http://www.doctordeluca.com/documents/CriteriaInptVsOutptDetox.htm
Circa 1998

Inpatient vs. outpatient detox? Criteria for deciding
(see also: "Outpatient Detox -  Is This Really a Good Idea?")

Patients who should not have outpatient detox procedures     

Here follows a brief discussion highlighting some of the criteria that suggest that the appropriate referral is to an inpatient hospital detoxification setting:

• Patient is at high risk for complicated withdrawal
• Current overdose-in-progress compromising vital signs, mental status or cardiac function, or life-threatening stupor.
• Head trauma, seizure, hallucinations, or symptoms of delirium tremens within the past 24 hours.
• History of seizures, hallucinations or delirium tremens when withdrawing from similar amounts of alcohol/sedatives; or history of recurrent or multiple seizures.
• Pregnant patient in need of detoxification.
• Daily use of sedative medications in doses above therapeutic levels for greater than one month, or in therapeutic doses but in combination with alcohol for greater than six weeks.
• CIWA >= 20, BAC >= 0.3, BAC >= 0.1 plus symptoms of alcohol withdrawal syndrome.
• CIWA = 10-19 plus pulse > 110 or BP > 160/110.
• Patient is at high risk for biomedical complications:
• Presence of biomedical problem(s) requiring inpatient diagnosis and treatment, such as, impending hepatic decompensation, acute pancreatitis or other condition requiring parenteral therapy, active gastrointestinal bleeding, cardiovascular disorder requiring monitoring, etc.
• Chemical use gravely complicating existing biomedical condition, or worsening of a condition making immediate abstinence critical to avoid severe morbidity or mortality.
• Patient is at high risk for psychiatric or behavioral complications:
• Uncontrolled behavior endangering self or others
• Impairment of cognitive function, mental confusion or fluctuating orientation, or extreme depression such that activities of daily living are impeded.
• Evidence of disorientation to self, alcoholic hallucinosis, or toxic psychosis within the past 24 hours or currently.
• Chemical use gravely complicating existing psychiatric condition, or worsening of a condition making immediate abstinence critical to avoid severe morbidity or mortality.
  

Patients who are good candidates for outpatient detoxification

• Patient is at minimal risk of severe withdrawal:
• CIWA < 10 after 4-8 hours abstinence, or, BAC = 0.0 with minimal or no medication that might mask signs or symptoms of withdrawal.
• Reliable history that use of substances in combination does not pose a significant risk of complicated withdrawal.
• Patient is likely to complete detoxification and accept referral:
• History of completion of outpatient detoxification and entry into continued treatment.
• Presence of support services to ensure commitment to complete detoxification and enter treatment.
• Patient has, and responds positively to, emotional support combined with treatment, and evidences decreased emotional symptoms by closure of initial treatment session.
• Patient and caretaker clearly understand instructions for care.
• Home environment able to provide adequate reality, reassurance and respect.

For further discussion of inpatient and outpatient detox see: "Outpatient Detox - Is This Really a Good Idea?"