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At any one time, 76 million people have an alcohol use disorder. Detoxification is a common intervention for alcohol dependence. There is a need regularly to assess and evaluate detoxification practice. The aim and objective of this paper is to describe the findings of audits which assessed the quality and safety of the detoxification experience and to implement changes to improve practice.

All community detoxifications in March 2009 and 2010 were included for the successive audits. Notes were inspected retrospectively three months post completion of detoxification using the audit standard.

A total of 50 and 59 people were eligible in respective audits. At 3 months post‐detoxification 23 per cent of patients had dropped out of treatment compared to 15 per cent in the re‐audit. In 2009, 31 per cent of patients remained completely abstinent and 10 per cent were drinking within safe limits but in 2010 figures improved to 36 per cent and 22 per cent, respectively. Disulfiram was continued by 66 per cent of abstinent patients in the initial audit and 89 per cent in the reaudit. Improved follow‐up protocol, regular advice and monitoring of disulfiram resulted in better abstinence and reduced drop out rates over successive years. Social and Behavioral Network Therapy and disulfiram taken under medical supervision after detoxification play a pivotal role in relapse prevention.

The study considers the importance of the post‐detoxification period, in terms of maintaining a patient's abstinence from alcohol.

Opiate use is no longer confined to the greater urban context in Ireland, with scant detoxification services present in rural areas (Carew et al, 2009; National Advisory Committee on Drugs, 2008). This exploratory research aimed to yield an illustrative account of opiate users' experiences of self‐detoxification by adopting a grounded theory approach (Glaser & Strauss, 1967). Data emerging from 21 in‐depth interviews (n=12 heroin users, n=9 drug service providers: statutory, community and voluntary) were analysed using the constant comparative method. The study generated a substantive theory of self‐detoxification as a subjective process of seeking heroin abstinence. Self‐detoxification emerged as a frequent and reactive or proactive process in collaboration with others (heroin users, family and drug service providers). The study has implications for drug service delivery in rural Ireland in terms of increasing information provision and access to opiate detoxification through the development of low threshold services and community‐based detoxification.

In light of the investigation by the General Medical Council on prescribing practices at a well‐respected treatment centre, we present the case for slow detoxification.

Buprenorphine (Subutex) was piloted in two Scottish prisons between 2004 and 2006 and consequently used within other penal establishments in Scotland. This 2007 qualitative study aimed to explore the use of Subutex and its associated effects on 14 participants on detoxification programmes.

All participants were male, aged from 21 to 44 years with prison sentences ranging from a few months to life imprisonment. Buprenorphine was unavailable to female prisoners at the time of this study. Participants were recruited from seven Scottish prisons. All 14 participants were on detoxification programmes, each was prescribed Subutex, and each was selected from a larger investigation that included both those undergoing detoxification and maintenance (n=21). All participants had previously also used methadone on previous detoxification programmes.

It can be concluded that the majority of detoxification participants within this study indicated that Subutex was a more effective treatment than methadone as it helped reduce craving, eased the process of withdrawal and improved sleeping patterns. In addition, the majority of participants noted higher levels of motivation and the ability to set goals towards obtaining an improved quality of life.

This study provides an alternative perspective to the use of Subutex within prison settings, when compared with results from previous quantitative studies reported. The study also highlights inconsistencies drawn from studies in this area, which may be an artefact of study design. It is recommended that further qualitative studies be conducted to explore further this alternative perspective. Finally, the issue of methodological approach taken should be addressed within the context of a related, but independent, research forum.

This paper examines a common presentation to primary care and specialist drug services. Often patients who are experiencing opioid dependencies when stabilising on methadone often increase their consumption of alcohol. Also, increasingly so, polydrug use is a growing presentation with heroin, crack and alcohol use used in dependent patterns when presenting for treatment.There is often a lack of alcohol detoxification treatment packages given to those who are on methadone, and often some prescribers in the area of substance use regard an alcohol detoxification programme when prescribing methadone as too risky. This has led to a reluctance in general to prescribe an alcohol detoxification programme for many patients who request it. This is the case in Islington, London.This paper looks at a new service set up in Islington, London and looks at the way it has treated the cohort of patients who have presented with polydrug use, including alcohol. It has seen that patients who were more stable on their methadone and had longer histories in treatment were more likely to complete an alcohol detoxification programme with some ‘dry’ time off alcohol. It proposes that while there is a risk of prescribing alcohol detoxification regimes with methadone, there is a cohort of patients were this can be prescribed with a favourable outcome.

The purpose of this paper is to estimate the costs of medical detoxification among patients with alcohol and substance abuse disorders.

The study data was drawn from a medical detoxification program in a community hospital in Texas. Secondary data analysis of 1337 cases from three years was reviewed. Age, gender, race, alcohol, cocaine, cannabis, amphetamines, sedatives, opioids, financial classification, cost, length of stay (LOS) and cost by LOS were analyzed using Kruskal‐Wallis test and Mann‐Whitney U‐test.

The sample comprised of 42.8 percent women and 57.2 percent males. The mean cost and cost by LOS was highest for cocaine ($2560.1 and $1,044, P<0.01), while opioid and cannabis ($815.5, p<0.01; $823.7, p<0.01) had significantly higher values than the rest. In each individual drug detoxification class, except for amphetamines, the mean and median LOS has been reported to be less among the uninsured category compared to privately insured subjects. In addition, the cost by LOS was also found to be higher in the uninsured group compared to those with private insurance. Subjects who were uninsured and abused alcohol had higher median costs of detoxification (P<0.01) by LOS.

Further in‐depth analysis for confounding and interactions between variables is warranted.

This research provides an estimation of LOS of a medical detoxification program by financial class in the USA and illustrates that early discharge of uninsured and Medicaid patients can be attributable to aggressive case management practices, interrupting the normal course of care.

The purpose of this paper is to describe an episodic detoxification treatment relationship as a complex dyadic interaction.

The paper is inspired by a grounded theory approach. The first author worked in the field at a Finnish detoxification center in the autumn of 2007, 2008, and 2009. The resultant data have been analyzed thematically to form a process model.

An empirically grounded process model consisting of four states; an initiation state, a fading state, a development state, and an ending state. Each state may include events enabling the process to progress and others that hinder it.

By focussing on an under-studied view of relationships, as dyadic, mental and behavioral, and successful and failing, the model highlights the complexity of the treatment. Furthermore, the model can be used to allocate resources (time, work) to the process states in which they are most needed to aid the success of the relationship.

Drug use has numerous consequences on health, the economy, culture and the peace and security of families and communities. Drug users often engage in various criminal activities, including drug dealing, to sustain their drug use. Under Nepalese law, consumption, possession and sale of drugs are illegal, which increases the risk of incarceration for drug users.

Using a phenomenological/qualitative approach, the paper explores how various activities can lead to the arrest of drug users, how they cope without taking drugs in custody and prison and how they plan abstinence after release.

Participants engaged in various categories of criminal activity, including stealing, looting, etc. Most of the drug users were in custody and prison at least once. Drug use relapses led the participants to re-engage in criminal activities including drug dealing. Parents were often overburdened by their sons and daughter's drug use and were worried about their repeated relapses. Finally, some parents negotiated with their sons and daughters to keep them in prison where they would be able to stay without taking drugs and their involvement in crimes and conflicts would decrease.

Keeping substance abusers in prison does not appear to be an effective strategy, as many participants relapse after release from prison. However, a prison-based educational and health promotion strategy would be beneficial for drug users to develop knowledge and skills on staying drug-free. However, to date, no effort has been made to provide such services to drug users and develop their coping strategy after release.

Background: A consistent finding in alcohol research is that residential treatment gains tend to be cost inefficient and short‐lived. Yet this is often the only option offered to alcohol‐dependent subjects who live alone, or who are entering into first time detoxification. Clinical implications: This paper outlines an extension of the services routinely provided by statutory services in the community, which would be community psychiatric nurse‐led. The prescribing responsibility should be with the specialist alcohol treatment agency. Suggestions are made to enhance the uptake of community services including measures to facilitate Alcoholics Anonymous (AA) attendance. Conclusion: Alcohol detoxification in the community is usually safe. If the recommendations are put into practice, a greater number of subjects could be treated in a community setting.

Dependent alcohol use is a severe addictive disorder with significant enduring consequences for health and social functioning. This study aims to inductively explore the process of identity change for alcohol dependent people progressing through a “pre-habilitation” intervention, alcohol detoxification and post-detoxification recovery support.

Qualitative study as a part of a process evaluation situated within a UK feasibility trial of a group-based intervention in preparation for structured alcohol detoxification. Semi-structured qualitative interviews (face-to-face or telephone) collected self-reported data on experiences of treatment provision as part of the feasibility trial. Thematic analysis of transcripts and iterative categorisation of identity-related themes and concepts was conducted with verification of analysis undertaken by a second coder.

Identity change was revealed in participant narratives around the meta themes of external (social-identity) and internal (self-identity) concepts. External influences impacting social identity were key, having influenced initiation into alcohol use, influencing acceptance of the stigmatised “alcoholic” label and then being central to the treatment journey. Internal influences on self-identity also impacted on the process of identity change. In recovery, there was hope in discovering a new “normal” identity or rediscovering normality.

Analysis demonstrates that moving from regular alcohol use to problematic use is a journey of identity change that is influenced at the macro (cultural), meso (group) and micro (relational) social levels. Throughout the treatment journey, social influences in gaining a new non-drinker identity are key. Findings suggest a need for long-term support through treatment and community-based groups specifically to foster positive identity change that may not have been addressed previously.