Community alcohol detoxification involves undertaking detoxification at home - rather than in a hospital or specialist clinic. Medication is usually prescribed by the patient's general practitioner and support offered from a community nurse. The criteria, advantages and disadvantages of community detoxification are outlined below.

CRITERIA FOR HOME DETOXIFICATION:

"Reasonable" psychological health.

"Reasonable" intellectual capacity.

Grossly intact cognitive functioning.

"Reasonable" physical health.

Mild / moderate level of physical dependency.

Absence of severe withdrawals.

No recent home detox "failures".

Safe and secure accommodation.

Good social support.

Harmonious home atmosphere.

Alcohol-free home situation.

Patient requests home detox.

"Insignificant" prescribed / illicit drug use.

Acute psychiatric problems egs. psychosis, actively suicidal.

Low level of intellectual capacity.

Significant cognitive deficits eg. Korsakov's psychosis.

Poor physical health eg. acute pancreatitis.

Diagnosis of epilepsy.

Severe level of physical dependency.

History of severe withdrawals egs. seizures, hallucinations.

Several recent home detox "failures".

Homelessness.

Social isolation.

Domestic violence / conflict.

Heavy drinker(s) in home.

Patient feels home detox. inappropriate.

Heavy use of sedatives / opiates / etc.

Greater support available from family / friends / etc.

May strengthen family bonds.

Family more involved in therapeutic processes.

Avoids stress of hospital admission.

Avoids stigma of hospital admission.

Ensures exposure to drinking cues during detox.

Encourages development of coping strategies "in vivo".

Enables more thorough assessment of social factors eg. accommodation.

Facilitates greater confidentiality.

Provides enhanced client choice.

Promotes better take-up of services.

May be less medical-model orientated.

Relatively inexpensive.

DISADVANTAGES:

Continuous ( i.e. 24 hours ) monitoring usually not possible.

May be more dangerous ( eg. greater risk of overdose ).

Slower response to problems ( eg. "breakthrough" withdrawals ).

Titration more difficult.

Greater risk of over-sedation / under-medication.

Less thorough assessment of mental state / psychiatric problems.

Less support during detox.

Less therapeutic input during detox. ( N.B. medical wards ).

Treatment may be seen as just symptom-focused.

Exposure to drinking cues during detox. -> more intense craving.

Higher risk of relapse due to increased craving / less support / etc.