Regional Alcohol and Drug Detoxification Manual 2019 Arkansas Department of Human Services Division of Aging, Adult and Behavioral Health Services Office of the Drug Director RADD Regional Alcohol and Drug Detoxification Regional Alcohol and Drug Detoxification Manual Office of the Drug Director P.O. Box 1437, Slot W-241 Little Rock, Arkansas 72203 501-686-9164 501-686-9396 (fax) 1 Regional Alcohol and Drug Detoxification Manual 2019 2 Regional Alcohol and Drug Detoxification Manual 2019 Contents Regional Alcohol and Drug Detoxification Program ......................................................................................................... 5 Chapter 1 ........................................................................................................................................................................... 7 Overview, Essential Concepts, and Definitions in Detoxification ...................................................................................... 7 Chapter 2 ......................................................................................................................................................................... 12 Settings, Levels of Care, and Patient Placement ............................................................................................................... 12 Chapter 3 ......................................................................................................................................................................... 22 An Overview of Psychosocial and Biomedical Issues During Detoxification ................................................................... 22 Chapter 4 ......................................................................................................................................................................... 35 Physical Detoxification Services for Withdrawal from Specific Substances ...................................................................... 35 Appendices ...................................................................................................................................................................... 70 Appendix A ..................................................................................................................................................................... 71 References ....................................................................................................................................................................... 71 Appendix B ..................................................................................................................................................................... 76 Common Drug Intoxication Signs and Withdrawal Symptoms ........................................................................................ 76 Appendix C ..................................................................................................................................................................... 79 Screening and Assessment Instruments ........................................................................................................................... 79 Appendix D..................................................................................................................................................................... 87 42 CFR Part 2 .................................................................................................................................................................. 87 Appendix E ................................................................................................................................................................... 117 Act 10............................................................................................................................................................................ 117 Appendix F ................................................................................................................................................................... 124 Sample forms ................................................................................................................................................................ 124 Appendix G................................................................................................................................................................... 166 List of RADD programs May 2019 ................................................................................................................................ 166 Appendix H ................................................................................................................................................................... 169 RADD Grant Document ............................................................................................................................................... 169 Appendix I .................................................................................................................................................................... 173 Program Administration Manual .................................................................................................................................... 173 Appendix J .................................................................................................................................................................... 179 Course Resources .......................................................................................................................................................... 179 3 Regional Alcohol and Drug Detoxification Manual 2019 4 Regional Alcohol and Drug Detoxification Manual 2019 Regional Alcohol and Drug Detoxification Program The primary goal of the Regional Alcohol and Drug Detoxification (RADD) program is to provide quality detoxification treatment services, while managing limited allotted resources. Meeting the unique needs of Arkansans by insuring proper and timely placement in treatment is the desired outcome of this process. The RADD manual is intended to be a guide for nurses, clinical staff, program administrators, and individuals that are involved in planning, evaluating, and providing alcohol and/or other detoxification services. All providers of RADD services will adhere to the Office of Alcohol and Drug Abuse Prevention (ADAP) rules of practice and procedure and the ADAP licensure standards for alcohol and other drug abuse treatment programs. Questions concerning the RADD program should be directed to the Arkansas Department of Human Services Division of Aging, Adult, and Behavioral Health Services Director of Treatment services or the RADD coordinator at (501) 686-9164. Questions regarding Admission and Data Management Information System (ADMIS) reporting should be directed to (501) 686-9164 as well. RADD Training Objectives (As defined in ADAP rules of practice and procedure, 2009): 1. Identify responsibilities of RADD staff • Screening applicants • Evaluating presenting symptoms • Compiling an accurate substance abuse history • Taking vital signs • Nonviolently diffusing hostile situations • Providing CPR/First Aid • Documenting any occurrence relative to the detox process 2. Identify symptoms of alcohol/drug withdrawal and implications of those symptoms 3. Learn to take vital signs and know the implications of those signs 4. Prepare participants to score 80% (or above) on written examination required to obtain certification 5 Regional Alcohol and Drug Detoxification Manual 2019 Regional Detoxification Specialist Certification (RDS) Regional Detoxification Specialists (RDS) are treatment professionals that have undergone a course of study to safely monitor clients who are in medical or observational detoxification facilities. To monitor clients in detox, you must be one of the following: Physician, Advanced Practice Registered Nurse, Registered Nurse, Licensed Practical Nurse, or RDS (Regional Detoxification Specialist). RDS Certification includes valid and up-to-date certifications in First Aid and cardiopulmonary resuscitation (CPR), Nonviolent Physical Crisis Intervention (NPCI), and RADD (Regional Alcohol Drug and Detoxification) training. If staff are not licensed medical professionals, or are without the previous trainings and certifications, they are not certified to monitor clients during the detoxification process. RDS Responsibilities: • Screening applicants • Evaluating presenting symptoms • Compiling an accurate substance abuse history • Taking vital signs • Nonviolently diffusing hostile situations • Providing CPR/First Aid • Documenting any occurrence relative to the detox process RDS must recertify every 2 years by retaking the course provided by Division of Aging, Adult, and Behavioral Health Services (DAABHS) and successfully completing the post-test with a score of 80% or better. All staff should feel comfortable taking vital signs and knowing the implications of those vital signs; evaluating signs and symptoms of withdrawal and implications of those signs and symptoms and be confident in knowledge of emergency procedures as defined in the facility policy and procedure manual. Emergency Care Plan: The program will maintain a written emergency care plan that will include the following: • At least 3 staff members trained as Regional Detoxification Specialists • The program does provide 24-hour availability of emergency services including adequate provision for handling special and difficult