This page is primarily intended for health care professionals working with seniors.

Home Detoxification

What is Home Detoxification?

Like its name suggest, home detoxification, occurs in a person’s home, as opposed to a clinic or hospital. However home detoxification is more than a place where withdrawal occurs, it is a process where patients, their carers (professional, voluntary and domestic), families and friends are all involved. One of the aims is more personal control over the process (empowerment) and increased compliance. (14)

As with other detoxification, the focus is on the safe elimination of toxic substances from a person’s body. The goal of home detoxification is:

1. to provide service to a population that otherwise would not go to detoxification centre;
2. provide support to those who do not enter detox centres; and
3. provide follow-up to detoxification, particularly for people who may be binge drinkers and very prone to relapse.

The length of the process is dependent on the length of time the person has been using a substance and the quantities he or she consumes on a regular basis. It is a specific clinical procedure and is managed by qualified personnel who have specifically trained and supervised. (15)

Home detoxification has been in use in the United Kingdom since the late1980s (16) and somewhat later in Australia. Research indicates that home detoxification is safe and works as well as inpatient care (certainly for younger adults). (17)

Clients, family, and general practitioners tend to be highly satisfied with the results. In one evaluation, the great majority of clients gave "home" as their preferred place of treatment and nearly half claimed they would have been unwilling to accept hospital care. (18)

Compared to other studies, home detoxification clients and their partners are to be more likely to continue with treatment after the home detoxification. Those clients who had fewer alcohol related problems to begin with, and those who attended after-care alone or with their spouse/partner seem to do the best. (19)

The literature suggests that in many instances, effective home detoxification can be considered when (20):

• there is no evidence of severe withdrawal, e.g .tremor, hallucinations, disorientation where there is no past history of delirium tremens or of seizures;
• in the presence of supportive relatives who elect to stay with the patient during the period of detoxification;
• where there is no evidence of a medical illness such as pneumonia or pancreatitis;
• when no previous history or evidence of suicide is contemplated;
• where the patient does not have any access to the drug from which they are being withdrawn.

Principles of Home Detoxification (1)

1. The general philosophy of home detoxification is to provide withdrawal from a substance in an atmosphere which is familiar and comfortable to the client. This can be the person’s own home, the home of a supportive relative or friend, or the home of a volunteer.
2. Home detoxification is a planned process. Information must be collected and initial steps completed before a date is set to begin the actual acute withdrawal stage.
3. The detoxification process is managed by the home detoxification team (client, nurse, family and Detox physician, outreach counsellor, and caregivers)
4. The client is assessed and monitored throughout the withdrawal process, to evaluate and respond to his or her needs as they change through the withdrawal process.
5. The client is supported by positive, non-judgmental staff during this process.
6. The client is linked to an outreach counsellor or treatment programme, as part of the continuum of treatment.

Advantages To Detoxing At Home (2):

Home detoxification has been seen as having a variety of advantages. First, home detox ensures that the client can remain within and make full use of the home and family support. At the same time, it enables the family and others affected by the person’s drinking both to give support and be supported.

Second, it enhances the continuing care process during the involvement of the primary worker and the nurse specialist.

Third, it may be helpful where the person has had unpleasant experiences with in patient detox.

Fourth, it may have certain financial advantages. The financial advantages are minimal or non-existent, if we are only looking at the straight cost of detoxification; but it is important to look at the hidden costs (such as hospitalization) associated with not detoxifying.

Disadvantages to Detoxing at Home

The home environment can contain a number of triggers: it could be that alcohol consumption normally occurs at home; or access to alcohol may be easy there. (3) There are many dangers to unsupervised home detox- particularly if the person has access to prescribed medication and alcohol. (4)

References

(1) Notes from Senior Well Aware Program, Vancouver, B.C. Home Detoxification Training Materials.

(2) D.B. Cooper (1994) Alcohol Home Detoxification and Assessment (New York: Radcliffe Medical Press) at 16.

(3) Ibid. at 19.

(4) Ibid.