PILOT PROGRAM TAKES DETOX TO THE HOME

Clients Visited Daily By Withdrawal Program's Staff

VANCOUVER - Substance abusers in the Fraser Valley can undergo
detoxification within the comfort of their own homes, with a pilot project
initiated by the local health authority.

The Home Withdrawal and Management Program gives addicts who are 19 years
and older the opportunity to manage their addictions at home with the help
of a community nurse.

The program was introduced by Maple Cottage Detox Centre, a 22-bed facility
that provides withdrawal management for men and women, and focuses on
giving substance abusers more autonomy.

"If the client has a safe, supportive home environment, and they have a
caregiver in their home who is willing to participate in the early
discharge follow-up program, then we provide them with the information on
how this program works," said Susan McKela, manager of health services as
the detox centre.

"If they meet our criteria . . . a stable home environment, a caregiver at
home and no medical issues that would alert us to the fact that their
withdrawal management needed to be managed at the centre . . .then we
discuss how to manage their detox at home."

Upon acceptance, clients are visited at home daily for by one of the two
program nurses. For six months the nurse provides counselling on nutrition,
assesses any physical problems related to the detoxification process and
makes recommendations for any referrals that may be needed.

The pilot project can deal with all addictions, although how to provide
methadone maintenance is still under discussion.

"We have to look at previous attempts at withdrawal and anticipated medical
issues that might occur," said McKela.

"If they do need 24-hour medical care, they wouldn't meet the criteria for
home detox. Within the first 24 hours of coming to the cottage, they're
assessed by the physicians.

The first client was admitted in January. Since then, six more have joined
the program.

"This is like being in the real world for these clients," she said.

Coping skills

"When things come up at home, they have to cope. They keep a daily log and
the discharge nurse will go over that with them and help them, or figure
out a way to help them do things differently. Once they've completed their
detox, a social worker at our facility can help if there is a need for
ongoing referral to other services."

Nurse clinician Rennie Celaya said education is key to success, for both
caregiver and client. At the initial meeting, clients are given a list of
over-the-counter medications such as Tylenol and Epsom salts to help
alleviate the physical symptoms of withdrawal. A link is established with
the GP and a specialist should the need arise.

"The whole project is tailored to the individual's needs," said Celaya.
"Every day, we're providing handouts with information on nutrition as well
as information on their particular addiction and the withdrawal symptoms
they can expect. It's important for them to know what will happen to their
body as they go through the withdrawal process.

"We look at nutrition, exercise, leisure, spirituality, sleep and
relationships. We look at daily emotional and medical status as well, and
make ourselves available to the patients via cell phone every day between
10 a.m. and 2 p.m. Maple Cottage is also available to them."

Followup is done three months after discharge from the program, said
McKela. The goal is to give patients more autonomy, and ideally, some
insight into the nature of their addiction.