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A description of the detoxification services in Greater Vancouver and a consideration of factors which determine policy formulation

University of British Columbia

The Alcohol and Drug Commission of British Columbia, under the jurisdiction of the Ministry of Health, is establishing a province-wide system of care for the alcohol or drug dependent person in the province. The services which are being developed encompass those of detoxification, personal counselling, rehabilitative treatment, and prevention. The detoxification services which are being set up throughout the province serve as a main entry point into the system of care. These detoxification centres supply therapeutic care in a crisis intervention mode for men and women who are or have been severely intoxicated and are in a condition of present or impending withdrawal from a specific addictive chemical. In this condition, the individual is in a state of health crisis. Within a detoxification centre remedial and custodial care is given to prevent the person from progressing into a more serious condition of ill health. Most of the clients who are admitted to a detoxification centre have a history of lengthy alcohol and/or drug abuse and, therefore, the illness occasioned by the chemical abuse is frequently complicated by the presence of other health abnormalities. There can be little argument that the presenting condition of the client warrants health care intervention. What kind and how much care to supply is one of the primary concerns of the Alcohol and Drug Commission planning committee as they seek to develop services which are responsive to client and community concerns. The Alcohol and Drug Commission of British Columbia has established through their research department that there are large numbers of alcohol dependent persons within the province, possibly 70 to 80 thousand; so that a service demand exists which merits the establishment of this specific health service. The form of service developed through the years has been influenced by the attitudes and beliefs held by both the professional health service personnel and by the lay public. These attitudes and beliefs relate to theories about the aetiology of the condition of alcoholism as demonstrated by the alcoholic. Most of the opinions group themselves into the three broad categories of i) "disease" origin theory, which proposes a genetically determined susceptibility to the chemical; ii) personality defects theory, which sees the person as a moral weakling with this specific form of self-indulgence; iii) social learning theory which attributes the development of the condition to behaviour learned through the social conditioning of his culture. The philosophy held by the health care planners of this province would seem to be that of accepting a combination of the disease theory and the social learning theory. Based upon these attitudes, they have developed services which are humanistic in their efforts to create a service which is available to all citizens in need. Balanced with this concept is that of instituting preventive measures which are of an educational nature to attempt some change in the cultural habits of the drinking population of our province. The Commission has also to be aware of the large segments of the public who do not share such views and so strive to tailor their services to prevent undue criticisms of being soft-hearted and paternalistic to persons who the citizenry view as being unworthy members of society. The detoxification services have been established in six centres in the province. The two centres in Greater Vancouver, Pender Street Detox, and Maple Cottage Detox, are directly funded services of the Ministry of Health, while the other units are funded indirectly through non-profit organizations. All of these units have followed the directives of the Alcohol and Drug Commission to present a socially oriented therapy rather than a medical-pharmaceutical therapy. The rationale for this policy decision had been derived from the observations of the effectiveness of such a mode as demonstrated in detoxification centres in Ontario and California. The identifying characteristic of the "social model" of detoxification therapy, is the minimal use of medication and medical intervention. Emphasis is given to behavioural techniques for the relief of withdrawal symptoms which are chiefly related to conditions of emotional stress. Close monitoring of the client's physical condition is maintained so that, if a client condition arises which demands professional attention, then such care is promptly accessed. The supporters, planners, and service deliverers recognize that crisis intervention only would be a short-sighted goal for the treatment of this highly recidivistic illness. Therefore, a second prime goal of the detox unit is to attempt to motivate the affected individual towards rehabilitative treatment. Outpatient counselling services, residential treatment centres, and half-way houses have been established to provide on-going services. A further component of the system of care is the Client Monitoring System which has been designed to record demographic information of the clients and provide a potential for feed-back for the providers and planners. As the detoxification centres have been set up throughout the province, problems have arisen which are related to the varying interpretations of the policy of using a social rather than a medical model of service. The restrictions upon medications vary from no medications (other than life-support prescriptions), to that of a restrained administration of tranquilizers. Physicians' services vary from daily attendance to that of infrequent consultation. The client care in all units has maintained satisfactory levels of safety and effectiveness. The problem areas which have been identified are associated with the selection and training of personnel. It has become evident that there is a need for training programs which are designed to provide the health care workers with competencies relevant to their practice. The recruitment of female workers does not present a problem since health care service is a common field for their education and practice. However, for male workers, the man-power pool is much more constrained. This situation would be improved if career programs could be developed which would provide for lateral and vertical mobility. The Alcohol and Drug Commission in their program of staff development offer a number of courses for educational enrichment and they are studying the desirable components of a basic core educational course for its service personnel. Detoxification services in Greater Vancouver have served over 10,000 persons in the last four years and there is the valid expectation that this usage will expand. New service units established where community need is indicated will enable maximum entry into our system of care for the alcohol dependent. The methods used in this study are those of literature search, participant observation, and review of the records of the Maple Cottage Detoxification Centre.

Text

2010-02-24

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http://hdl.handle.net/2429/20833

Health Care and Epidemiology

University of British Columbia

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