Suffering from withdrawal? Make an appointment
“I never met a nine- to- five drunk.”
That’s what one veteran Nova Scotian addictions counsellor had to say about the province’s admissions process for alcoholics and other addicts looking to detox.
Changes in procedures put shaking drunks and twitching junkies through an “intake” interview, conducted during regular working hours, before they’re admitted for drug or alcohol withdrawal management (detox). In the past, counsellors assessed and admitted patients, sometimes immediately, depending on available beds.
When an addict decides he or she’s had enough and wants help, it rubs against every principle many of these counsellors live by to tell that addict to call back, make an appointment, and wait to see an intake nurse on some future day, between 9 a.m. and 5 p.m.
But Linda Courey, director of mental health and addictions at the Nova Scotia Health Authority, says change always meets some resistance, and added the changes in addictions treatment are based on the best evidence.
Detox doesn’t treat addiction, and the processes now in place result in an ongoing recovery plan for each patient.
She points to the experience in Cape Breton, where she did similar work for the former district health authority there, one of nine merged into the NSHA.
“When we moved to a (work) day admissions protocol, the number of patients in withdrawal management increased,” she said in a recent interview. People who needed, and truly wanted, help with their addiction were willing to go through the process.
The perspective on the front lines can be very different.
It should be noted here that addictions services workers can’t be identified because the NSHA forbids employees from speaking publicly without permission, and workers believe doing so puts their jobs at risk.
Courey and the counsellors agree on one essential point: An addict must want to get well, otherwise attempts at treatment are futile. That’s where agreement ends.
One long- term addictions counsellor said the “nice, civil- ized” intake process can filter out people who aren’t committed to getting off booze or drugs, but disputes the evidence the NSHA is using to justify its admission procedures.
That evidence doesn’t account for the hardcore drunk or junkie who hits a wall and wants help now. He or she will go into detox immediately, or during a narrow and rapidly closing window of opportunity. But if these worst-case addicts are told to come in for an intake interview next Thursday at 2 p.m., the chances they will show are slim to none.
“They get well the only way they know how: score some dope or get some liquor or other form of alcohol,” said the counsellor, and Thursday’s 2 p.m. appointment is forgotten or passes by while its principal is high or passed out.
The hardest cases, the alcoholic that can’t make it through breakfast without a drink, the addict wracked by withdrawal pain, are the people most likely to fall through the designer cracks in the NSHA’S intake process.
“They’re dying,” said another counsellor.
The pain of opioid withdrawal can be excruciating. Alcohol and benzodiazepine withdrawal, while less physically painful, can be fatal. Opioid withdrawal is rarely fatal, but an addict going through it unaided wishes it was.
Some doctors advise alcoholic patients to continue drinking to ward off severe withdrawal, delirium tremens and seizures until they get through the intake and are admitted to detox. Options for other addicts are less obvious.
The best advice NSHA has for addicts in severe withdrawal is to head for the nearest hospital emergency department. The instruction should come with the words “and hope.”
Those who wind up at emergency need to hope there is a doctor there who knows more than average about addiction or the trip can be a futile one, or worse, a short stay on the way to jail.
The stigma attached to addictions is only slightly less prevalent but often more virulent among emergency room workers, because nothing can throw an already hectic environment into total chaos like a drunk or an addict.
The province recently added $800,000 to the health budget to treat opioid abuse. It doesn’t need to throw money at detox, but a little common sense and a willingness to listen to experience wouldn’t hurt.