1. Presented by: Theresa Lemus, MBA, BSN, LADC

2. 
Quick Guide for Clinicians Based on TIP 45
Detoxification and Substance Abuse Treatment

TIP 45 Detoxification and Substance Abuse
Treatment (free resource)

American Society of Addiction Medicine‟s Patient
Placement Criteria 2-Revised

Diagnostic and Statistical Manual IV TR

3. 

To inform participants about the basic
principles of withdrawal from alcohol and
other drugs and to help participants
understand their role in caring for persons in
a community-based detoxification setting
To help participants meet the legal
requirements for detox providers

4. After completion of this class participants will:
1. Understand the laws and regulations that govern social
and modified medical model detoxification programs in
Nevada (NRS)
2. Have improved knowledge of the biopsychosocial aspects
of withdrawal (signs and symptoms, ASAM dimensions)
3. Have knowledge of the most common medications used
in withdrawal management
4. Understand the parameters and limitations of a social
model setting (NRS, medications, care coordination)
5. Understand their role in providing care in a detox setting
(limitations, guidelines, engagement, retention, NHIPPS)
6. Understand and successfully demonstrate how to
measure, record and report vital signs
7. Have met one of the legal requirements established in
NRS for detox providers

5. 


Nevada Administrative Code, Chapter 449
for Medical and Other Related FacilitiesThe Bureau of Health Care Quality and
Compliance formerly Bureau of Licensure and Certification
Nevada Revised Statutes, Chapter 458SAPTA
Nevada Revised Statutes, Chapter 641C Alcohol, Drug And Gambling Counselors
And Detoxification Technicians- Board of
Examiners for Alcohol, Drug, and Gaming
Counselors

6. 
Education / training (this class) initially and every two
years

Seizure care

Tuberculosis and communicable diseases

Current certification in Cardiopulmonary
Resuscitation

Pass skills test for measuring, recording and
reporting vital signs

7. 


The State Board of Health's regulations governing the control
of communicable diseases are found in the Nevada
Administrative Codes (NAC) Chapter 441A
These regulations mandate public health
professionals, medical providers, laboratories and
others in Washoe County to report approximately
50 diseases or conditions to the District Health
Department Communicable Disease Program.
All reported information is CONFIDENTIAL.

8. 

Prior to the 1970‟s public intoxication was
commonly treated as a criminal offense.
Drunk tanks, withdrawal with no medical
intervention.
From this- arose the medical model and
social models of detoxification.

9. 


According to the U.S. Department of Health
and Human Services, Substance Abuse and
Mental Health Administration (SAMHSA)
detoxification is a set of interventions aimed
at managing acute intoxication and
withdrawal.
Clearing of toxins from the body.
The primary goal is to build a therapeutic
alliance and motivate clients to enter
treatment.

10. Social model substance abuse treatment
programs concentrate on providing
psychosocial services.
Trained detox personnel and other clinicians
provide supportive withdrawal management
services in addition to individual and family
counseling and coordination of care.

11. 

A clinically managed residential detoxification
that may be delivered by appropriately trained
staff, who provide 24-hour
supervision, observation and support for patients
who are intoxicated or experiencing withdrawal.
Clinically managed detoxification is characterized
by its emphasis on peer and social support.
Intoxication and withdrawal signs and symptoms
are sufficiently severe enough to require 24-hour
structure and support but not severe enough to
warrant the resources of a Level III.7-D medically
monitored inpatient detoxification.

12. 
Medically monitored inpatient detoxification
is an organized service delivered by medical
and nursing professionals, which provides for
24 hour medically supervised evaluation and
withdrawal management in a permanent
facility with inpatient beds. Services are
delivered under a defined set of physicianapproved policies and physician monitored
procedures or clinical protocols.

13. Modified and full medical detox can be characterized
by:





directed by a physician
staffed by other health care personnel
range from hospital-based inpatient programs to
free-standing medically based residential
programs in hospitals or in community facilities
can draw on various medical resources within the
community
designed to treat more serious substance
withdrawal syndromes that require the use of
detox medications and medical oversight

14. 1. Evaluation
2. Stabilization
3. Fostering client readiness for and entry into
treatment
*a detox process that does not incorporate
all three critical components is considered
incomplete and inadequate

15. INTAKE
Client presents for
SM detox service
Ensure Client has
medical clearance for
SM Detox
Ensure client has
had a drug test
Establish diagnosis
and check for
prescription or OTC
detox medication
Search for Client
Profile in NHIPPS, if
none exists, create a
new profile record
NHIPPS -- Treatment Flowchart
SOCIAL MODEL DETOX EPISODE
revised 09/08 - MMD / SAPTA
Clearance can be granted by
ER or other qualified medical
personnel
ADMISSION /
ASSESSMENT
Complete Admission Record for ASAM Level III.2D
Lab license required for testing. Testing is critical to identify
drug used, determine diagnosis, increase client safety and
reduce agency liability
Complete NHIPPS assessment including HDPC within
24 hours of admission
Note in HDPC clinical summary that only ASAM
Intoxication / Withdrawal is the driving dimension
The assessment may be left “in progress” so it can be reviewed when client is admitted
to the next level of care or if the client does not stay to complete the assessment
Any staff with chart entry privileges can do
this if a diagnosis has been established
TREATMENT
Develop detox treatment plan (not the NHIPPS
treatment plan) to
address ASAM withdrawal dimension
Detox TX plan can be recorded in Chart Note
Monitor for withdrawal symptoms, record vitals
and observations in NHIPPS Chart Note or
paper file
Complete one NHIPPS Progress Note per day
Progress Note should include observation,
vitals summary, engagement attempts,
client participation and readiness for care
TX plan should engage client, monitor withdrawal
symptoms and medications, and introduce client to
individual or group therapeutic events .
DISCHARGE /
TRANSFER
Once client has adequately
completed detox, review
assessment and mark it complete
Create
Discharge Record – refer to
appropriate level of care
Goal is 40% engagement in
continued care after detox
Complete discharge HDPC
Complete within 5 days of
actual client discharge
Complete intra or inter agency
transfer steps (Client must consent
to inter-agency transfer of his / her
records)
Open completed discharge record in the
activity list to access discharge HDPC

16. 
The American Society of Addiction Medicine Patient
Placement Criteria 2nd Edition Revised (ASAM-PPC2R) is the evidenced-based literature referenced in
support of the Health Division Placement Criteria
required by SAPTA.

17. The placement criteria describe levels of
treatment that are differentiated by the
following characteristics:
 (1) degree of direct medical management
provided,
 (2) degree of structure, safety, and security
provided, and
 (3) degree of treatment intensity provided.

18. Dimension 1
Dimension 2
Dimension 3
Acute Intoxication
&/or Withdrawal
Potential
Biomedical
Conditions &
Complications
Emotional,
Behavioral, or
Cognitive
Conditions &
Complications
Dimension 4
Dimension 5
Dimension 6
Readiness to
Change
Relapse,
Recovery / Living
Continued Use or
Environment
Continued
Problem Potential

19. The Goals of Care:
1. Avoidance of potentially hazardous
consequences of discontinuation
2. Facilitation of the client‟s completion of
detoxification
3. Promotion of client dignity

20. Are there current physical illnesses?
Are there chronic conditions that affect
treatment?

21. 
Persons undergoing withdrawal are in
profound medical and personal crisis!

Withdrawal can cause and/or exacerbate
physical, emotional, psychological or mental
problems.

22. 
NAC 449.1214 Medical Clearance requires a physical
assessment/exam by an MD, PA, NP, or RN within 24 hours to
ensure that a social model is appropriate
◦ Diagnosis
◦ Detox medications
◦ Special instructions

Clients are provided with continuous monitoring based upon
established written and MD approved policies and procedures
(see sample)


*Drug test
Comply with NAC 449.144 Medications
*Not yet required but preferred

23. 






General health history
Mental status
General and physical
assessment and neuro
check
Vital signs
Patterns of use
Urine toxicology
Past treatment or
withdrawal
Biomedical








Demographics
Living conditions
Violence/suicide risk
Transportation
Financial situation
Dependent children
Legal status
Physical, sensory or
cognitive disabilities
Psychosocial

24. 


Medication assist
Right container
Labeled
◦
◦
◦
◦
◦
◦
Client name
Medication
Dosage
Instructions
Prescribing physician
Not expired!
NAC 449.144

Detox staff make
medication available
◦
◦
◦
◦
Observe
Document
Monitor
Contact prescribing or ER
physician as needed
“Medication Assist”

25. 
Change in mental status
Increasing anxiety
Hallucinations
Temperature greater than 100.4 (infectious)
Significant increase/decrease in vitals
Insomnia-prolonged
Upper and lower GI bleeding
Change in responsiveness- pupils
Heightened deep tendon reflexes
*Immediate MH needs: Suicidality, Anger and Aggression

27. Brains
have been
Re-Wired
by Drug Use

29. DRUG ADDICTION IS A COMPLEX
www.drugabuse

30. 



One of the neurotransmitters playing a major
role in addiction is dopamine.
As a chemical messenger, dopamine is similar
to adrenaline.
Dopamine affects brain processes that
control movement, emotional response, and
ability to experience pleasure and pain.
Regulation of dopamine plays a crucial role in
our mental and physical health.

54. Your Brain on
Drugs
1-2 Min
3-4
5-6
6-7
7-8
8-9
9-10
10-20
20-30
Photo courtesy of Nora Volkow, Ph.D. Mapping cocaine
binding sites in human and baboon brain in vivo. Fowler
JS, Volkow ND, Wolf AP, Dewey SL, Schlyer DJ, Macgregor
RIR, Hitzemann R, Logan J, Bendreim B, Gatley ST. et al.
Synapse 1989;4(4):371-377.

55. Your Brain
After Drugs
Normal
Cocaine Abuser
(10 days)
Cocaine Abuser
(100 days)
Photo courtesy of Nora Volkow, Ph.D. Volkow ND, Hitzemann R, Wang C-I, Fowler IS, Wolf AP, Dewey SL. Long-term frontal brain metabolic changes
in cocaine abusers. Synapse 11:184-190, 1992; Volkow ND, Fowler JS, Wang G-J, Hitzemann R, Logan J, Schlyer D, Dewey 5, Wolf AP. Decreased
dopamine D2 receptor availability is associated with reduced frontal metabolism in cocaine abusers. Synapse 14:169-177, 1993.

56. Drugs
Have
Long-term
Consequen
ces
Photo courtesy of NIDA from research conducted by
Melega WP, Raleigh MJ, Stout DB, Lacan C, Huang
SC, Phelps ME.

57. The Memory of
Drugs
Front of Brain
Amygdala
not lit up
Amygdala
activated
Back of Brain
Nature Video
Photo courtesy of Anna Rose Childress, Ph.D.
Cocaine Video

58. Partial Recovery of Brain Dopamine
Transporters in Methamphetamine (METH)
Abuser After Protracted Abstinence
3
0
ml/gm
Normal Control
METH Abuser
(1 month detox)
METH Abuser
(24 months detox)
Source: Volkow, ND et al., Journal of Neuroscience 21, 9414-9418, 2001.

60. 
Pharmacologic therapies are indicated for use
in persons with substance use disorders to
prevent life-threatening withdrawal
complications such as seizures and delirium
tremens, and to increase compliance with
psychosocial forms of addiction treatment.

61. 

Methamphetamine is a powerful central nervous
system stimulant that strongly activates multiple
systems in the brain. Methamphetamine is closely
related chemically to amphetamine, but the central
nervous system effects of methamphetamine are
greater.
Methamphetamine causes a tremendous release of
dopamine into the synapse and causes
displacement in little sacs of the dopamine
transmitters.

62. Forms of Methamphetamine
Methamphetamine Powder
Description: Beige/yellowy/off-white powder
Base / Paste Methamphetamine
Description: ‘Oily’, ‘gunky’, ‘gluggy’ gel, moist, waxy
Crystalline Methamphetamine
Description: White/clear crystals/rocks;
‘crushed glass’ / ‘rock salt’

63. 



The effects of methamphetamine include increased activity,
decreased appetite, and a sense of well-being that can last
from six to eight hours.
The drug has limited medical uses for the treatment of
narcolepsy, attention deficit disorders, and obesity.
Increase wakefulness and physical activity and decrease
appetite.
Methamphetamine can also cause a variety of cardiovascular
problems, including rapid heart rate, irregular heartbeat, and
increased blood pressure. Hyperthermia (elevated body
temperature) and convulsions may occur with
methamphetamine overdose, and if not treated immediately,
can result in death.
(National Institute on Drug Abuse, Methamphetamine: Abuse and Addiction, April 1998.)

64. 





Anxiety
Confusion
Insomnia
Mood disturbances
Violent behavior
Psychotic features, including paranoia, visual and auditory
hallucinations, and delusions (for example, the sensation of
insects creeping under the skin). Psychotic symptoms can
sometimes last for months or years after methamphetamine
abuse has ceased, and stress has been shown to precipitate
spontaneous recurrence of methamphetamine psychosis in
formerly psychotic methamphetamine abusers.

65. 



Peak period: 1-3 days after cessation
Duration: 5–7 days depending on various
factors
Signs: Social withdrawal, psychomotor
retardation, hypersomnia, hyperphagia
Symptoms: Depression, anhedonia, suicidal
thoughts and behavior, paranoid delusions

66. 



Peak period: 24 hours after cessation
Duration: 5–7 days depending on various
factors
Signs:
Anxiety, Restlessness, Irritability, Sleeplessne
ss
Symptoms: Depression

67. 
Management of alcohol withdrawal is based
on the client‟s history and current clinical
status. The single best predictor of the
likelihood of future withdrawal symptoms
when alcohol is concerned is the patient's
previous history, e.g., the presence or
absence of seizures or delirium tremens

68. 



Peak period: 1-3 days after cessation
Duration: depends on various factors
Signs: Elevated blood pressure, pulse and
temperature, hyperarousal, agitation, restlessnes
s, cutaneous
flushing, tremors, diaphoresis, dilated
pupils, ataxia, clouding of
consciousness, disorientation
Symptoms: Anxiety, panic, paranoid
delusions, illusions, visual and auditory
hallucinations (often derogatory and
intimidating)

69. 

Valium- (Diazepam) is a
benzodiazepine with a medium to
long duration of action. Used for
withdrawal to decrease blood
pressure, to relieve anxiety, to
help relax muscles or relieve
muscle spasm.

Ativan- (Temesta or Lorazepam) is
a benzodiazepine with short to
medium duration of action.

Atenolol – (Tenormin) is a betablocking agent used in the
treatment of high blood pressure,
used to relieve angina, and in
heart attack patients to help
prevent additional heart attacks. It
is also used to correct irregular
heartbeat, prevent migraine
headaches, and to treat tremors.
Clonidine (Catapres)- lowers blood
pressure by decreasing the levels
of certain chemicals in your blood.
Reduces anxiety.

70. 




At the first sign- summon trained medical
personnel
Prevent injury-protect head, move nearby
objects
Place on side if client is vomiting
Soothing, calm voices/actions
Medical Evaluation!

71. 

Is a potentially fatal form of alcohol withdrawal.
Symptoms may begin a few hours after the
cessation of ethanol but may not peak until 4872 hours. Emergency Room Physicians must
recognize that the presenting symptoms may not
be severe and identify those at risk for
developing DT. For patients in DT, early
recognition and therapy are necessary to prevent
significant morbidity and death.

72. 
Management of withdrawal can be
accomplished with medications to alleviate
symptoms

73. 



Peak period: 1-3 days after cessation
Duration: 7-14 days depending on various
factors
Signs: Drug
seeking, mydriasis, piloerection, diaphoresis,
rhinorrhea, lacrimation, diarrhea, insomnia, el
evated blood pressure and pulse (mild)
Symptoms: Intense desire for drugs, muscle
cramps, arthralgia, anxiety, nausea, vomiting,
malaise

74. 


Represent a diverse class and include
sedative-hypnotics, stimulant and
hallucinogens
Clubs/raves
Adolescent/young adult

75. 



Common household products that give off mind-altering
chemical fumes when sniffed
Paint thinner, fingernail polish
remover, glues, gasoline, cigarette lighter fluid, and nitrous
oxide, whipped cream, hair and paint sprays, and computer
cleaners
The chemical structure of the various types of inhalants is
diverse, making it difficult to generalize about the effects of
inhalants.
Inhalant users are also at risk for Sudden Sniffing Death
(SSD), which can occur when the inhaled fumes take the place
of oxygen in the lungs and central nervous system.

76. 
Withdrawal from benzodiazepines such as
Xanax, Librium, Ativan, etc. cannot be
managed in a social model detox setting

Withdrawal must be overseen by a physician

Detox can be done on an outpatient basis

77. INTAKE
Client presents for
SM detox service
Ensure Client has
medical clearance for
SM Detox
Ensure client has
had a drug test
Establish diagnosis
and check for
prescription or OTC
detox medication
Search for Client
Profile in NHIPPS, if
none exists, create a
new profile record
NHIPPS -- Treatment Flowchart
SOCIAL MODEL DETOX EPISODE
revised 09/08 - MMD / SAPTA
Clearance can be granted by
ER or other qualified medical
personnel
ADMISSION /
ASSESSMENT
Complete Admission Record for ASAM Level III.2D
Lab license required for testing. Testing is critical to identify
drug used, determine diagnosis, increase client safety and
reduce agency liability
Complete NHIPPS assessment including HDPC within
24 hours of admission
Note in HDPC clinical summary that only ASAM
Intoxication / Withdrawal is the driving dimension
The assessment may be left “in progress” so it can be reviewed when client is admitted
to the next level of care or if the client does not stay to complete the assessment
Any staff with chart entry privileges can do
this if a diagnosis has been established
TREATMENT
Develop detox treatment plan (not the NHIPPS
treatment plan) to
address ASAM withdrawal dimension
Detox TX plan can be recorded in Chart Note
Monitor for withdrawal symptoms, record vitals
and observations in NHIPPS Chart Note or
paper file
Complete one NHIPPS Progress Note per day
Progress Note should include observation,
vitals summary, engagement attempts,
client participation and readiness for care
TX plan should engage client, monitor withdrawal
symptoms and medications, and introduce client to
individual or group therapeutic events .
DISCHARGE /
TRANSFER
Once client has adequately
completed detox, review
assessment and mark it complete
Create
Discharge Record – refer to
appropriate level of care
Goal is 40% engagement in
continued care after detox
Complete discharge HDPC
Complete within 5 days of
actual client discharge
Complete intra or inter agency
transfer steps (Client must consent
to inter-agency transfer of his / her
records)
Open completed discharge record in the
activity list to access discharge HDPC

78. Client Profile
•Profile record should be the first or
bottom record in the client activity list
– this is controlled by profile date
•Always assume there is a profile for
the client before creating one – in
other words, search for a profile
before entering a new one
•If your agency has multiple
treatment locations where intake
could occur, techs and counselors
should have access to view client
records from the Business Level and
should also have the ability to move
to any treatment location within the
system to share records with the
detox treatment location
•TURN YOUR POPUP BLOCKER OFF
BEFORE ENTERING A NEW CLIENT
PROFILE – this way, if one already
exists at your agency, the system will
find it and notify you
•Enter only the city in Birth City field

79. Admission Record (page 1)
•Do not select Transitional Housing as the admission type for a detox admission
– detox is a residential admission, transitional housing is paired with outpatient
services
•Do not enter dollar signs or decimal places in monetary fields

80. Admission record (page 2)
Admission justification should be written by a counselor, however if a technician must enter an admission record, the
justification should rely on a medical record that indicates a diagnosis of intoxication or withdrawal and can include drug
and other test results and prior admissions for detox within 30 days of the current admission. The technician should
contact supervisor as soon as possible to schedule a complete assessment.
Example 1: Client arrived at 11:00pm, cleared through ER. ER documentation states intoxication (alcohol) diagnosis,
cleared for social detox.
Example 2: Client assessed by Dr. Jones, medically cleared with intoxication diagnosis for social detox treatment.

81. Detox TX Plan (Chart Note)
•Chart note is accessed from the toolbar in the Client Activity List screen
•Exercise care when entering information in the Chart Note as it cannot be deleted
•If creating a treatment plan for detox, enter Detox TX Plan for as the topic

82. Screening
•The screening record contains questions about gambling behavior and should be
completed
•The screening score is not the justification for an assessment, it is a tool to be used by
a provider to establish a business process

83. Assessment / General - Leave In Progress
•Leave the assessment in progress for clinical staff at the next level of care to review
and modify if necessary

84. Assessment / Substance

85. Assessment / HDPC (ASAM)
•If the HDPC record is idle for more than 5 minutes, it is advisable to copy the clinical summary before saving
the record. This will ensure that if the current NHIPPS session is terminated, the text entered into the
clinical summary field will be stored on the computer Clipboard and can be copied back into this record

87. *
*
*
*
*
*
Precontemplation
Contemplation
Preparation
Action
Maintenance
Recurrence
Treatment Improvement Protocol
Series (35), 1999
87

88. Reflects Prochaska & DiClemente‟s
“Stages of Change Model”
An individual‟s emotional and cognitive
awareness of the need to change and his
or her level of commitment to and
readiness for change indicate his or her
degree of cooperation with treatment…

89. Precontemplation- The substance use has
not considered change and does not plan to
make changes in the near future. The may
be partly or completely unaware that the
problem even exists.
Strategies- Rapport & trust building, raise
doubts or concerns, elicit CSO‟s assistance.
TIPS 35, 1999
89

90. Contemplation client is aware of the
problem and starts to examine the
possibility of change. These are individuals
who are ambivalent (seeing reasons to
change and at the same time seeing
reasons not to change). They are sitting on
a teeter-totter. The “Ya, but..”
Strategies- Normalize the ambivalence, elicit
self-motivation statement from the client, “tip” the
scale.
TIPS 35, 1999
90

91. Preparation- The individual can see the
advantages to change and is aware that
they outweigh the disadvantages. They
have a strengthened commitment to change
and may have even set a date to quit use or
have decreased their use. It‟s a window that
opens for a short period.
Strategies- Clarify goals, offer a menu of
options, negotiate strategies for change, help client
to enlist social support, make a public
announcement.
TIPS 35, 1999
91

92. Action - The individual chooses strategies
to change and actively works towards
change. They are taking steps to change.
Often they are behaviorally definable
differences. However, they have not reached
a stable state.
Strategies- Continue to engage and reinforce any
changes with a focus on the importance of
remaining in recovery, support small step, identify
high-risk situations, help client assess current
social support system.
TIPS 35, 1999
92

93. Maintenance- The individual works to
sustain any gains made during the action
phase. They have achieved the initial goals
towards change and now are working
towards maintaining them.
Strategies- “fire-escape” plan, review long-term
goals, sample drug-free sources of pleasure, roleplay & practice coping skills.
TIPS 35, 1999
93

94. Recurrence- the client experiences a
recurrence of the symptoms and now has to
face the consequences.
 Assist in reentry and commend any willingness to
consider continued change.
 Explore the recurrence as a learning experience
and learning opportunity.
 Elicit social support
 Explore alternative coping strategies.
TIPS 35, 1999
94

95. Relapse
Relapse is an act or instance of
backsliding, worsening, or subsiding, and
may be the common denominator in one
of the outcomes of treatments designed to
address psychological problems and
health-related behaviors especially those
related to alcohol and drug misuse.

97. 
Vital signs include the measurement of:
temperature, respiratory rate, pulse, blood pressure
and, where appropriate, blood oxygen saturation.
Vital Signs can:
1.
2.
3.
Identify the existence of an acute medical problem.
Are a means of rapidly quantifying the magnitude of an
illness and how well the body is coping with the resultant
physiologic stress. The more abnormal the vitals, the sicker
the clients.
Vital signs are a marker of chronic disease states (e.g.
hypertension is defined as chronically elevated blood
pressure).

98. 


The room should be quiet, warm and well
lit.
Prior to measuring vital signs, the clients
should have had the opportunity to sit for
approximately five minutes so that the
values are not affected by the exertion.
All measurements are made while the client
is seated.

99. 
Normal range is 96 to 99.5 degrees
Fahrenheit

100. 




Respirations are recorded as breaths per
minute
They should be counted for at least 30
seconds
Try to measure discretely so that the client
does not consciously alter their rate of
breathing
Counting breaths can be done by observing
the rise and fall of the client‟s chest while
you appear to be taking their pulse.
Normal range is between 12 and 20.

101. 


Generally done by palpating the radial
impulse
Measure the rate of the pulse (recorded in
beats per minute).
Count for 30 seconds and multiply by 2 (or
15 seconds x 4). If the rate is particularly
slow or fast, it is probably best to measure
for a full 60 seconds

Normal range is between 60 and 100.

102. 



Blood pressure is the force of blood pushing
against the walls of arteries – the blood vessels
that carry blood away from the heart to other parts
of the body
Blood pressure can rise and fall depending on a
person‟s general health, their level of physical
activity, the time of day and many other factors
Normal range is Systolic: 100 to 140.
Diastolic: Equal to or less than 90

103. 


Dependent on agency policies
Social Model Detox reports all abnormal
vital sign measurements to licensed
healthcare professionals
Medical Detox has option to medicate and
treat the individual based on physicianapproved protocols and physician„s orders