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Department of Human Services (DHS) Division of Addiction Services (DAS) Information Systems ... - page 3 / 21

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DIMENSION 1: ACUTE INTOXICATION/WITHDRAWAL

PROCEED TO NEXT DIMENSION IF (a) OR (b):

____ a. There is no recent use; OR

____ b. No indication of acute intoxication or withdrawal problems.

LEVEL I-D – OUTPATIENT DETOXIFICATION

Status characterized by (a) and (b) and (c):

a. Minimal risk for severe withdrawal as evidenced by any of the following:

1.

.CIWA-Ar < 8 after 8-24 hours of abstinence from alcohol; OR

2.

Any recent use of sedative hypnotics was at therapeutic levels and not complicated by daily use of   

a.

alcohol or other drugs known to have a significant withdrawal syndrome; OR   

3.

withdrawing from therapeutic doses of sedative hypnotics, but no evidence of other active

a.

alcohol/drug abuse or dependence, and withdrawal symptoms have responded to, or are likely to

b.

respond to, substitute doses of sedative-hypnotics in the therapeutic range within 2 hours; OR              

4.

Injectable or smoked heroin has not been used daily for more than 2 weeks preceding admission or use of opiates is near the therapeutically recommended level; OR

5.

Gradual detoxification of opioid maintenance therapy, or treatment for mild withdrawal symptoms; OR

6.

Stimulant withdrawal with some lethargy, agitation, paranoia, mild psychotic symptoms, or depression,

but impulse control is good; OR

7.

Nicotine withdrawal requires nicotine replacement therapies or non-nicotine agents for symptomatic

      treatment.

AND

b. Has withdrawal symptoms, but is at minimal risk for severe withdrawal syndrome and is likely to

           complete detoxification and enter continued treatment or self-help recovery as evidence by (1) and

           either(2) or (3):

1.

Willing to accept recommendation for treatment; AND

2.

Adequate understanding of ambulatory detox and has commitment to enter treatment; OR

3.

Has adequate support services to ensure commitment to detox and ongoing treatment.

AND

c. Shows positive response to emotional support and comfort as evidenced by both (1) and (2):

1.

Has decreased emotional symptoms by close of the initial treatment session; AND

2.

Patient and/or support person have clear understanding of instructions for care and both the ability and  

      Resources to follow these instructions.

LEVEL II-D – AMBULATORY DETOXIFICATION WITH EXTENDED ON-SITE MONITORING

Status characterized by (a) and (b) and (c):

a. Moderate risk of severe withdrawal syndrome outside the program setting; AND

b. Free of severe physical and psychiatric complications and would safely respond to several hours of

    monitoring, medication, and treatment as evidenced by any of the following:

    1. CIWA-Ar score of 8 to 15; OR

    2. Current withdrawal from sedative hypnotics without evidence of other active alcohol/drug abuse or

         Dependence. Withdrawal symptoms, have responded to, or should respond to substitute doses of

         Sedative-hypnotics in the therapeutic range within the observable hours of the program; OR

    3. Used sedative-hypnotics in excess of therapeutic levels daily for at least 4 weeks, but risk of seizures,

         hallucinations, or other complications during unobserved periods outside th e program assessed as

         minimal. Close hourly monitoring is available if needed. There are no accompanying chronic mental or

         physical disorders posing a danger during withdrawal; OR

  4. Used sedative-hypnotics at  or below therapeutic levels daily for at least 6 months, in combination with

         daily alcohol use or regular use of another drug known to have its own dangerous withdrawal syndrome.

         nonetheless, risk of seizures, hallucinations, dissociation or severe affective symptoms outside the program

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