[State of practice: withdrawal management in adult addiction rehabilitation service centres]

C. Boutin, I. Linteau
Record ID 32018000885
Original Title: État des pratiques: la gestion du sevrage dans les services de réadaptation en dépendance, regard sur les pratiques d’ici et d’ailleurs
Authors' objectives: There were three objectives in preparing this state of practice report: • To describe the use of withdrawal management services in public institutions in Quebec offering such services; • To document withdrawal management practices of addiction rehabilitation centres relating to the best practice statements in the FQCRPAT practice guide [2008]; • To collate the main recommendations of practice guides and guidelines issued since the publication of the FQCRPAT practice guide [2008].
Authors' methods: Analysis of the data from the clinical and administrative databanks indicates the following for 2016–2017: • 2,877 people 18 years of age and older were admitted for a total of 3,307 stays in one of the 10 CISSS/CIUSSS with an ARC mission offering residential withdrawal management services. An average length of stay was 7.2 days. • 411 people 18 years of age and older received outpatient withdrawal management services in one of the four CISSS/CIUSSS with an ARC mission offering withdrawal management services on an external basis. These people received a total of 1,124 interventions, an average of 2.7 per person, each lasting an average of 39 minutes. • 4,571 visits were made to Québec emergency rooms due to alcohol withdrawal syndrome. Three-quarters of these visits were by men, and just over half were by people between 40 and 64 years of age. • 3,233 people were hospitalized for withdrawal syndrome in Québec, for a total of 3,862 stays. Three-quarters of these stays were by men, and just over half were by people between 40 and 64 years of age. Four out of every five hospital stays (82%) were for alcohol withdrawal, and the average length of stay for the province as a whole was 11.9 days. In addition, these data, together with the practice statements in the FQCRPAT guide [2008], highlighted certain practices that are more widespread and others that vary from one region to the next. Among the more widespread practices reported by institution representatives are the following: • Multidisciplinary teams which suggest a mixed-model approach (medical and psychosocial); • Interventional approaches based on motivation (motivational approach) and cognition and behaviour (cognitive-behavioural approach) as well as relapse prevention and harm reduction; • A hierarchical model of withdrawal severity (ASAM 2001) based on patient risk assessment; • Use of standardized clinical tools, such as the Niveau de désintoxication-évaluation médicale, (NiD-ÉM, a medical withdrawal level assessment tool), the Niveau de désintoxication-évaluation psychosociale (NiD-ÉP, a psychosocial withdrawal assessment tool), the Clinical Institute Withdrawal Assessment for Alcohol, Revised (CIWA-AR) and the Indice de gravité d’une toxicomanie (IGT).
Project Status: Completed
Year Published: 2019
Requestor: Minister of Health
English language abstract: An English language summary is available
Publication Type: Other
Country: Canada
Province: Quebec
MeSH Terms
  • Substance Abuse Treatment Centers
  • Substance Withdrawal Syndrome
  • Drug addiction
  • Withdrawal syndrome
Organisation Name: Institut national d'excellence en sante et en services sociaux
Contact Address: L'Institut national d'excellence en sante et en services sociaux (INESSS) , 2021, avenue Union, bureau 10.083, Montreal, Quebec, Canada, H3A 2S9;Tel: 1+514-873-2563, Fax: 1+514-873-1369
Contact Name: demande@inesss.qc.ca
Contact Email: demande@inesss.qc.ca
Copyright: Gouvernement du Québec
This is a bibliographic record of a published health technology assessment from a member of INAHTA or other HTA producer. No evaluation of the quality of this assessment has been made for the HTA database.