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An article by David B Cooper
NCA Outstanding Contribution to Nursing Award in 2003
Here is an informative article written for 1-1 detox by David Cooper, one of the world’s top authorities on home detox, in which he summarises some of his research into its benefits and applications. Specifically, David assesses the clinical effectiveness of home detoxification versus in-patient detoxification.
 David Cooper’s background and credentials
Advantages of home detox over in-patient detoxification
It has long been recognised that the psychiatric ward in not the correct place for alcohol detoxification as predominately those who require in-patient care are in danger of a medical emergency juxtaposed to psychiatric emergency. Moreover, admissions tend to extend far beyond the required intervention oft-times from 14, and more usually, 28 days in-patient care – when the average duration for alcohol withdrawal requiring a medication regime is 9 days.
I am pleased to say that the custom and practice of in-patient detoxification has now been overtaken by home detoxification and detoxification protocols are being developed, meeting individual needs specific to the areas served, not only in the UK but in Australia, Canada, USA and Europe to name but a few!
It is now established that of those identified as requiring supervised alcohol detoxification – and we have to be aware that a high number referred for such treatment do not require any clinical monitoring – on average only 10-30% require in-patient detoxification. This group comprises of those individuals who are primarily at serious risk of DT’s and seizures. The remaining 70-90% can be safely detoxed within the home or other community environment provided that the detoxification is supervised and monitored by an appropriately trained and qualified individual.
Additional advantages include:
- client and family satisfaction
- improved treatment outcome
- GP and other worker satisfaction
- cost-effective- in terms of length on intervention and treatment, and successful treatment outcome, thus reducing the bed occupancy and relapse requiring additional intervention and treatment.
Research studies into advantages in home detox
Many studies have concluded that the above advantages in home detoxification outweigh the formerly traditional in-patient regime. The WHO Process Evaluation workbook related to the work I undertook in Suffolk. This followed on from my work in Blackburn and Colchester where I developed and evaluated home detoxification services – in the former from a non-service provision and the latter from a traditional alcohol treatment unit. The difference with the Suffolk project was that it was a voluntary sector service employing a qualified nurse(s) to develop and undertake home detoxification and assessment rather than NHS funded projects.
Focus of the Suffolk research project
The Suffolk project looked specifically at the:
- number of inappropriate referrals:
- impact of education and training on appropriate referrals:
- cost-effectiveness in comparison to in-patient treatment and intervention:
- client and family satisfaction:
- GP and other professional satisfaction:
- advantage of home detoxification over in-patient detoxification in terms of bed occupancy and effectiveness of treatment.
Research findings
The Suffolk report revealed similar patterns to the Blackburn and Colchester projects and others throughout the UK and Australia. It concluded that in the overall advantages in each of the above areas, home detoxification outweighed the advantages of in-patient care. Specifically in terms of:
- reduction in length of client engagement:
- improved treatment outcome and reduced relapse:
- improved treatment compliance - as you know, many patients within the psychiatric unit or specialist units discharge before completion of treatment:
- overall satisfaction:
- more cost-effective than in-patient care.
Author’s summary
I perhaps need to state at this point that for a minority, in-patient detoxification is the only option and that there is a need to accommodate these individuals. Alcohol withdrawal inappropriately managed can be life threatening. However, for the majority, correctly monitored and supervised, using a reducing level of intervention and medication as symptoms dictated, by a qualified individual, is far more effective and beneficial to the individual, the family and the service.
I should stress that alcohol detoxification is only the beginning of any intervention and not the end. The advantage of home detoxification is that the worker can commence other interventions and therapies as the individual feels able. At the same time, family work can be undertaken as well as valuable support. In addition, preparation for the final withdrawal from client work can commence at the beginning of treatment and preparation for the identification of, and relapse interventions, can be in place before the final client and family withdrawal.
This is a tremendous advantage over in-patient care where the individual is cocooned from many of the problems that interact with his or her alcohol consumption / problem, and from family issues that could usefully be explored and addressed quickly. Traditionally, as an inpatient, the individual remains in hospital for up to 28 days, sometimes even more. Unusually, there are no staff trained to offer adequate intervention and there is an inbred suspicion that the individual may be drinking that seems almost endemic in psychiatric unit. Therefore, there is little therapeutic intervention and the individual does not address the issues that are important to him or her. On discharge, he or she returns the home environment without hope or coping strategies to deal with the alcohol problem and arising issues. Relapse is usually inevitable. However, a correctly supervised home detoxification and therapeutic intervention avoid this unnecessary impact on the patient, family and services.
I hope the above helps to clarify my understanding and position of home detoxification. I am pleased to say that this treatment option is now standard in the UK and elsewhere. Over the past 22 years it has been developed as a serious option to in-patient care. Many scientific research papers, of which I have indicated only a few below, support this approach for appropriately identified individuals. They acknowledge that it is the preferred option and that in-patient care should only be offered for those who are likely to experience a medical emergency during the alcohol withdrawal period.
Books and research papers on home detox
Addictions treatable with home detox
Home detox facts
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