Home Detox: 21st Century Rehabilitation
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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.

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 Home Detox: 21st Century Rehabilitation Presentation Transcript

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