ul><ul><ul><li>Overwhelmingly, 12-Step model </li></ul></ul></ul>
    6. 7. Traditional rehab: problems <ul><li>Frequent use of addicts in recovery as counsellors </li></ul><ul><li>Mandatory attendance in all programme elements (including daily AA meetings)‏ </li></ul><ul><li>Prohibitions on “luxuries” </li></ul><ul><ul><li>Single rooms, Mobile phones, </li></ul></ul><ul><ul><li>Internet, books, TV, </li></ul></ul><ul><ul><li>Cosmetics, Immodest clothing, </li></ul></ul><ul><ul><li>Some foodstuffs. </li></ul></ul>
    7. 8. Traditional Rehab: problems <ul><li>Time consuming (28 days minimum)‏. </li></ul><ul><li>Stigmatising, shame-based tactics. </li></ul><ul><li>Expensive (₤2,000 – 10,000 per week).‏ </li></ul><ul><li>Lack of privacy (treatment involves open groups and public meetings, frequent newspaper interest).‏ </li></ul>
    8. 9. <ul><li>“If the only tool you have is a hammer...” </li></ul>
    9. 10. <ul><li>“....then every problem will come to look like a nail” </li></ul>
    10. 11. “ I Don't Wanna Go To Rehab” <ul><li>Clients likely to refuse structured, group-based Programmes: </li></ul><ul><li>Unhappy refugees from previous 12 step programmes </li></ul><ul><li>“ never again” </li></ul><ul><li>Reserved or shy people </li></ul><ul><ul><ul><li>“ too much soul-baring with strangers” </li></ul></ul></ul><ul><li>People with reputations to lose </li></ul><ul><ul><ul><li>Aristocracy, Royalty, Businessmen, Doctors, Lawyers, Clerics. </li></ul></ul></ul><ul><li>People in the public eye </li></ul><ul><ul><ul><li>Sportsmen/TV personalities/Models/Pop stars/Actors/Politicians </li></ul></ul></ul>
    11. 12. Rehab: 2000 - <ul><li>Newest trends in addiction treatment: </li></ul><ul><li>Individually-tailored programmes </li></ul><ul><li>No compulsory elements </li></ul><ul><li>More use of 1:1 therapy </li></ul><ul><li>No mandatory attendance at AA/NA </li></ul><ul><li>More physical comfort </li></ul><ul><li>Holistic therapy (CBT/complementary therapies, nutrition, fitness, weight control) </li></ul>
    12. 13. Alternatives to Residential Care ‏ <ul><li>“ Sweating it out” </li></ul><ul><li>Hospital-based inpatient detoxification </li></ul><ul><li>Outpatient detoxification </li></ul><ul><li>Home Detoxification </li></ul>
    13. 14. Post- detox. interventions <ul><li>Motivational Interviewing </li></ul><ul><li>Cognitive Behavioural Therapy </li></ul><ul><li>Twelve Step Fellowship meetings </li></ul><ul><li>Day Programmes </li></ul><ul><li>Individual counselling </li></ul><ul><li>Religious organisations </li></ul><ul><li>Aversion/anti-craving medications </li></ul>
    14. 15. Preparing for Home Detox. <ul><li>Detailed initial assessment </li></ul><ul><ul><li>Drink and drug history </li></ul></ul><ul><ul><li>Comorbid physical problems </li></ul></ul><ul><ul><li>History of severe withdrawals (DT's, epilepsy)‏ </li></ul></ul><ul><li>Plan B </li></ul><ul><ul><li>GP </li></ul></ul><ul><ul><li>Psychiatrist </li></ul></ul><ul><ul><li>Inpatient medical ward </li></ul></ul>
    15. 16. Detox: Published outcomes <ul><li>Specialist inpatient unit, 24/7 trained staff: </li></ul><ul><li>80%+ complete </li></ul><ul><li>General Hospital Ward, general staff: </li></ul><ul><li>50%+ complete </li></ul><ul><li>Domiciliary detox, nurse visits Mon-Fri , 9-5: </li></ul><ul><li>50-75% complete </li></ul><ul><li>Outpatient, doctor-supervised, daily attendance Mon-Fri +/- family support: </li></ul><ul><li>20-50% complete </li></ul>
    16. 17. 1:1 Home detox: > 300 cases, 1999- <ul><li>24/7 Home CNS, medically supervised: </li></ul><ul><li>95% complete </li></ul><ul><li>Advantages </li></ul><ul><li>Discretion </li></ul><ul><li>Excellent safety record, (client and nurse) </li></ul><ul><li>High client satisfaction </li></ul><ul><li>1:1 therapy & support throughout detox. </li></ul><ul><li>Client accompanied to medical OPA, AA meetings, assessments for aftercare, etc. </li></ul>
    17. 18. Detox. myths <ul><li>'they always relapse, so there's no point....' </li></ul><ul><li>Of those who relapse, 40-50% show significantly reduced use/improved health over the next six months </li></ul><ul><li>'there's no point in forcing people....' </li></ul><ul><li>Outcomes for coerced patients are almost as good as those of voluntary patients </li></ul><ul><li>'they have to hit rock-bottom first....' </li></ul><ul><li>Some will die. Many will be damaged irreversibly. Early intervention works best. </li></ul>
    18. 20. Home detox: the rock star
    19. 21. Home detox: the businessman
    20. 22. Home detox: the GP's visit
    21. 23. Home detox: medication delivery
    22. 24. Home detox: the Consultant arrives

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