Substance withdrawal management

Sound withdrawal management (sometimes known as detoxification) allows a person who is dependent on alcohol or some other drug, to cease their use with safety and some level of comfort. It can involve rest, counselling, good nutrition, vitamins, and at times medications.

A range of public and private services provide withdrawal programs. For a list of services in South Australia visit the Drug and Alcohol Services page.

Aims of withdrawal management

The aim of withdrawal management is to treat the unpleasant and at times life-threatening clinical features of withdrawal, to prevent complications, and to enable the planning of ongoing treatment after the withdrawal process has subsided.

Many drug users, their parents and the general community believe that ending dependence is simply a matter of ceasing use and detoxifying the body. As such, they see withdrawal management as a treatment. For more information, visit the Treatment options page.

Withdrawal management is only the first step but it enables drug users to move towards the next stage of dealing with their alcohol or drug problems. At the least it enables a period of respite from the risks associated with regular drug use. At best it links directly into follow up treatments.

People using alcohol and other drugs have different reasons for wanting to withdraw and will be at different stages in changing their behaviour. Understanding the person’s goals and expectations of withdrawal management will help you advise them appropriately on the best form of intervention for them.

Withdrawal management for commonly misused substances

Withdrawal setting

Withdrawal from alcohol and other drugs can be managed in a variety of clinical and community settings depending on the individual’s needs and circumstances, health risks and severity of withdrawal.

Suitability for GP withdrawal management includes:

  • withdrawal likely to be mild to moderate severity and no medical/psychiatric contraindications
  • where patient wants it and will comply with instructions
  • where the GP is able, willing and available (daily review)
  • where carer support is available (to look after the patient, supervise medication and call for help if deterioration)
  • where the patient is able to arrange their responsibilities and commitments to give themselves a period of minimal stress and sufficient time for withdrawal.

Intensive inpatient care is appropriate with:

  • unstable medical or psychiatric condition
  • poly-drug dependence
  • a history of medical or psychiatric conditions or uncertain past drug use indicating a need for close monitoring
  • a history of complicated alcohol withdrawal (seizures or delirium)
  • a history of seizures associated with benzodiazepine withdrawal.

Supported residential care, such as a community withdrawal unit, is appropriate if:

  • there is an unsupportive home environment, such as with other drug users, or without anyone reliable to supervise and support the patient
  • there has been repeated failure at outpatient withdrawal.

A model of the decision process for matching drug users to treatment setting is shown in the diagram.

DASSA treatment setting flowchart

Assessment

Take a comprehensive substance use history, including:

  • all types of drugs used
  • duration of use, quantity and frequency of recent use, route of use and time of last use
  • assessing previous drug treatment attempted
  • assessing the level of current intoxication and withdrawal
  • assessing general physical and mental state, including ongoing health problems
  • establishing whether the patient is dependent on any substance(s).

For more information, visit the page called Assessment and initial intervention.

Follow-up treatment

Detoxifying the body is not a cure for tolerance and dependence and, without follow-up treatment, the person is likely to relapse and start using alcohol or other drugs again. This is because their brain chemistry has changed in response to the alcohol or other drug being constantly present. Therefore, it is a good idea to try to follow up withdrawal treatment with counselling, residential rehabilitation, and for some substances ongoing medication assisted treatment.

Many patients will want to deal with a range of personal, emotional or relationship problems during the withdrawal episode, but they should be persuaded to defer all this until later. Withdrawal is not the optimal time for working through issues because it is likely to be stressful. Crisis intervention may be needed during withdrawal to ensure adequate accommodation, food or other urgent welfare needs are met. However, it is better to address wider problems as part of ongoing rehabilitation, after the withdrawal attempt.

Further information

  • For medical advice, patient information and resources regarding withdrawal and counselling contact the Alcohol and Drug Information Service (ADIS) on 1300 13 1340.

  • Call Drug and Alcohol Clinical Advisory Service (DACAS) on 7087 1742.
    DACAS provides a telephone and email service for South Australian health professionals seeking clinical information and clarification around clinical procedures, guidelines and evidence-based practice.

    Telephone: (08) 7087 1742 — 24 hours a day 7 days/week including public holidays or email your enquiry to: HealthDACASEnquiries@sa.gov.au

    This service does not provide proxy medical cover and cannot assume responsibility for direct patient care.