THE BASICS. Community Based Medically Assisted Alcohol Withdrawal. World Health Organisation The Issues 5/18/2011. RCGP Conference May 2011

Size: px
Start display at page:

Download "THE BASICS. Community Based Medically Assisted Alcohol Withdrawal. World Health Organisation 2011. The Issues 5/18/2011. RCGP Conference May 2011"

Transcription

1 RCGP Conference May 2011 Community Based Medically Assisted Alcohol Withdrawal THE BASICS An option for consideration World Health Organisation 2011 Alcohol is the world s third largest risk factor for premature mortality, disability and loss of health; It results in 2.5 million deaths each year worldwide. Major factor in many health related conditions. Also associated with several infectious diseases like HIV/AIDS, tuberculosis and sexually transmitted infections (STIs). The Issues In 2009 there were 8,664 alcohol related deaths in the UK (Office for National Statistics) Deaths attributed to alcohol misuse more than doubled between 1990 and 1999 and they continue to rise. (Scottish Health department 2002) Alcohol dependent patients consult their General Practitioners (GPs) about twice as frequently as other patients in the Practice (SIGN) 1

2 Alcohol Drinking Terms HAZARDOUS DRINKING - Defined as regular consumption of: over 5 units per day for men, over 3 units per day for women. HARMFUL DRINKING - defined in ICD-10 as pattern of drinking that causes/has caused damage to physical or mental health (SIGN 2003) Alcohol Dependence Affects physical and mental health, yet unable to stop drinking. Lack control over drinking levels. Increased importance of alcohol, Increased tolerance to alcohol, Repeated withdrawal symptoms, Drinking to avoid withdrawal symptoms. (RCP 2001) Community Assisted Withdrawal Carries risks, requires careful clinical management. Does not address psychological dependence. The choice of timing is important Should be seen as the first step towards achieving abstinence. 2

3 Community Assisted Withdrawal Effective and safe treatment for clients with mild or moderate withdrawal symptoms. Not a treatment for alcohol dependence in itself. It allows elimination of physical dependence in a safe manner, with support. NOT recommended if the client is: Confused or has hallucinations History of previous complicated withdrawal, Epilepsy or a history of fits Undernourished Severe vomiting or diarrhoea Risk of suicide Severe dependence and is unwilling to be seen daily Uncontrollable withdrawal symptoms Acute physical or psychiatric illness Home environment unsupportive of abstinence Medically Assisted Withdrawal Only if alcohol levels at/reduced to around 30 units daily or less. Chlordiazepoxide d (or diazepam) is the medication of choice. Lorazepam with limited liver metabolism. It is generally only required if daily amounts are >15 units/day for men >10 units/day for women Score of 20 or more on AUDIT 3

4 What are the risks? Other co morbidities Why do some clients need to reduce their intake before starting a community assisted withdrawal Other medications prescribed & otherwise Alcohol Withdrawal Onset 3-6 hours after last drink Duration 5-7 days Headache, nausea, vomiting, sweating and tremor Grand mal convulsions may occur. Delirium tremens in about 5% of those suffering withdrawal Onset hours or more after last drink Agitation, confusion, visual and auditory hallucinations, paranoia plus marked tremor Alcohol Withdrawal Complications DTs - serious complication: fits, hyperthermia, dehydration, electrolyte imbalance, cardiovascular collapse DT - associated with chest infections, pancreatitis, and hepatitis Prognosis In hospital practice the mortality is high, about 10% 4

5 Wernicke-Korsakov Syndrome and Vitamin Supplements *** Clients with any sign of Wernicke-Korsakov syndrome should be admitted to secondary care immediately Confusion Ophthalmoplegia Memory disturbance Coma Ataxia especially truncal ataxia Nystagmus Hypothermia and hypotension Community Medically Assisted Withdrawal: Preparation Begins at least two weeks before detox Social stability. Timing Motivational work. Assess for focus & motivation. Be sure this is client driven! Prescriber Appointments Assess suitability Motivational work Previous assisted withdrawals Plan start date and book all appointments. Discuss re withdrawal and reduction prior to commencing prescribing Commence vitamins Benzodiazepine scripts/use!! 5

6 Recovery Coordinator Input Motivational work Plan structure to days. Help client elicit and arrange support Ensure client has alternatives to drink, sufficient food etc. Reinforce information re withdrawal, reduction beforehand. Book all appointments in advance Assisted Withdrawal Plan Week 1 Start on Monday mornings The client should be seen by prescriber on alternate days as a minimum, Monday, Wednesday, Friday in the first week This is to detect early any complications: delirium tremens continuous vomiting deterioration in mental state and to adjust medication as needed. Prescribing Appointment Day One BP and pulse as baseline Complete medication programme sheet. No alcohol can be consumed once the first dose of chlordiazepoxide / diazepam has been taken In the case of lapse medication should be stopped immediately. Prescribe chlordiazepoxide doses only up to the next appointment. 6

7 Prescriber Day 3 Monitor breath alcohol Measure pulse, blood pressure and temperature Check for signs of DT s + Wernicke Korsakov, dehydration and marked tremor. Adjust dose of chlordiazepoxide if necessary Successive appointments See at least twice during the second week. Discuss aftercare prescribing and support. Ensure regular engagement with recovery coordinator if available. Aftercare support is vital Maintaining Abstinence The detoxification is only the start of the patients journey. Options including naltrexone, disulfiram and/or acamprosate should be discussed and offered. Regular appointments for support and relapse prevention work will also be needed. 7

8 Maintaining Abstinence Advise on other support networks including; Alcoholics Anonymous Narcotics Anonymous ADS in Leeds SMART recovery Continue to address causative factors of initial drinking with client. Maintain relapse prevention support long term if needed. In-Patient Assisted Withdrawal Client unable to reduce alcohol intake to near 30 units a day or below Repeated failed or high risk for community assisted withdrawal. Severe dependence requiring parenteral vitamins, or very high doses of chlordiazepoxide / diazepam. Client choice (and resources) Other Factors Liver Hepatitis C Buprenorphine Depressants Methadone Heroin Benzodiazepines 8

9 Other Factors Physical Health Mental Health Vulnerable Aggressive Domestic Violence Child protection Reduces resilience to other substances Thank you Any Questions?? 9

10 Practical Case Study Background Ben 36yr old male. Drinks 6 litres 7.5% cider daily (45 units daily). Diazepam dependant 30mg daily No other illicit drug use Prescribed methadone 40mg/ml daily Recently diagnosed Hepatitis C on PCR What would you address first? Diazepam Alcohol Psychosocial Hepatitis C 10

11 Bens Options To do nothing Community based assisted withdrawal In patient assisted withdrawal In patient rehab after detox Community based aftercare Parameters What level of drinking would Ben need to self reduce to before he could start a community MAAW? What level of diazepam would a reducing script need to reduce to before a chlordiazepoxide prescription could start Other Interventions What other prescribing should you consider Medical history? Diazepam script dose & duration Bloods? 11

12 Bens Outcome Reducing dose diazepam script Community assisted alcohol withdrawal Disulfiram started Poor engagement in aftercare support Lapsed No motivation to change Continued to Work with Ben He realised his future Motivational work Reduced and finished methadone script Completed in patient withdrawal Straight to rehabilitation Housing relocation Hepatitis C treated (SVR) Any Questions? 12

SPECIFICATION FOR THE LOCAL COMMISSIONED SERVICE FOR THE MANAGEMENT ALCOHOL MISUSE

SPECIFICATION FOR THE LOCAL COMMISSIONED SERVICE FOR THE MANAGEMENT ALCOHOL MISUSE SPECIFICATION FOR THE LOCAL COMMISSIONED SERVICE FOR THE MANAGEMENT OF ALCOHOL MISUSE Date: March 2015 1 1. Introduction Alcohol misuse is a major public health problem in Camden with high rates of hospital

More information

Guidance for the Detoxification of Alcohol Dependent Patients in Community or Outpatient Settings

Guidance for the Detoxification of Alcohol Dependent Patients in Community or Outpatient Settings Title: Identifier: Replaces: Guidance for the Detoxification of Alcohol Dependent Patients in Community or Outpatient Settings NHSG/Guid/Detox_ADP/MGPG663 N/A - New document Across NHS Boards Organisation

More information

GUIDELINES FOR COMMUNITY ALCOHOL DETOXIFICATION IN SHARED CARE

GUIDELINES FOR COMMUNITY ALCOHOL DETOXIFICATION IN SHARED CARE GUIDELINES FOR COMMUNITY ALCOHOL DETOXIFICATION IN SHARED CARE Dr Millicent Chikoore MBBS MRCPsych Dr O Lagundoye MBBS MRCPsych Community based alcohol detoxification is a safe and effective option for

More information

CALDERDALE ALCOHOL TEAM & Calderdale Substance Misuse Service COMMUNITY ALCOHOL DETOXIFICATION GUIDELINE

CALDERDALE ALCOHOL TEAM & Calderdale Substance Misuse Service COMMUNITY ALCOHOL DETOXIFICATION GUIDELINE CALDERDALE ALCOHOL TEAM & Calderdale Substance Misuse Service COMMUNITY ALCOHOL DETOXIFICATION GUIDELINE Unique Identifier Number: Approved By: NYA Effective From July 2010 Review Date: July 2012 Review

More information

Alcohol Dependence and Motivational Interviewing

Alcohol Dependence and Motivational Interviewing Alcohol Dependence and Motivational Interviewing Assessment of Alcohol Misuse Checklist Establish rapport patients are often resistant Longitudinal history of alcohol use Assess additional drug use Establish

More information

DRUG AND ALCOHOL DETOXIFICATION: A GUIDE TO OUR SERVICES

DRUG AND ALCOHOL DETOXIFICATION: A GUIDE TO OUR SERVICES 01736 850006 www.bosencefarm.co.uk DRUG AND ALCOHOL DETOXIFICATION: A GUIDE TO OUR SERVICES An environment for change Boswyns provides medically-led drug and alcohol assessment, detoxification and stabilisation.

More information

Alcohol. Problems with drinking alcohol

Alcohol. Problems with drinking alcohol Alcohol Alcoholism is a word which many people use to mean alcohol dependence (alcohol addiction). Some people are problem drinkers without being dependent on alcohol. If you are alcohol- dependent then

More information

Supported Alcohol Withdrawal Treatment Information

Supported Alcohol Withdrawal Treatment Information Supported Alcohol Withdrawal Treatment Information Alcohol Liaison Service What is Alcohol Withdrawal Syndrome? If you are dependent on alcohol and suddenly stop drinking or you are admitted to hospital

More information

Alcohol management York Service Alcohol management - medically assisted alcohol withdrawal and supported reduction

Alcohol management York Service Alcohol management - medically assisted alcohol withdrawal and supported reduction Alcohol management York Service Alcohol management - medically assisted alcohol withdrawal and supported reduction Version 4 JT January 2014 page 1 Alcohol Management York Service assessment of alcohol

More information

New York State Office of Alcoholism & Substance Abuse Services Addiction Services for Prevention, Treatment, Recovery

New York State Office of Alcoholism & Substance Abuse Services Addiction Services for Prevention, Treatment, Recovery New York State Office of Alcoholism & Substance Abuse Services Addiction Services for Prevention, Treatment, Recovery USING THE 48 HOUR OBSERVATION BED USING THE 48 HOUR OBSERVATION BED Detoxification

More information

GP Drug & Alcohol Supplement No.7 May 1997

GP Drug & Alcohol Supplement No.7 May 1997 GP Drug & Alcohol Supplement No.7 May 1997 This is the seventh of the monthly Drug and Alcohol Supplements prepared for Central Coast GPs. Detoxification from Alcohol Dr Tony Gill Introduction The management

More information

Alcohol Liaison Service. Alcohol Withdrawal. Information

Alcohol Liaison Service. Alcohol Withdrawal. Information Alcohol Liaison Service Alcohol Withdrawal Information Alcohol withdrawal If you are dependent on alcohol and suddenly stop drinking, there are a series of symptoms that you may experience. These include:

More information

ALCOHOL DETOXIFICATION (IN-PATIENTS) PRESCRIBING GUIDELINE

ALCOHOL DETOXIFICATION (IN-PATIENTS) PRESCRIBING GUIDELINE ALCOHOL DETOXIFICATION (IN-PATIENTS) PRESCRIBING GUIDELINE Authors Sponsor Responsible committee Ratified by Consultant Psychiatrist; Pharmacist Team Manager Medical Director Medicines Management Group

More information

2.6.4 Medication for withdrawal syndrome

2.6.4 Medication for withdrawal syndrome .6.3 Self-medication Self-medication presents a risk during alcohol withdrawal, particularly when there is minimal supervision (low level and medium level 1 settings). Inform patients of the risk of selfmedication

More information

A Guide to Alcoholism and Problem Drinking

A Guide to Alcoholism and Problem Drinking A Guide to Alcoholism and Problem Drinking Alcoholism is a word which many people use to mean alcohol dependence (alcohol addiction). Some people are problem drinkers without being dependent on alcohol.

More information

Alcoholism and Problem Drinking

Alcoholism and Problem Drinking Page 1 of 5 Alcoholism and Problem Drinking Alcoholism is a word which many people use to mean 'alcohol dependence' (alcohol addiction). Some people are 'problem drinkers' without being dependent on alcohol.

More information

Glasgow Assessment and Management of Alcohol

Glasgow Assessment and Management of Alcohol Glasgow Assessment and Management of Alcohol If you would like further information or advice on the alcohol screening and withdrawal management guideline(gmaws) please contact your local acute addiction

More information

Alcoholism and Problem Drinking

Alcoholism and Problem Drinking Page 1 of 5 Alcoholism and Problem Drinking Alcoholism is a word which many people use to mean alcohol dependence (alcohol addiction). Some people are problem drinkers without being dependent on alcohol.

More information

Public Health England. Alcohol & alcohol related harm

Public Health England. Alcohol & alcohol related harm Public Health England Alcohol & alcohol related harm Mission To protect and improve the nation s health and to address inequalities, working with national and local government, the NHS, industry, academia,

More information

Version 2 This guideline describes how to manage patients who are showing signs and symptoms of alcohol withdrawal and Wernicke s Encephalopathy.

Version 2 This guideline describes how to manage patients who are showing signs and symptoms of alcohol withdrawal and Wernicke s Encephalopathy. Title of Guideline (must include the word Guideline (not protocol, policy, procedure etc) Contact Name and Job Title (author) Directorate & Speciality A Guideline for the Management of Acute Alcohol Withdrawal

More information

INTOXICATED PATIENTS AND DETOXIFICATION

INTOXICATED PATIENTS AND DETOXIFICATION VAMC Detoxification Decision Tree Updated May 2006 INTOXICATED PATIENTS AND DETOXIFICATION Patients often present for evaluation of substance use and possible detoxification. There are certain decisions

More information

Naltrexone Shared Care Guideline for the treatment of alcohol dependence and opioid dependance

Naltrexone Shared Care Guideline for the treatment of alcohol dependence and opioid dependance Naltrexone Shared Care Guideline for the treatment of alcohol dependence and opioid dependance Introduction Indication/Licensing information: Naltrexone is licensed for use as an additional therapy, within

More information

Alcohol Withdrawal Syndrome & CIWA Assessment

Alcohol Withdrawal Syndrome & CIWA Assessment Alcohol Withdrawal Syndrome & CIWA Assessment Alcohol Withdrawal Syndrome is a set of symptoms that can occur when an individual reduces or stops alcoholic consumption after long periods of use. Prolonged

More information

Alcohol-use disorders: diagnosis, assessment and management of harmful drinking and alcohol dependence

Alcohol-use disorders: diagnosis, assessment and management of harmful drinking and alcohol dependence Alcohol-use disorders: diagnosis, assessment and management of harmful drinking and alcohol dependence Issued: February 2011 guidance.nice.org.uk/cg115 NICE has accredited the process used by the Centre

More information

SCOTTISH PRISON SERVICE DRUG MISUSE AND DEPENDENCE OPERATIONAL GUIDANCE

SCOTTISH PRISON SERVICE DRUG MISUSE AND DEPENDENCE OPERATIONAL GUIDANCE SCOTTISH PRISON SERVICE DRUG MISUSE AND DEPENDENCE OPERATIONAL GUIDANCE 1 P a g e The following Operational Guidance Manual has been prepared with input from both community and prison addictions specialists

More information

Alcohol information. A standard drink contains about 10g of alcohol takes a healthy liver about 1 hour to remove alcohol from the body.

Alcohol information. A standard drink contains about 10g of alcohol takes a healthy liver about 1 hour to remove alcohol from the body. Alcohol information Facts about alcohol use Alcohol (grog) is the most widely used recreational drug in Australia NT drinks 70% more and WA 25% more than the rest of Australia Alcohol related deaths for

More information

Alcohol detoxification

Alcohol detoxification Alcohol detoxification A guide to alcohol detoxification for service users and families. Stockton Treatment Alcohol and Recovery Service Alcohol dependence If you are dependent on alcohol then you will

More information

OUT-PATIENT DETOX CLINIC NEIL TURNER: ALCOHOL LIAISON NURSE

OUT-PATIENT DETOX CLINIC NEIL TURNER: ALCOHOL LIAISON NURSE OUT-PATIENT DETOX CLINIC NEIL TURNER: ALCOHOL LIAISON NURSE Introduction Admissions to hospital for alcohol detoxification in Skye and Lochalsh have been up to 78% higher than national average (www.scotpho.org))

More information

Alcohol-use disorders: alcohol dependence. Costing report. Implementing NICE guidance

Alcohol-use disorders: alcohol dependence. Costing report. Implementing NICE guidance Alcohol-use disorders: alcohol dependence Costing report Implementing NICE guidance February 2011 (February 2011) 1 of 37 NICE clinical guideline 115 This costing report accompanies the clinical guideline:

More information

Adjunctive psychosocial intervention. Conditions requiring dose reduction. Immediate, peak plasma concentration is reached within 1 hour.

Adjunctive psychosocial intervention. Conditions requiring dose reduction. Immediate, peak plasma concentration is reached within 1 hour. Shared Care Guideline for Prescription and monitoring of Naltrexone Hydrochloride in alcohol dependence Author(s)/Originator(s): (please state author name and department) Dr Daly - Consultant Psychiatrist,

More information

Alcohol-use disorders

Alcohol-use disorders Issue date: February 2011 Alcohol-use disorders Diagnosis, assessment and management of harmful drinking and alcohol dependence Alcohol dependence: NICE guideline FINAL DRAFT (February 2011) 1 NICE clinical

More information

ALCOHOL CARE PROVISION 2013

ALCOHOL CARE PROVISION 2013 . In 2013 NHS Health Scotland on behalf of the Scottish Government commissioned research by Iconic Consultants. The aim of the research was to assess the availability, demand, utilization and capacity

More information

Specialist Alcohol & Drug Services in Lanarkshire

Specialist Alcohol & Drug Services in Lanarkshire Specialist Alcohol & Drug Services in Lanarkshire This brochure describes what help is available within Lanarkshire s specialist treatment services. These include the North Lanarkshire Integrated Addiction

More information

Alcohol-use disorders

Alcohol-use disorders Issue date: February 2011 Alcohol-use disorders Diagnosis, assessment and management of harmful drinking and alcohol dependence Alcohol dependence: NICE guideline FINAL DRAFT (February 2011) 1 NICE clinical

More information

Outpatient Treatment of Alcohol Withdrawal. Daniel Duhigg, DO, MBA

Outpatient Treatment of Alcohol Withdrawal. Daniel Duhigg, DO, MBA Outpatient Treatment of Alcohol Withdrawal Daniel Duhigg, DO, MBA DSM V criteria for Alcohol Withdrawal A. Cessation or reduction of heavy/prolonged alcohol use B. 2 or more of the following in hours to

More information

Does This Hospital Serve Cocktails? Alcohol Withdrawal: A Nursing Perspective. Written and presented by: Susan Laffan, RN, CCHP-RN, CCHP-A

Does This Hospital Serve Cocktails? Alcohol Withdrawal: A Nursing Perspective. Written and presented by: Susan Laffan, RN, CCHP-RN, CCHP-A Does This Hospital Serve Cocktails? Alcohol Withdrawal: A Nursing Perspective Written and presented by: Susan Laffan, RN, CCHP-RN, CCHP-A Disclaimer: This speaker has no financial disclaimers to report.

More information

Treatment of Alcoholism

Treatment of Alcoholism Treatment of Alcoholism Why is it important Prevents further to body by getting people off alcohol. Can prevent death. Helps keep health insurance down. Provides assistance so alcoholics don t t have to

More information

Alcohol Abuse and Addiction Management Protocol

Alcohol Abuse and Addiction Management Protocol Alcohol Abuse and Addiction Management Protocol All Team Members: Patient Self-Management Education and Support Alcohol is the most commonly abused drug in the United States. About 18 million people in

More information

Alcohol addiction treatment

Alcohol addiction treatment Alcohol addiction treatment VERESIES CLINIC offers treatment of alcohol dependence. The program is offered both as an inpatient and outpatient program. It offers an intensive program of personal Psychological

More information

EPIDEMIOLOGY OF OPIATE USE

EPIDEMIOLOGY OF OPIATE USE Opiate Dependence EPIDEMIOLOGY OF OPIATE USE Difficult to estimate true extent of opiate dependence Based on National Survey of Health and Mental Well Being: 1.2% sample used opiates in last 12 months

More information

Corl Kerry - Referral and Assessment for Residential Treatment (Tier 4) Introduction Types of Tier 4 Services Services provided at Tier 4

Corl Kerry - Referral and Assessment for Residential Treatment (Tier 4) Introduction Types of Tier 4 Services Services provided at Tier 4 Corl Kerry - Referral and Assessment for Residential Treatment (Tier 4) This document seeks to name the criteria that can guide referrals to residential tier 4 facilities (Part A). It provides guidance

More information

Alcohol Addiction. Introduction. Overview and Facts. Symptoms

Alcohol Addiction. Introduction. Overview and Facts. Symptoms Alcohol Addiction Alcohol Addiction Introduction Alcohol is a drug. It is classed as a depressant, meaning that it slows down vital functions -resulting in slurred speech, unsteady movement, disturbed

More information

Comprehensive Behavioral Care, Inc. Level of Care Guidelines Substance Abuse Adult

Comprehensive Behavioral Care, Inc. Level of Care Guidelines Substance Abuse Adult Comprehensive ehavioral Care, Inc. delivery system that does not include sufficient alternatives to a particular LOC and a particular patient. Therefore, CompCare considers at least the following factors

More information

1. According to recent US national estimates, which of the following substances is associated

1. According to recent US national estimates, which of the following substances is associated 1 Chapter 36. Substance-Related, Self-Assessment Questions 1. According to recent US national estimates, which of the following substances is associated with the highest incidence of new drug initiates

More information

Opiate Abuse and Mental Illness

Opiate Abuse and Mental Illness visited on Page 1 of 5 LEARN MORE (HTTP://WWW.NAMI.ORG/LEARN-MORE) FIND SUPPORT (HTTP://WWW.NAMI.ORG/FIND-SUPPORT) GET INVOLVED (HTTP://WWW.NAMI.ORG/GET-INVOLVED) DONATE (HTTPS://NAMI360.NAMI.ORG/EWEB/DYNAMICPAGE.ASPX?

More information

Audit of Alcohol Detoxification Prescribing Observatory for Mental Health (POMH-UK) Regional Event

Audit of Alcohol Detoxification Prescribing Observatory for Mental Health (POMH-UK) Regional Event Audit of Alcohol Detoxification Prescribing Observatory for Mental Health (POMH-UK) Regional Event Wakefield 4th December 2013 definition and guidance Duncan Raistrick Leeds Addiction Unit Detoxification

More information

Title: How to manage risky drinkers in Primary Health Care. Authors: Acknowledgements:

Title: How to manage risky drinkers in Primary Health Care. Authors: Acknowledgements: Title: How to manage risky drinkers in Primary Health Care Authors: Acknowledgements: This guide has been writen in accordance with the criteria of the PHEPA Training Programme on identification and brief

More information

Alcohol Withdrawal. Introduction. Blood Alcohol Concentration. DSM-IV Criteria/Alcohol Abuse. Pharmacologic Effects of Alcohol

Alcohol Withdrawal. Introduction. Blood Alcohol Concentration. DSM-IV Criteria/Alcohol Abuse. Pharmacologic Effects of Alcohol Pharmacologic Effects of Alcohol Alcohol Withdrawal Kristi Theobald, Pharm.D., BCPS Therapeutics III Fall 2003 Inhibits glutamate receptor function (NMDA receptor) Inhibits excitatory neurotransmission

More information

Co-morbid physical disorders e.g. HIV, hepatitis C, diabetes, hypertension. Medical students will gain knowledge in

Co-morbid physical disorders e.g. HIV, hepatitis C, diabetes, hypertension. Medical students will gain knowledge in 1.0 Introduction Medications are used in the treatment of drug, alcohol and nicotine dependence to manage withdrawal during detoxification, stabilisation and substitution as well as for relapse prevention,

More information

Alcoholism. Alcoholism is a type of drug addiction. There is both physical and mental dependence on alcohol.

Alcoholism. Alcoholism is a type of drug addiction. There is both physical and mental dependence on alcohol. Alcoholism Alcoholism Alcohol dependence; Alcohol abuse Definition Alcoholism is drinking alcoholic beverages at a level that interferes with physical health, mental health, and social, family, or job

More information

BARKING & DAGENHAM COMMUNITY ALCOHOL TEAM

BARKING & DAGENHAM COMMUNITY ALCOHOL TEAM CRI Barking & Dagenham Community Alcohol Service St Luke s Centre Dagenham Road Dagenham RM10 7UP Tel 0208 595 1375 Fax 0208 595 1445 BARKING & DAGENHAM COMMUNITY ALCOHOL TEAM ALCOHOL DETOXIFICATION ON

More information

Improving Outcomes in Patients Who are Prescribed Alprazolam with Concurrent Use of Opioids

Improving Outcomes in Patients Who are Prescribed Alprazolam with Concurrent Use of Opioids Improving Outcomes in Patients Who are Prescribed Alprazolam with Concurrent Use of Opioids Pik-Sai Yung, M.D. Staff Psychiatrist Center for Counseling at Walton Background and Rationale Alprazolam is

More information

Treating harmful drinking and alcohol dependence

Treating harmful drinking and alcohol dependence Understanding NICE guidance Information for people who use NHS services Treating harmful drinking and alcohol dependence NICE clinical guidelines advise the NHS on caring for people with specific conditions

More information

The CCB Science 2 Service Distance Learning Program

The CCB Science 2 Service Distance Learning Program S2S 2055 DETOXIFICATION Module 1 Post-Test 1. A common use of a biochemical marker is. a. to support or refute other information that leads to proper diagnosis b. for forensic purposes c. in detecting

More information

Naltrexone Pellet Treatment for Opiate, Heroin, and Alcohol Addiction. Frequently Asked Questions

Naltrexone Pellet Treatment for Opiate, Heroin, and Alcohol Addiction. Frequently Asked Questions Naltrexone Pellet Treatment for Opiate, Heroin, and Alcohol Addiction Frequently Asked Questions What is Naltrexone? Naltrexone is a prescription drug that effectively blocks the effects of heroin, alcohol,

More information

Alcohol Withdrawal Recognition and Treatment

Alcohol Withdrawal Recognition and Treatment Alcohol Withdrawal Recognition and Treatment Thomas Meyer BS EMS, MICP SREMSC Page 1 Purpose As EMTs a mantle of responsibility is placed upon you to ensure the safety and well-being of those in your charge

More information

a five-day medically supervised residential detoxification programme

a five-day medically supervised residential detoxification programme Substance PICU and Acute Misuse and Services Detox Services Psychiatric Cygnet Hospital Intensive Harrogate Care and Acute services a five-day medically supervised residential detoxification programme

More information

Substance Use Learning Event Nov 3, 2015 Bill Bullock MD, CCFP

Substance Use Learning Event Nov 3, 2015 Bill Bullock MD, CCFP Substance Use Learning Event Nov 3, 2015 Bill Bullock MD, CCFP Medical assessment of patient with Alcohol Use Disorder Identification patients suitable for home detox Process for referral to inpatient

More information

Brief guide: substance misuse services detoxification or withdrawal from drugs or alcohol

Brief guide: substance misuse services detoxification or withdrawal from drugs or alcohol Brief guide: substance misuse services detoxification or withdrawal from drugs or alcohol Context Detoxification or withdrawal is a key stage in achieving abstinence for people who are dependent on drugs

More information

CO-OCCURRING DISORDERS. Michaelene Spence MA LADC 8/8/12

CO-OCCURRING DISORDERS. Michaelene Spence MA LADC 8/8/12 CO-OCCURRING DISORDERS Michaelene Spence MA LADC 8/8/12 Activity Chemical Health? Mental Health? Video- What is Addiction HBO Terminology MI/CD: Mental Illness/Chemical Dependency IDDT: Integrated Dual

More information

Alcohol Withdrawal. Mild Withdrawal Moderate Withdrawal Severe Withdrawal. Mild anxiety Malaise Marked anxiety

Alcohol Withdrawal. Mild Withdrawal Moderate Withdrawal Severe Withdrawal. Mild anxiety Malaise Marked anxiety Alcohol Withdrawal Recognition and Assessment Alcohol withdrawal may be a presenting feature or occur as an unexplained development in a patient who has been admitted for other reasons and deprived of

More information

Alcohol and nicotine are widely abused substances and are often used together One study showed that 15% of patients visiting a primary care practice

Alcohol and nicotine are widely abused substances and are often used together One study showed that 15% of patients visiting a primary care practice Dr IM Joubert Alcohol and nicotine are widely abused substances and are often used together One study showed that 15% of patients visiting a primary care practice for any reason had either an at-risk pattern

More information

Health Care Service System in Thailand for Patients with Alcohol Use Disorder

Health Care Service System in Thailand for Patients with Alcohol Use Disorder Health Care Service System in Thailand for Patients with Alcohol Use Disorder Health Care Service System In Thailand Screening for alcohol use disorder and withdrawal syndrome AUDIT MAST CAGE CIWA or AWS

More information

TREATMENT MODALITIES. May, 2013

TREATMENT MODALITIES. May, 2013 TREATMENT MODALITIES May, 2013 Treatment Modalities New York State Office of Alcoholism and Substance Abuse Services (NYS OASAS) regulates the addiction treatment modalities offered in New York State.

More information

Development and Implementation of an Evidence-Based Alcohol Withdrawal Order Set. Kathleen Lenaghan MSN, RN-BC

Development and Implementation of an Evidence-Based Alcohol Withdrawal Order Set. Kathleen Lenaghan MSN, RN-BC Development and Implementation of an Evidence-Based Alcohol Withdrawal Order Set Kathleen Lenaghan MSN, RN-BC 1 2 Genesis Medical Center Davenport, Iowa Objectives Identify the process of developing and

More information

SOMERSET DUAL DIAGNOSIS PROTOCOL OCTOBER 2011

SOMERSET DUAL DIAGNOSIS PROTOCOL OCTOBER 2011 SOMERSET DUAL DIAGNOSIS PROTOCOL OCTOBER 2011 This document is intended to be used with the Somerset Dual Diagnosis Operational Working guide. This document provides principles governing joint working

More information

Prescribing for substance misuse: alcohol detoxification

Prescribing for substance misuse: alcohol detoxification Prescribing for substance misuse: alcohol detoxification POMH-UK Quality Improvement Programme. Topic 14a: baseline Prepared by the Prescribing Observatory for Mental Health-UK for Kent and Medway NHS

More information

methadonefact.qxd 8/11/01 2:05 PM Page 1 INFORMATION Advantages of methadone treatment DEPRESSANT Methadone maintenance Pregnancy METHADONE

methadonefact.qxd 8/11/01 2:05 PM Page 1 INFORMATION Advantages of methadone treatment DEPRESSANT Methadone maintenance Pregnancy METHADONE methadonefact.qxd 8/11/01 2:05 PM Page 1 INFORMATION Advantages of methadone treatment 10 DEPRESSANT Methadone maintenance Pregnancy METHADONE methadonefact.qxd 8/11/01 2:05 PM Page 2 WHAT IS METHADONE

More information

COMMUNITY BUPRENORPHINE PRESCRIBING IN OPIATE DEPENDENCE

COMMUNITY BUPRENORPHINE PRESCRIBING IN OPIATE DEPENDENCE COMMUNITY BUPRENORPHINE PRESCRIBING IN OPIATE DEPENDENCE INTRODUCTION High dose sublingual buprenorphine (Subutex) tablets are available in the following strengths 0.4 mg, 2 mg, and 8 mg. Suboxone tablets,

More information

Treatments for drug misuse

Treatments for drug misuse Understanding NICE guidance Information for people who use NHS services Treatments for drug misuse NICE clinical guidelines advise the NHS on caring for people with specific conditions or diseases and

More information

The University of Toledo - Main Campus Policy

The University of Toledo - Main Campus Policy The University of Toledo - Main Campus Policy IV-12 3360-30-12 Alcohol and Substance Abuse. (A) Alcohol and drug abuse policy statement The University of Toledo is committed to promoting and maintaining

More information

Naltrexone and Alcoholism Treatment Test

Naltrexone and Alcoholism Treatment Test Naltrexone and Alcoholism Treatment Test Following your reading of the course material found in TIP No. 28. Please read the following statements and indicate the correct answer on the answer sheet. A score

More information

Getting help for a drug problem A guide to treatment

Getting help for a drug problem A guide to treatment Getting help for a drug problem A guide to treatment Who we are The National Treatment Agency for Substance Misuse is part of the National Health Service. We were set up in 2001 to increase the numbers

More information

TAMESIDE & GLOSSOP NATIONAL ENHANCED SERVICE FOR ALCOHOL MISUSERS

TAMESIDE & GLOSSOP NATIONAL ENHANCED SERVICE FOR ALCOHOL MISUSERS TAMESIDE & GLOSSOP NATIONAL ENHANCED SERVICE FOR ALCOHOL MISUSERS THE NEW G.P. CONTRACT The new GP contract Provision of specialist services Minor surgery; depression; drug dependency Payments Accreditation

More information

Cambridgeshire Community Services NHS Trust: delivering excellence in drug services across Luton as part of the ResoLUTiONs Pathway

Cambridgeshire Community Services NHS Trust: delivering excellence in drug services across Luton as part of the ResoLUTiONs Pathway Respite House Alcohol Detox Client Information Sheet Cambridgeshire Community Services NHS Trust: delivering excellence in drug services across Luton as part of the ResoLUTiONs Pathway Respite House client

More information

Kanawha Valley Fellowship Home

Kanawha Valley Fellowship Home Kanawha Valley Fellowship Home Client Assessment Form Date: Time: Assessment Taken Caller s Name: Agency (if applicable) Address: County: Relationship to Patient: Phone # Client s Name: Age: D.O.B.: Current

More information

Residential Sub-Acute Detoxification Guidelines

Residential Sub-Acute Detoxification Guidelines I. Background Information A. Definition of Detoxification Residential Sub-Acute Detoxification Guidelines SAMSA s TIP #45, Detoxification and Substance Abuse Treatment: Treatment Improvement Protocols

More information

This controlled document shall not be copied in part or whole without the express permission of the author or the author s representative.

This controlled document shall not be copied in part or whole without the express permission of the author or the author s representative. Title: Staff Guidelines For The Management Of Alcohol Withdrawal In NHS Grampian Adult ( Age 18) Inpatients Unique Identifier: Replaces: (provided by the NHS Grampian Review Group for Clinical Process

More information

Prevention and treatment of alcohol misuse

Prevention and treatment of alcohol misuse Prevention and treatment of alcohol misuse Liz Burns Public Health Development Advisor elizabeth.burns@mhsc.nhs.uk Alison Rodriguez alison.rodriguez@mhsc.nhs.uk Head of Service Community Alcohol Team and

More information

DrugFacts: Treatment Approaches for Drug Addiction

DrugFacts: Treatment Approaches for Drug Addiction DrugFacts: Treatment Approaches for Drug Addiction NOTE: This is a fact sheet covering research findings on effective treatment approaches for drug abuse and addiction. If you are seeking treatment, please

More information

Alcohol. And Your Health. Psychological Medicine

Alcohol. And Your Health. Psychological Medicine Alcohol And Your Health Psychological Medicine Introduction Alcohol, when used in moderation and as part of a healthy lifestyle, can have beneficial effects for some people, particularly in the prevention

More information

Maintenance of abstinence in alcohol dependence

Maintenance of abstinence in alcohol dependence Shared Care Guideline for Prescription and monitoring of Acamprosate Calcium Author(s)/Originator(s): (please state author name and department) Dr Daly - Consultant Psychiatrist, Alcohol Services Dr Donnelly

More information

Locally Enhanced Service for a practice-based Alcohol Monitoring, Withdrawal and Detoxification Service

Locally Enhanced Service for a practice-based Alcohol Monitoring, Withdrawal and Detoxification Service 08/09 Locally Enhanced Service for a practice-based Alcohol Monitoring, Withdrawal and Detoxification Service Reference: LES24 Contents: 1. Finance Details 2. Service Aims 3. Service Criteria 4. Ongoing

More information

Update and Review of Medication Assisted Treatments

Update and Review of Medication Assisted Treatments Update and Review of Medication Assisted Treatments for Opiate and Alcohol Use Disorders Richard N. Whitney, MD Medical Director Addiction Services Shepherd Hill Newark, Ohio Medication Assisted Treatment

More information

Alcohol Use Disorders Information for Patients and Carers

Alcohol Use Disorders Information for Patients and Carers Alcohol Liaison Service Alcohol Use Disorders Information for Patients and Carers Information Drinking too much alcohol greatly increases your risk of serious health problems. Many different health problems

More information

Prescribing for substance misuse: Alcohol detoxification

Prescribing for substance misuse: Alcohol detoxification Prescribing for substance misuse: Alcohol detoxification Dr Julia Sinclair Senior Lecturer in Psychiatry University of Southampton Previously: Sensible Hazardous Harmful Dependence Current: Lower Risk

More information

Table of Contents. I. Introduction... 2. II. Summary... 3. A. Total Drug Intoxication Deaths... 5. B. Opioid-Related Deaths... 9

Table of Contents. I. Introduction... 2. II. Summary... 3. A. Total Drug Intoxication Deaths... 5. B. Opioid-Related Deaths... 9 Table of Contents I. Introduction... 2 II. Summary... 3 III. Charts A. Total Drug Intoxication Deaths... 5 B. Opioid-Related Deaths... 9 C. Heroin-Related Deaths... 11 D. Prescription Opioid-Related Deaths...

More information

Alcohol & Chemical Dependence. Chisoo Choi, M.D. Internal Medicine Consultant Brookhaven Hospital Tulsa, Oklahoma

Alcohol & Chemical Dependence. Chisoo Choi, M.D. Internal Medicine Consultant Brookhaven Hospital Tulsa, Oklahoma Alcohol & Chemical Dependence Chisoo Choi, M.D. Internal Medicine Consultant Brookhaven Hospital Tulsa, Oklahoma Objectives Increased awareness of alcohol and chemical dependence problems Hallmarks of

More information

These guidelines are intended to support General Practitioners in the care of their patients with dementia both in the community and in care homes.

These guidelines are intended to support General Practitioners in the care of their patients with dementia both in the community and in care homes. This is a new guideline. These guidelines are intended to support General Practitioners in the care of their patients with dementia both in the community and in care homes. It incorporates NICE clinical

More information

Resources for the Prevention and Treatment of Substance Use Disorders

Resources for the Prevention and Treatment of Substance Use Disorders Resources for the Prevention and Treatment of Substance Use Disorders Table of Contents Age-standardized DALYs, alcohol and drug use disorders, per 100 000 Age-standardized death rates, alcohol and drug

More information

Benzodiazepines. benzoes, downers, sleepers, rohies, roofies, moggies, sarahs, footballs, normies

Benzodiazepines. benzoes, downers, sleepers, rohies, roofies, moggies, sarahs, footballs, normies 3 Benzodiazepines benzoes, downers, sleepers, rohies, roofies, moggies, sarahs, footballs, normies Benzodiazepines belong to a group of central nervous system depressants (see definition on page 2) called

More information

NHS FORTH VALLEY. Guidance on Alcohol Dependence: Maintenance of Abstinence. Contact: Valerie Kippen Area Drug & Therapeutics Committee

NHS FORTH VALLEY. Guidance on Alcohol Dependence: Maintenance of Abstinence. Contact: Valerie Kippen Area Drug & Therapeutics Committee NHS FORTH VALLEY Guidance on Alcohol Dependence: Maintenance of Abstinence Approved 06/09/2012 Version 5.0 Date of First Issue February 2008 Review Date 06/09/2014 Current Issue Date 26/11/2012 EQIA Yes

More information

Box 1: Screening and brief interventions ASSESS elicit patient s concerns how does alcohol fit in? ELICIT AND RECORD typical day s drinking maximum in a day alcohol related physical, emotional and social

More information

ALCOHOL WITHDRAWAL SYNDROME

ALCOHOL WITHDRAWAL SYNDROME ALCOHOL WITHDRAWAL SYNDROME INTRODUCTION Alcohol is the most commonly abused drug in the United States and when someone who chronically abuses alcohol does not drink, that person is at risk for developing

More information

Management of benzodiazepine misuse

Management of benzodiazepine misuse York Service Management of benzodiazepine misuse Version 2 JT July 2013 page 1 background Note: not all those who use benzodiazepines are dependent, and not all those who are dependent will benefit from

More information

Alcohol Withdrawal Syndromes

Alcohol Withdrawal Syndromes Alcohol Withdrawal Syndromes Should You Treat This Patient s Alcohol Withdrawal With Benzodiazepines?! Meta-analysis of RCTs of benzodiazepines for the treatment of alcohol withdrawal! 11 RCTs identified,

More information

DETOXING THE DEPENDENT DRINKER ON METHADONE JEFF FERNANDEZ NURSE CONSULTANT FOR SUBSTANCE MISUSE ISLINGTON

DETOXING THE DEPENDENT DRINKER ON METHADONE JEFF FERNANDEZ NURSE CONSULTANT FOR SUBSTANCE MISUSE ISLINGTON DETOXING THE DEPENDENT DRINKER ON METHADONE JEFF FERNANDEZ NURSE CONSULTANT FOR SUBSTANCE MISUSE ISLINGTON BACKGROUND Substance misuse services Prescribing conducted by: IDASS PCADS ISIS Tier two provision:

More information

Like cocaine, heroin is a drug that is illegal in some areas of the world. Heroin is highly addictive.

Like cocaine, heroin is a drug that is illegal in some areas of the world. Heroin is highly addictive. Heroin Introduction Heroin is a powerful drug that affects the brain. People who use it can form a strong addiction. Addiction is when a drug user can t stop taking a drug, even when he or she wants to.

More information

ADVANCED BEHAVIORAL HEALTH, INC. Clinical Level of Care Guidelines - 2015

ADVANCED BEHAVIORAL HEALTH, INC. Clinical Level of Care Guidelines - 2015 The Clinical Level of Care Guidelines contained on the following pages have been developed as a guide to assist care managers, physicians and providers in making medical necessity decisions about the least

More information

opiates alcohol 27 opiates and alcohol 30 April 2016 drug addiction signs 42 Ranked #1 123 Drug Rehab Centers in New Jersey 100 Top 10 380

opiates alcohol 27 opiates and alcohol 30 April 2016 drug addiction signs 42 Ranked #1 123 Drug Rehab Centers in New Jersey 100 Top 10 380 opiates alcohol 27 opiates and alcohol 30 April 2016 drug addiction signs 42 ed #1 123 Drug Rehab Centers in New Jersey 100 Top 10 380 effects of alcohol in the brain 100 Top 30 698 heroin addiction 100

More information