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Ambulatory Detox-What Is It And Where Is The Closest Location?

Isaac Alexis, M.D., AAMA, AMP-BC

Medically reviewed by

Isaac Alexis, M.D., AAMA, AMP-BC

January 17, 2019

The first step towards recovery is going through the detoxification process which can be difficult depending on the degree of addiction. Determining what kind of detox is appropriate may be difficult for individuals seeking to enter into treatment. Fortunately, there are treatment specialists to help everyone get the treatment that they need.

Drug and alcohol addictions do not fit neatly into a box. Just as the individuals who struggle with them are unique, so are these situations. Due to this, a variety of treatment options exist—not every treatment method is right for every person. It may seem daunting to you to consider the many options that exist to treat substance use and addiction; however, keep in mind the more you begin to know and understand your options, the better your chance of choosing the treatment that is best for you and the higher the likelihood that you will find success.

Fortunately, within addiction medicine, certain guidelines exist to aid individuals, their families, and their care providers in finding not only the type, but the level of care that will best serve their needs. This is an especially pertinent concern when an individual is detoxing or withdrawing from drugs and/or alcohol.

What Is Detox?

Though many individuals may be familiar with the term, not everyone may fully understand the process. When a person becomes addicted to either drugs or alcohol, the substance exerts such a chemical force on their body and brain, that it actually changes the way the person’s brain functions. Specifically, a person’s brain experiences a profusion of chemical alterations within its myriad important systems.

Our brains contain chemical substances called neurotransmitters, which are chemical messengers responsible for carrying messages across the brain, so that important functions that are essential for your balance and health are properly carried out. The problem arises when your brain responds to addictive substances in a way that is similar to how it reacts to these naturally occurring chemical messengers within your brain. Basically, our brains our tricked—as drugs or alcohol stimulate and alter the production and function of these critical neurotransmitters, the brain begins to believe that it no longer needs to produce its own. As your brain’s communication and reward systems are compromised by this switch, your brain begins to rely on the constant influx of chemicals that the compulsive drug-seeking behavior of addiction offers, in order to maintain these balances.

When the addictive substance is suddenly removed, your brain is thrown off-kilter and struggles to function in the absence of the drug. If this happens too quickly, such as in the case where a person quits suddenly or “cold-turkey,” they will likely begin to exhibit symptoms of withdrawal. The extent of this withdrawal is dependent on several factors, including if the person quit immediately, or tapered their dosage; the drug of abuse, how long they were using the addictive substance for, how much of the addictive substance they were using, if they were concurrently using any other addictive substances, the general state of their physical and mental health, and numerous other factors that may vary per individual. Detox happens in several steps and best occurs under the guidance of a trained professional.

The level of detox care is dependent on the severity of withdrawal. Not every person experiencing withdrawal needs the same level of support. Certain substances, such as alcohol can hit a person very hard during withdrawal, to the extent that wide-ranging dangers, including death, arise. On the other hand, others—like cocaine, due to its chemical nature—exit your system so quickly, that detox may be quicker.

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How Do You Determine What Sort Of Detox Care You Need?

Firstly, it is strongly recommended that you never attempt to detox on your own without medical supervision, as it can not only be very uncomfortable but even dangerous in the capacity that it could endanger your life. For this reason, we urge you to seek medical supervision, so that your detox can be planned accordingly and monitored to ensure the best and safest outcome.

The truth is that many people who are addicted to drugs or alcohol may have experienced a measure of withdrawal before, as they may have attempted it on their own or even experienced detox within a program. Despite these prior experiences, it is still important to seek medical guidance, as certain factors within your life may have changed, leading to nuances that could influence the outcome.

In order to ensure your best chances at finding the most optimal setting for detox, you need to be very honest with your treatment provider or rehab treatment specialist, so that they can make a fully educated decision as to how to advise you. To aid in this process, the American Society of Addiction Medicine (ASAM) have created a set of criteria to help determine your need. The ASAM criteria formerly termed the ASAM patient placement criteria, adheres to the following six dimensions that are utilized “to create a holistic, biopsychosocial assessment of an individual,” these include:

  1. Acute Intoxication and/or Withdrawal Potential—In this stage, a person’s history of drug use and withdrawal will be considered against their current substance use and withdrawal concerns.
  2. Biomedical Conditions and Complications—In order to offer en pointe treatment, it is important that the provider fully understands a person’s current physical state, while also taking into account their past medical history.
  3. Emotional, Behavioral, or Cognitive Conditions and Complications—Mental health concerns are fully examined, in a way that offers insight into a person’s thought process and emotional standing.
  4. Readiness to Change—In this step, the provider will seek to determine how, if at all, a person is seeking or ready to change.
  5. Relapse, Continued Use, or Continued Problem Potential—Examining whether or not a person has a history of relapse, and if so, understanding how this condition has influenced their current use or struggles with substances.
  6. Recovery/Living Environment—The provider ascertains the environment a person will exist in while, or after they undergo treatment and continue working on their recovery.

After your, or your loved one’s situation has been thoroughly and thoughtfully examined, a decision can be made regarding the best avenue of detox care and the treatment to follow. Again, numerous options exist, and the information gleaned from this assessment will serve to ensure you receive the detox plan most aligned with your needs. According to ASAM, this criterion is required in 30 states.

What Is Ambulatory Detox?

First, let’s examine the root of the term. According to MedlinePlus’s medical dictionary, ambulatory means “b: performed on or involving a patient who is able to walk about…c: performed on or provided to an outpatient… relating to or intended for outpatient care.” Thusly, when used in the context of drug and alcohol treatment, ambulatory detox is that which allows a person to leave after their treatments and receive them in an outpatient setting.

Within Dimension One of the above criteria, ASAM outlines five placement levels of care, the first two of which are outlined as ambulatory. They include, as extracted from ASAM’s resource materials:

  • Level I-D: Ambulatory Detoxification Without Extended Onsite Monitoring (e.g., physician’s office, home healthcare agency). This level of care is an organized outpatient service monitored at predetermined intervals.
  • Level II-D: Ambulatory Detoxification With Extended Onsite Monitoring (e.g., day hospital service). This level of care is monitored by appropriately credentialed and licensed nurses.

Essentially within ambulatory treatment, a person may seek outpatient care one of two ways: first, they may go to scheduled and more brief appointments within a clinic or doctor’s office that are equipped to treat them, or secondly, they may enter into treatment that is broken down into day-length sessions. In the latter case, a person will likely have access to a variety of the same methods and modalities that are offered in inpatient rehab, albeit in some cases on a more limited basis. These may include individual or group counseling, various forms of psychotherapies, family therapy and support, and medication-assisted treatment. This form of care may occur in a hospital setting or at a treatment facility and many programs offer 24-hour ambulatory detox care. Ambulatory detox care may be administered by a variety of treatment professionals, including physicians, nurse practitioners, registered nurses, and various behavioral health specialists.

Outpatient treatment is best for individuals who have or are expected to have, mild to moderate symptoms of withdrawal. However, beyond this, other factors are considered—a person may be anticipating this level of withdrawal, yet have other factors of medical conditions that warrant more intense medical care or a residential setting as is offered in an inpatient drug rehab. According to American Family Physician (AFP), some of these concerns include: history of unsuccessful outpatient detox, no clear means of following up on a person or no contact person who can aid in monitoring the individual within treatment, a coexisting medical condition that requires additional treatment, pregnancy, and in the case of alcohol withdrawal, a seizure disorder.

Also, in regard to alcohol withdrawal, the AFP recommends that “Patients with serious psychiatric involvement (e.g., suicidal ideation), concurrent acute illness, or severe AWS-related symptoms, or those who are at high risk for developing delirium tremens, are best detoxified in inpatient settings.” Individuals who have polysubstance abuse or addiction may also need extra measures of care.

Ambulatory and outpatient care is more appealing to many people due to their lower cost and greater flexibility. As individuals are allowed to remain at home, they can continue to engage in their family life, career, or any other responsibilities they deem important. It is worth noting, however, that for some individuals this form of treatment may allow for certain temptations, negative influences, or triggers to continue to exist in a person’s life, counterbalancing the benefit of treatment. This is why it is important, should you choose ambulatory detox and treatment, to ensure that you have an ample and supportive network of friends or family behind you to help you stay optimistic, accountable, and focused on your recovery. To ensure you can best focus on your treatment, many programs will help to connect you to aftercare support in the time after you’ve successfully detoxed and completed treatment.

Finding Treatment Near You

Ambulatory outpatient programs are diverse and accessible all across the nation. They exist in a variety of venues, from a doctor’s office to hospital setting, and within many excellent rehab facilities. Many communities or cities have immediate access to them, even offering several options; however, sometimes individuals in smaller, rural communities may yet have to travel to receive this care. We can help you find the program nearest you that is best prepared to meet your needs.

Take time to consider what you feel you need to receive the most individualized care. Anytime you are searching for a detox or treatment program, it can be helpful to organize your thoughts and any questions you might have so that you can ask focused and directed questions from the treatment providers. If the thought of doing all of this is too overwhelming, don’t let that deter you from getting help—reach out to a friend or family member and ask them to help you stay on track.

We Can Help You Find The Best Option

If your drug or alcohol use has spiraled out of control into addiction and you’re wanting to quit, let us help you. Don’t let fears of withdrawal put you off from getting the life-changing treatment you so desperately need. At we understand how important all your questions and concerns are and are standing by to answer them, so that you may make the best decision. Let us help you find an ambulatory detox program so that you can get started on the path to sobriety today. Contact us now.

American Society of Addiction Medicine - What is the ASAM Criteria?

American Family Physician - Ambulatory Detoxification of Patients with Alcohol Dependence

U.S. National Library of Medicine - 2 Settings, Levels of Care, and Patient Placement

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