An Inpatient Unit (IPU) provides care to service users with substance-related problems (medical, psychological or social) that are so severe that they require medical, physical and psychological care. The key feature of the IPU is the provision of these services with 24 hour cover 7 days per week, from a multi-disciplinary clinical team who have had specialist training in managing addictive behaviours
Treatment in an inpatient (admitted) setting may involve one or more of the following interventions:
1. Assessment
2. Stabilisation
3. Assisted withdrawal (detoxification)
A combination of all three may be provided or one followed by the other.
IPU treatment is based on a plan of care, developed prior to admission, and should encompass relevant preparatory work and a seamless transition to on-going treatment after discharge.
The three main settings for inpatient treatment are:
•General hospital psychiatric units
•Specialist drug misuse inpatient units in hospitals
•Residential rehabilitation units (usually as a precursor to the rehabilitation programme)
The modality / intervention start date is the date of admission to the inpatient facility.
i) Inpatient Treatment Assessment Only (Definition of Intervention)
Individuals with drug and alcohol dependence present with a wide range of psychiatric, physical and social problems.
Substance misuse services provide a comprehensive assessment of these needs and formulate a treatment care plan to tackle them.
A hospital setting permits a higher level of medical observation, supervision and safety for service users needing more intensive forms of care. Specific tasks of the IPU may include assessment of substance misuse / mental health / physical health / social problems.
ii) Inpatient Treatment Stabilisation (Definition of Intervention)
IPU should have care pathways, clinical protocols and sufficient human and physical resources to offer the following range of stabilisation procedures:
1. Dose titration.
Admission to an IPU with staff skilled in monitoring the effects of methadone and the opioid withdrawal syndrome may prevent the individual dropping out of treatment, or else continuing to supplement their prescribed methadone or buprenorphine dose with illicit opioids.
2. Dose titration on injectable opioid medication
IPU admission allows interventions to optimise the service users injection technique, and 24 hour monitoring allows safer and more efficient calculations of dosage.
3. Stabilisation on maintenance therapy
Use of heroin on top of prescription of methadone can be problematic and attempts to tackle it within the community may lead to increasing doses of methadone and rising opiod tolerance without the desired break from the illicit drug market. A short (one or two week) admission to an IPU maybe an effective way of breaking this cycle, particularly when followed up by day care or intensive community support.
4. Combination assisted withdrawal / stabilisation
A period of IPU treatment may allow assessment and treatment of the withdrawal symptoms from stimulant drugs, alcohol or benzodiazepines, and in doing so facilitate stabilisation on opioid maintenance treatment. Such individuals can then continue to receive Tier 3 interventions in a community setting.
iii) Inpatient Treatment Detoxification / Assisted Withdrawal (Definition of Intervention)
Assisted withdrawal should only be encouraged as the first step in a longer treatment process, and needs to be integrated with relapse prevention or rehabilitation treatment programmes.
Withdrawal in an IPU setting offers better opportunities for clinicians to ensure compliance with medication and to manage complications. IPU admission also offers a major opportunity to recruit service users into longer term treatment to reduce the risk of relapse back into regular drug or alcohol use.
The IPU should have care pathways, clinical protocols and sufficient human and physical resources to offer assisted withdrawal for a wide range of single and poly drug and alcohol misuse problems.
This may also include pharmacological interventions (excluding maintenance substitute opiate prescribing) such as acamprosate, disulfiram, methadone, Buprenorphine, lofexidine, Naltrexone, and other prescribing for symptomatic treatment such as nausea.