Emergency Room, Inpatient Detox, Inpatient Medical Unit with Detoxification, Inpatient “Dual Diagnosis”
or Psychiatric Hospitalization with Detoxification
- Emergency Room:
The emergency room (ER) is ideally the most short term level of care. For patients with either severe substance use problems, co-morbid medical or psychiatric issues, the multidisciplinary staff in the emergency room can provide acute, life-saving care and also help patients determine the appropriate next steps in treatment. There may be instances in which patients and family can avoid the ER by contacting detoxes or outpatient clinics directly, but when safety concerns arise or there is any doubt about the best course, the ER is a safe option.
- Inpatient Detoxification:
For many patients with primary alcohol, benzodiazepines or opioid use disorders, stopping on one’s own is at best extremely uncomfortable and at worse medically unsafe. For that reason, patients and families may seek medically-assisted detoxification. Detoxification for alcohol or benzodiazepines is usually accomplished under medical monitoring with a relatively brief course of prescribed benzodiazepines. For opioid use disorders, the same process is accomplished usually using methadone or buprenorphine, and in many cases one of these medications can be continued as part of a successful maintenance treatment, which is true at all levels of care including those below. For most patients lacking significant, co-morbid psychiatric or medical issues, there are various detoxification centers around the city and state that can withdrawal patients safely from these substances and help them connect with residential or outpatient addiction treatment.
- Inpatient Medical Unit with detoxification:
For patients admitted to general medical floors from the emergency room due to comorbid medical issues or very complicated withdrawal needs, this setting allows for the maximum intensity of medical monitoring and interventions. Of note, patients with severe co-morbid psychiatric needs can also be held safely in these settings if other medical needs require it (and visited by a consulting psychiatrist), but for such patients a transition to a psychiatric unit is ideal as soon as they are more stable medically.
- Inpatient “Dual Diagnosis” or psychiatric hospitalization with detoxification:
Locked inpatient psychiatric units, especially those located inside general medical hospitals, are usually able to provide detoxification services, as well as high intensity psychiatric interventions for co-morbid disorders. These settings will usually provide greater access to milieu therapy, group and individual therapy in addition to medication adjustments and other treatments. Of notes, general psychiatric units in medical hospitals are generally assumed to provide “dual-diagnosis” care alongside care of other patients with mental illness, but there also exist locked units set up specifically to provide care for patients with co-morbid addiction and other mental health needs.