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Indra Cidambi, M.D.
Indra Cidambi, M.D.

Outpatient Detox Model Gaining Popularity in Treatment

Why ambulatory (outpatient) detox is more effective

The first step on the road to recovery for someone suffering from substance abuse is to safely detox off of alcohol and drugs. Traditionally detoxification was offered only in an inpatient setting, where the patient stayed at the facility up to nine days. However, a new and innovative form of treatment is on the rise in the field of addiction medicine: Medically Monitored Ambulatory (Outpatient) Detox. In this program patients stay at the facility during the day and then return home in the evening.

According to Dr. Indra Cidambi, Medical Director at The Center for Network Therapy, New Jersey’s first state licensed Ambulatory Treatment Facility, while deaths climbed from 6.2% per 100,000 people in 2000 to 13.8% in 2013, the most widespread treatment model, inpatient detoxification, failed to damper the rising overdose trend.

“Due to the inability of Inpatient Detox programs to help with rising addiction rates, several states started licensing Ambulatory Detoxification facilities to provide detoxification from all substances (alcohol, benzodiazepines and opiates) with the hope of adding another weapon to the fight against America’s drug epidemic,” says Dr. Cidambi. She believes the Ambulatory (Outpatient) Detoxification model delivers better results while significantly lowering costs, which will sideline the Inpatient Detoxification model over the next few years.

The Center for Network Therapy is New Jersey’s first facility to implement the Ambulatory Detox model. The Center for Network Therapy conducted a phone survey this year covering 200 former patients. Approximately 55% of patients who received treatment from The Center for Network Therapy’s Ambulatory Detoxification program remained sober between 6 and 11 months.

Dr. Cidambi explains the five factors that drive better outcomes for Ambulatory Detox, which she believes are reasons why this lesser known detoxification program will displace Inpatient Detox as the standard form of addiction treatment:

Incorporating the client’s living environment into treatment ensures real change

“In the inpatient detoxification model, patients are in a bubble with no ‘real life’ interaction during their stay,” says Dr. Cidambi. “When they return home, patients are often overwhelmed by their real life situation and more likely to relapse in the near-term. In comparison, the outpatient model focuses on helping the patient cope with the home environment and stay sober. This brings about real change that supports long-term sobriety.”

Bringing family into treatment elevates support the patient receives at home

In the inpatient model, patient’s families are not an integral part of treatment, so the family is usually not fully aware of the struggles the patients face, leaving the patients to fight the disease of addiction alone. In contrast, in the Ambulatory Detoxification model, family is brought in for therapy and updated on the patient’s progress and struggles, as well as educated on ways to help. “This encourages the patient to use family as a permanent support system that they can turn to when they feel vulnerable, instead of relapsing,” says Dr. Cidambi.

Longer length of stay leaves patients with lesser cravings

Private health insurance providers usually allow longer stays at the Ambulatory Detoxification level of care due to lower costs. According to Dr. Cidambi, “this allows us to titrate medications more gently during the detoxification process. The patient usually has fewer cravings and less withdrawal symptoms at the end of the detox process compared to Inpatient treatment. This makes it more likely patients will continue with follow-up care.”

Customized medication titration ensures comfort and helps avoid relapse

Since patients go home every day in the Ambulatory Detoxification model, medication used to detox clients is titrated in a highly individualized manner to ensure patient comfort during the night. In contrast, Inpatient Detoxification medication protocols are usually standardized and ignore the individual needs of patients. “This customized medication titration used in the Ambulatory model leaves the patient more comfortable with less cravings and withdrawal symptoms,” said Dr. Cidambi.

Ability to stay in touch with social network, work/school lowers stress

According to Dr. Cidambi, “one of the stressors patients face is the need to be out of touch while in an inpatient setting. This completely disrupts their social life and they need to explain their absence to coworkers and/or their boss. In the Ambulatory Detox model patients get some time during the day to attend to their work needs using a phone or laptop. They also go home every night, lowering the stress associated with being in treatment.”

“It is rare in the medical treatment world when higher efficacy comes with lower costs. Ambulatory Detoxification costs about a third of inpatient detoxification, which usually runs between $1,200 and $2,200 per day,” said Dr. Cidambi. “This cost advantage is an added driver for the acceptance of the Ambulatory Detoxification model and will propel growth and market penetration.”

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About the Author
Indra Cidambi, M.D.

Indra Cidambi, M.D., is the founder and medical director of the Center for Network Therapy (CNT), New Jersey's first state licensed Ambulatory (Outpatient) Detoxification care and treatment facility.

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