Addiction Medicine Services

Introduction The Private Practice of Addiction Medicine
Evaluation and Assessment Reviewing the story, crisis management, setting priorities and initial goals, laying the foundation.
Detoxification Understanding the process and committing to the (usually short) course of (usually) outpatient treatment.
Early Recovery  Symptoms: anxiety, insomnia, depression, irritability, mood-swings. Very common. Very treatable.
Stable Recovery The ongoing pursuit of positive lifestyle changes.


Outpatient Detoxification
Sometimes medication is needed to prevent a withdrawal syndrome which can occur if you suddenly discontinue taking alcohol or drugs. This detoxification procedure can almost always be accomplished on an outpatient basis. The most dangerous withdrawals are from alcohol and other sedative medications, and these require medical treatment. Getting off of heroin or other opiate drugs, or from cocaine or several different substances need not be painful or humiliating or incapacitating. All of these can be treated with medication and therapy, and often without major disruption of a person's life. 

  • Detoxification from alcohol can usually be accomplished in 2-3 visits over a week. Detox from opiate medications or heroin, if there are no complications like chronic pain, or major medical / psych problems, can usually be done in 4-7 visits over a two week period. Every person is different.

  • One nice thing about doing detox as an outpatient is that we can take our time. Inpatient detoxes are often rushed affairs, with the doctors bullied by the insurance companies into making inpatient stays so short that some people are really not getting the time they need to make the transition to a drug-free state.

  • The patient and I determine the pace of the detox based mostly on patient preference (some people like to take the band-aid off slowly, others like to rip it off all at once).



Outpatient Detoxification Services

The outpatient detoxification process is straightforward. Patients are seen daily by the nurse for vital signs and alcohol/drug screening, and by the physician who reviews any symptoms of withdrawal or overmedication, and any problems the patient might be having with the detoxification procedure. Only enough medication is prescribed to get the patient back to the next visit eliminating risk of serious overdose on detox medications. Patient’s are given a phone number through which they can reach a Smithers physician 24 hours a day. As the detoxification progresses, the patient completes the biopsychosocial evaluation and begins to attend groups designed to assess and enhance motivation. Individual counseling beyond that provided daily by the physician is available if necessary. Generally this detoxification and engagement period can be accomplished in three to ten days depending on the substance(s) involved and the severity of the case.

Issues of patient safety and clinical experience

We have been doing outpatient detoxification as a routine procedure for over four years at Smithers, longer than most other substance abuse treatment facilities in this area, and have honed our service by studying outcomes and adjusting treatments and procedures accordingly. We have had no major medical or psychiatric complications, and our completion rates rival those reported by the best research. Our detoxification procedures are designed and overseen by Dr. Alexander DeLuca, Chief and Medical Director of Smithers. Dr. DeLuca is the Chairperson of the American Society of Addiction Medicine’s Certification Review Course. He is also a consultant to the State of New York’s Office of Alcoholism and Substance Abuse Services and has helped the State write regulations for outpatient detoxification and teaches medical aspects of withdrawal and detoxification in the State mandated licensure course.

Expert detoxification is about more than the prevention of medical and psychiatric complications. It is the provision of non-judgmental, compassionate medical care. It is the reassurance of patients who are frightened and ashamed. It is the engagement of patients in a process of recovery that can spare them decades of pain and misery.