Choice of setting for planned withdrawal management in substance use
Planned withdrawal management can take place at the patient’s home, in a community residential withdrawal unit or in a hospital with medical monitoring of withdrawal. Choosing the appropriate setting for planned withdrawal management depends on the level of associated risk. This varies with substance, method of ingestion, extent of use, number of substances used, duration of use, and individual factors (eg age, physical and mental health). A history of symptoms in previous withdrawals is generally a good indicator of risks for subsequent attempts. Guidance for selecting a suitable withdrawal setting is outlined below; see substance-specific topics for additional considerations. Work with the patient in assessing their needs and preferences for a suitable setting. Seek local specialist advice on the best location for management of withdrawal that is predicted to be moderate to severe.
Suggested requirements for withdrawal management in a home setting include the following:
- Withdrawal is predicted to be of mild to moderate severity with no medical or psychiatric contraindications.
- The patient wants home management and can comply with instructions, including avoiding driving until the withdrawal process is complete.
- The patient has a safe and supportive environment.
- The GP, pharmacist or other involved healthcare professionals are able and willing to provide frequent reviews, which may include supervised dosing and staged supply of medications.
- A carer is available to support the patient, supervise medication and call for help if deterioration occurs, using an agreed deterioration plan (eg to phone an agreed health professional to escalate care, which may involve a home visit or transfer to a community residential withdrawal unit).
- The patient can arrange their responsibilities and commitments to give themselves a period of minimal stress and sufficient time for withdrawal.
Withdrawal management in a community-based residential withdrawal unit (with staff trained in withdrawal monitoring but without 24-hour a day medical support) may be suitable if the person:
- is predicted to experience mild to moderate withdrawal
- is in an unsupportive home environment
- is living alone
- is homeless
- has had more than one unsuccessful attempt at withdrawal at home
- has dependent use of more than one substance (polysubstance use).
Withdrawal management in a hospital setting with close medical monitoring may be suitable if the person has:
- an acute medical, surgical or psychiatric condition
- uncertain drug use or a history of a condition that indicates a need for close medical monitoring
- a history of severe or complicated withdrawal.