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Department of Human Services (DHS) Division of Addiction Services (DAS) Information Systems ... - page 4 / 21

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           is minimal; OR

   5. Opiate abstinence syndrome( vital signs, physical discomfort, or craving) can be stabilized by the end of

         each day’s monitoring , so that such symptoms can be managed at home with appropriate supervision; OR

   6. Opiate withdrawal signs and symptoms are of such severity or instability that extended monitoring is

         Required to determine the appropriate dosage; OR

   7. Stimulant withdrawal with significant lethargy, agitation, paranoia, psychotic symptoms, or depression   

         Requiring extended outpatient monitoring to determine impulse control; OR

   8. No additional biomedical problems. AND

c. Patient is likely to complete detoxification and enter continued treatment or self-help recovery as evidenced

    by meeting(1) and either(2) or (3) or (4):

  1.Patient or support persons clearly understand instructions for care and are able to follow instructions; AND

  2.Has an adequate understanding of ambulatory detoxification and has expressed commitment or enter such

         a program; OR

  3.Has adequate support services to ensure commitment to completion of detoxification and ongoing      treatment or recovery; OR

  4. Willing to accept a recommendation (e.g. attend outpatient sessions or self-help groups) for treatment once

          Withdrawal has been managed.

LEVEL III.2-D  - CLINICALLY MANAGED RESIDENTIAL DETOXIFICATION

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

a.

Not at risk for severe withdrawal, and moderate withdrawal is safely manageable at this level of surface as evidenced by any of the following.

1.

Intoxicated or is withdrawing from alcohol and CIWA-Ar less than 8 at admission, and monitoring is available to assure that it remains below this level; OR

2.

Opiate withdrawal signs and symptoms are distressing but do not require medication for reasonable withdrawal discomfort, and patient is impulsive and lacks skills needed to prevent immediate continued drug use; OR

3.

stimulant withdrawal – marked lethargy, hypersomnolence, paranoia or mild psychotic symptoms, and these are still present beyond period of outpatient monitoring available in Level II-D

AND

b.

Assessed as not requiring medication, but does require this level of service to complete detoxification and enter into continued treatment or self-help recovery because of  inadequate home supervision or support structure as evidenced by meeting (1) or (2) or (3):

1.

Lacks coping skills to deal with a recovery environment that is not supportive of detoxification and entry into treatment; OR

2.

Has a recent history of detoxification at less intensive levels of service marked by inability to complete  detoxification; OR

3.

Recently has demonstrated an inability to complete detoxification at less intensive levels of service.

LEVEL III.7-D – MEDICALLY MONITORED INPATIENT DETOXIFICATION

Status characterized by either (a) or (b):

a.

severe withdrawal risk that is manageable at this level of service as evidenced by any of the following:

1.

CIWA-Ar score = 10 or greater by the end of the period of outpatient monitoring available in level II-D; OR

2.

Daily use of sedative-hypnotics at more than therapeutic levels for more than 4 weeks and is unresponsive to appropriate efforts to maintain dose at therapeutic levels; OR

3.

daily use of sedatives above a therapeutic level for more than four weeks, plus daily alcohol use of regular use of another drug known to pose a severe risk of withdrawal. Signs and symptoms of withdrawal are of moderate severity, and cannot be stabilized by the end of the period of outpatient monitoring available at Level II-D; OR

4.

Marked lethargy or hypersomnolence due to intoxication with alcohol or other drugs, and a history of severe withdrawal, or the altered level of consciousness has not stabilized at the end of  the period of outpatient monitoring available at level II-D; OR

5.

Daily use of injectable opiates for more than two weeks and a history of inability to complete withdrawal as an outpatient or without medication at Level III.2-D; OR

6.

Antagonist medication is to be used in withdrawal in a brief but intensive detoxification (as in multi-day pharmacological induction onto naltrexone); OR

7.

Marked lethargy, hypersomnolence, agitation, paranoia, depression or mild psychotic symptoms due to stimulant withdrawal, and has poor impulse control and/or coping skills to prevent immediate continue drug use.

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