What to expect when entering treatment...

Here is some general info on what to expect when entering treatment:

All care for addiction treatment is based on an assessment. This assessment determines the level of care needed to provide safe treatment. For this assessment the American Society of Addiction Medicine [ASAM] dimensional model is often used. This model is also used when a program calls your insurance company to authorize admission to treatment. The assessment determines how severe the addiction is and what kind of treatment is needed- understand need and want are not always in alignment.

Here’s a few examples:

A 67-year-old male comes to the emergency room because of chest pain. He reports drinking 1 pint of vodka every day for the last 20 years. He reports only being able to maintain sobriety for a week or two at a time. He reports getting the “shakes” when he wakes up in the morning and has reported previous history of blacking out and seizures. He also reports some serious heart problems and has not taken his medications consistently. Due to this medical history and significant alcohol use, this male will most likely need to be hospitalized to be safely detoxed from alcohol. This would be an ASAM Level 4-level of care. (Side note- in chronic alcoholism a person can display withdrawal symptoms, including shaking, nausea and even seizures when they are intoxicated. This is because there is not enough alcohol in their system to prevent withdrawal symptoms. In personal practice I have seen many alcoholics with elevated breathalyzer readings have withdrawal symptoms and seizures).
A 20-year-old physically healthy female college student met a boy who introduced her to heroin. She began sniffing a few bags a day and when she broke up with him and tried to stop, she got sick- like a bad case of the flu and incredible intense cravings for the drug. She realized she needed help. She never used any drugs prior to meeting her ex-boyfriend. She has been able to maintain good grades and has the strong support of her family, whom she lives with, and this is a healthy environment with no substance use. She works as a server in a restaurant, and no one is aware of her drug problem. She is not pregnant (this is significant). Due to this history, she would most likely meet the requirements for an office based opiate detox treatment program (Like a Level 1) utilizing buprenorphine (Suboxone) for outpatient detox as well as one-on-one counseling sessions and group therapy. She does not meet the requirements for inpatient care based on these circumstances. (Side note- pregnancy changes the care for most detoxes and treatment is based on many different circumstances.)

What to expect when you enter detox

Detox is the highest level of care you can be in. In most cases detox can be completed in a non-hospital setting with 24hr nursing coverage and physician support on an as needed basis. Finding the right detox is hit or miss- the most important thing is YOU being ready for treatment. You can be in the most beautiful ocean front hotel like facility or in the middle of the most drug infested area. Most addicts I’ve met could run their own program- it’s not what’s around you that matters- its what’s inside. Maybe this time this really IS IT…

After spending several hours in an admission area you’ll finally make it to the floor you’ll be on while detoxing. You should have done a urine drug test in the admissions area, but if not, they will most likely ask and watch you pee in a cup. You’ll be met by a tech (different places call them different things- they are like security and crowd control) and you’ll be searched. Sometimes this is done by nursing staff in some facilities, and generally they try and keep it to male staff searching male clients and female staff searching female clients, but this isn’t always possible and more often a female nurse searches a male with another male staff member in the room. This isn’t a basic airport search… You should be stripped completely naked, asked to at least squat and cough, lift your breasts/testicles, have your mouth searched with a flashlight, etc. Generally, there is not cavity searches- unless there is a reasonable suspicion of something being hidden, but this is not general practice. All your clothes will be searched thoroughly. Some places launder all clothes or treat with a UV bed bug light- this just promotes a clean environment. Also, in some places you’ll be given scrubs to wear during the detox. You should not have more then 3-4 days clothes in detox. If you bring toiletries they need to be non-alcohol based and should be unopened. Most facilities have toiletries available for use-not great ones, but they have things.

After being searched you’ll meet with a nurse where you will be asked the same questions you’ve already been asked in the admissions area. The nurse should go a bit more in depth and ask more medical related questions, ask about medications, medical problems, mental health concerns, prior treatment history, etc. They should give you information specific to your detox, what medications you’ll receive, how long detox will be and they should answer any questions you have.

Common Medications Used for Detox/Rehab:

Methadone
- Used for detox from opiates (heroin, Percocet, oxycodone). Due to increased fentanyl in heroin many facilities use methadone for detox instead of Suboxone.
Suboxone (Buprenorphine & Naloxone/Narcan)
- Used for detox from opiates (heroin, Percocet, oxycodone)
Ativan/Librium/Valium/Klonpin/Phenobarbital
- Used for detox from alcohol and benzodiazepines (Xanax, Klonpin)
Vistaril/hydroxyzine
- Used for anxiety. This medication is an antihistamine, like Benadryl.
Ibuprofen (aka Motrin/Advil)
- Used for body aches, headache, general mild to moderate pain related to detox
Acetaminophen (aka Tylenol)
- Used for body aches, headache, mild-moderate pain
Baclofen
- Used for muscle aches. This medication is used to treat pain in muscle rigidity and stiffness that can occur sometimes with substance withdrawal.
Clonidine
- Used for high blood pressure related to detox, it also works on the receptor sites in the brain to help with withdrawal symptoms.
Trazodone
- Used for sleep, also helps with depression.
Melatonin
- Used for sleep. Melatonin is a hormone that your brain produces when its dark to help you sleep. Supplements can help with insomnia

Common Blood Tests related to Addiction Medicine

There are a few tests that will be ordered upon admission to a new facility or outpatient program. These tests are required for admission based on state regulations and patient indication.

Complete Blood Count aka CBC

Why: Abnormalities may point to a medical condition and further testing may be required. Things such as anemia, infection and bleeding disorders could be detected. Here are a few examples:

Low hemoglobin (HgB) may be a sign of anemia and if your result is very low it may indicate a need for a blood transfusion
WBC Count (white blood cells) significantly elevated white blood cells could indicate possible infection or inflammation, or the blood could have been taken at times of very high stress

Comprehensive Metabolic Panel aka CMP

Why: While a CBC takes a measurement of components of your blood, a CMP measures a few other areas. Again, abnormalities suggest further testing, not necessarily disease.

Sodium (Na), Potassium (K+), Calcium (Ca) are all important electrolytes that send signals and hormonal responses through the body. Abnormalities in either of these can be serious and lead to significant cardiac or other issues. Thankfully, with medications abnormalities are quickly resolved.
ALT and AST are enzymes produced in the liver. Elevations of both are most often seen in cases of alcoholism and Hepatitis C. In alcoholism the elevations usually begin to decrease once drinking stops. The liver is like a sponge and it can repair itself to some degree. In cases of alcoholism over many years the liver can become hardened and not function to filter out toxins leading essentially to poisoning. This is why in patients with liver disease medication adjustments are often needed to reduce chances of toxicity. Hepatitis C may cause the same type of damage, however treatment for Hep C is effective and stops damage. Hep C is usually treated by taking 1-3 tablets over 8 or 12 weeks. You can become reinfected with Hepatitis C. Click here for more Hep C information.
Glucose (Glu) measures the amount of glucose in your blood. While this test DOES NOT indicate diabetes (that would be a HbA1c or hemoglobin A1C) it can show abnormalities that would lead to further testing.
Creatinine (Cr), BUN abnormalities can indicate dehydration or kidney disease.

Tuberculosis Test (aka TB Test)

Tuberculosis is a bacterial infection that affects the lungs and other organs. It spreads easily through sneezing or coughing.

This is called a “test” but its really an injection that is given just under the skin of your forearm. The TB test is given upon admission at many facilities to prevent spread of the disease. After the injection is given under your skin a nurse will check in 48-72 hours to measure any swelling that may be present. A blood test can also be used for testing, called Quantiferon. A positive test is when the bubble remains enlarged. If this happens a chest x-ray or blood tests are used to confirm active disease.

Watch this video about TB

Syphilis (RPR Testing)

Syphilis is a sexually transmitted infection. Syphilis cases have been increasing over the last few years. In New Jersey cases of congenital syphilis are also on the rise due to mothers passing the infection to their babies. Syphilis testing is required by the states of New Jersey & New York for in addiction treatment.

When Syphilis is confirmed the result is a number such as 1:256, 1:32, 1:16- known as a titer. Generally higher numbers indicates an untreated infection. Preferred treatment consists of 3 injections of penicillin spaced 1 week apart each. The injections are rather large and a larger needle is used- it is given deep into a muscle. If there is a penicillin allergy oral antibiotics can also be given for 30 days. Once treatment is completed it can take several months for your titer to come down. It is important to keep your lab records with your titer information. If within a year you repeat testing with another provider they may believe you have a new infection and want to treat again. As long as the titers are going down, all medication has been taken and you are not getting reinfected then there generally is not a reason to treat again. Also, because Syphilis is a state reportable disease your state department of health may call you and want to know the names and phone numbers of everyone you've slept with since being infected.

Read & See More