A friend took in a house guest not long ago and, under a doctor’s instruction, kept the guest medicated with a regular and generous ration of strong drink.
Both guest and host were waiting out the days until the former would undergo an assessment leading — they hoped — to a place in one of Nova Scotia’s few remaining inpatient detox units. A few days after the assessment — days spent observing the same rationing routine — it did.
An alcoholic in withdrawal resembles a normal drinker with a hangover like a hurricane resembles an onshore breeze. The risks associated with acute alcohol withdrawal include the dreaded delirium tremens and life-threatening seizures.
The “strong-drink” prescription was intended to ward off those dangerous manifestations until the alcoholic/guest was safely under medical supervision. But that medical supervision, at an inpatient detox unit, can be tricky to access.
In days not long past, getting a drunk in the throes of withdrawal — or one about to enter that grim near-reality — into detox was an act of perseverance. It still is, but the Nova Scotia Health Authority layered on process that demands patience, too.
It’s also handy these days to have a plan to keep the alcoholic alive while s/he waits for the assessment and whatever treatment follows. Harbouring a moderately-drunken house guest for a few weeks is one such plan and an increasingly common one.
Just a few years ago, the family or friends of an alcoholic would call detox units across Nova Scotia until one confessed to having an open bed. The shaking, wretched drunk would be delivered forthwith to that facility.
But the Nova Scotia Health Authority built a detour on that road to detox. First comes an appointment where the extent and nature of the problem is assessed. A determination follows as to whether the afflicted requires inpatient detox or outpatient treatment.
(While opioid addiction is a growing and deadly problem, alcohol remains Canada’s most prevalent substance abuse problem — excluding tobacco.)
The NSHA mental health and addictions folks will tell you that inpatient detox is not required, or even advised in many cases. In the past, they’ve also said that the assessment process, with its attendant delay, helps to weed out people who aren’t fully committed to recovery.
That’s one way of looking at it. Another is that while the drunk waits for an assessment and then for a placement, the window of opportunity can close.
An alcoholic coming off a prodigious bender may hit that necessary moment of desperate clarity when s/he realizes there are only two choices: Stop drinking or die.
The clarity comes with a measure of sobriety, which brings the tortures of withdrawal. Faced with days of waiting for an assessment, many — most? — alcoholics will self-medicate. For those who climb fully back into a bottle, the window of opportunity slams shut for weeks, months, years or until almost merciful death.
The NSHA recommends taking an alcoholic gripped by dangerous withdrawal to the emergency department, which seems like good advice until you get there. A drunk shouldn’t expect a sympathetic welcome to an overcrowded, overworked emergency room.
“I feel like I’m dying,” the drunk tells the triage nurse, who’s heard it all before.
“That’s because you are,” replies his escort, a long-sober alcoholic who’s been down this road countless times, remembers when same-day admissions to detox were routine and sees no point in lying to his suffering ward, who is most assuredly dying and will do so soon if booze remains a staple.
Detox is just the first step back for every drunk who makes it back. It occurs in a hospital under close medical supervision, through some outpatient arrangement, or alone where the alcoholic alternates between fearing he will die and fearing he will not.
“Inpatient services may not always be medically necessary. Many people can withdraw with the support of their care team safely in community settings,” the NSHA wrote in reply to questions about detox, adding, “If an individual is clinically assessed to require admission, a bed is located for them as close as possible to their community.”
According to the same response, the province now has five inpatient detox units, down from nine just a few years ago.
The NSHA says it recognizes the need for inpatient detox, even as it rations access by closing detox beds and operating others on an “as needed” basis. Inpatient detox that’s available on a “when needed” basis is a relic of health care past.