People often ask why I started an Acute Medical Detox and Addiction Medicine practice in Nashville. The reason is simple.
I met my father when I was 28 years old. He was living in a shack in rural Mississippi that had no running water or electricity. He had lost everything because of alcohol addiction. Today, my father has been sober for more than 16 years. Detox saved my father’s life.
After ten years of practicing emergency medicine, I graduated from the Addiction Medicine Fellowship in the Department of Psychiatry at Vanderbilt University Medical Center and decided to start a practice to help people like my father on the road to recovery. About half the cases we see involve alcohol. The rest of the cases usually involve a combination of opiates, benzodiazepines and alcohol.
No one wakes up one day and says, “I think I’ll become addicted to drugs and alcohol.” It happens over time for a variety of reasons. Addiction is a disease, not a moral failing. Fortunately, effective treatment is available for those willing to change. Detox is the first step. In cases involving alcohol, we typically administer Valium (diazepam) according to the Clinical Institute Withdrawal Assessment for Alcohol Protocol for a total of five hours as required by the client’s symptoms. IV Therapy is an important part of our concierge approach to detox. The goal is to make the client as comfortable as possible in his or her home, a hotel suite or medical office. To accomplish this, we administer IV infusions as well as anti-nausea drugs that improve the client’s comfort level. Most patients feel better within two hours of starting detox.
Days 2 and 3 of detox are important from the standpoint of monitoring vital signs and preventing seizures. Diazepam has a half-life of 48 hours and is effective at preventing seizures, but we still carefully monitor each patient for warning signs. We have a number of medications on hand that can be administered as needed to control symptoms such as irritability, headache, muscle and joint aches, and nausea. We occasionally administer IV fluid on Days 2 and 3 of detox. Day 4 includes an assessment of coexisting dual diagnoses, most notably anxiety, depression, post-traumatic stress disorder and bipolar disorder. By Day 5, most patients are ready to enter an intensive outpatient program, a partial hospitalization program, or a residential treatment program.
Clients who are compliant with follow-up have a success rate of 80% after one year. Most people have the best chance at recovery when we combine medical management with individual therapy sessions. Daily therapy is most effective for the first month, followed by weekly sessions in months two and three.
