# Title 75 — Department of Human Services

## Article 75-09.1 — Substance Abuse Treatment Programs

## Chapter 75-09.1-08 — Social Detoxification ASAM Level III.2-D

### § 75-09.1-08-01. Definitions.

1. "CIWA-Ar" means the revised clinical institute withdrawal assessment for alcohol scale
published in the archives of general psychiatry 48:442-447, May 1991, which is a ten-item
scale for clinical quantification of the severity of alcohol withdrawal syndrome.
2. "Detoxification" means the process of interrupting the momentum of compulsive use in an
individual diagnosed with substance dependence and the condition of recovery from the
effects of alcohol or another drug, the treatment required to manage withdrawal symptoms
from alcohol or another drug, and the promotion of recovery from its effects.
3. "Social detoxification" means detoxification in an organized residential nonmedical setting
delivered by appropriately trained staff who provide safe, twenty-four-hour monitoring,
observation, and support in a supervised environment for a client to achieve initial recovery
from the effects of alcohol or another drug. Social detoxification is characterized by its
emphasis on peer and social support and it provides care for clients whose intoxication or
withdrawal signs and symptoms are sufficiently severe to require twenty-four-hour structure
and support but the full resources of a medically monitored inpatient detoxification are not
necessary.
History: Effective October 26, 2004.
General Authority: NDCC 50-06-16, 50-31
Law Implemented: NDCC 50-31
### § 75-09.1-08-02. Program criteria.

A social detoxification program must provide:
1. Hospital affiliation providing twenty-four-hour medical backup;
2. A trained staff member familiar with complications associated with alcohol and other drug use
and with community resources awake on all shifts;
3. A quite, positive atmosphere;
4. Use of detoxification time as preparation for referral to another level of care; and
5. Recognition of the chronic nature of the disease of substance dependence and the fact that
some clients will require multiple admissions.
History: Effective October 26, 2004.
General Authority: NDCC 50-06-16, 50-31
Law Implemented: NDCC 50-31

### § 75-09.1-08-03. Provider criteria.

A social detoxification provider shall:
1. Maintain a safe, comfortable, positive environment in a residential setting;
2. Have an agreement with local medical providers that ensure readily accessible emergency
care when needed;
3. Implement a protocol so that the nature of the medical interventions required are developed
and supported by a physician knowledgeable in addiction medicine;
4. Have available specialized clinical consultation and supervision for biomedical, emotional,
behavioral, and cognitive problems;
5. Have awake staff twenty-four hours per day to monitor clients' conditions;
6. Have staff trained in admission, monitoring skills, including signs and symptoms of alcohol and
other drug intoxication and withdrawal as well as appropriate treatment of those conditions,
supportive care, basic cardiopulmonary resuscitation technique, assessment, and referral
procedures;
7. Have services including close observation, supportive staff-client interaction, provision for
proper fluid and nutritional components, and provision for client space that offers low to
moderate sensory stimulation;
8. Implement a clearly defined policy for admission, care, discharge, and transfer of a client to
another level of care;
9. Develop a method of documentation of care and train staff in documentation procedures;
10. Develop linkage with providers of other levels of care so the client may begin a therapeutic
process as soon as the client is physically and mentally able to do so;
11. Administer a range of cognitive, behavioral, medical, mental health, and other therapies on an
individual or group basis designed to meet the client's ability to participate in order to enhance
the client's understanding of addiction, the completion of the detoxification process, and
referral to an appropriate level of care for continuing treatment;
12. Develop a preliminary individualized treatment plan with the client that includes problem
identification in ASAM PPC dimension two through six and development of treatment goals
and measurable treatment objectives and activities designed to meet those objectives; and
13. Implement a policy for medication storage, security, and self-administration to assure that the
client receives the client's medication and for observation of the medication taking behavior.
History: Effective October 26, 2004.
General Authority: NDCC 50-06-16, 50-31
Law Implemented: NDCC 50-31
### § 75-09.1-08-04. Admission and continued stay criteria.

Before a client may be admitted to a social detoxification program, the client must meet the
diagnostic criteria for a substance-induced disorder of the current DSM and current clearance by a
physician or a CIWA-Ar score of less than eight and the presence of any of the following:
1. Diffuse mild central nervous system symptoms such as:

a. Cerebral symptoms, including slow responses to questions, difficulty in following
complicated instructions, mild impairment of immediate memory, slurred speech, and
mild disorientation to time but not to place or client;
b. Coordination symptoms, including mild abnormality in movement or gait, difficulty in
finger-to-nose or finger-to-finger testing and rapid movements;
c. Reflex abnormalities, including normal or slightly depressed but symmetrical; or
d. Motor abnormalities, are normal or slightly depressed but symmetrical.
2. Onset of any stated symptoms listed in subsection 1 over a few hours;
3. Intoxication;
4. The absence of other more serious symptoms, including medical or psychiatric histories of
significant problems and the absence of suicidal ideations or suicidal ideation of low lethality
without plan or means;
5. Presence of any one of the following physical findings:
a. A temperature of ninety-seven degrees to one hundred degrees Fahrenheit [36.1 to 37.6
degrees Celsius] taken orally;
b. Tachycardia up to one hundred twenty beats per minute;
c. Blood pressure of up to one hundred sixty over one hundred twenty at rest;
d. Respiration of twelve to twenty-six breaths per minute;
e. Flushed skin color;
f. Pupils have a sluggish reaction to light; or
g. Other, such as alcohol odor on breath; or
6. Ability to comprehend and function in an ambulatory setting.
History: Effective October 26, 2004.
General Authority: NDCC 50-06-16, 50-31
Law Implemented: NDCC 50-31
### § 75-09.1-08-05. Referral to acute care criteria.

A social detoxification program shall refer a client to an acute care facility or consult with a
physician upon an increase in score to greater than a seven CIWA-Ar score scale or when a client has
any one or more of the following symptoms:
1. Seizures or a history of seizures;
2. Current persistent vomiting or vomiting of blood;
3. Current ingestion of vomit into lungs;
4. Clouded sensorium such as gross disorientation or hallucination;
5. A temperature higher than one hundred and one degrees Fahrenheit [38.1 degrees Celsius]
taken orally;

6. Abnormal respiration such as shortness of breath or a respiration rate greater than twenty-six
breaths per minute;
7. Elevated pulse such as a heart rate greater than one hundred twenty beats per minute or
arrhythmia;
8. Hypertension such as blood pressure greater than one hundred sixty over one hundred
twenty;
9. Sudden chest pain or other sign of coronary distress or severe abdominal pain;
10. Recent head injury or any trauma other than minor;
11. Unconscious and not arousable; or
12. Other signs of significant illness such as jaundice, unstable diabetes, acute liver disease,
severe allergic reaction, progressively severe Antabuse reaction, poisoning, progressively
worsening tremors, chills, severe agitation, exposure, internal bleeding, shock, uncontrollable
violence, suicidal or homicidal ideations.
History: Effective October 26, 2004.
General Authority: NDCC 50-06-16, 50-31
Law Implemented: NDCC 50-31
### § 75-09.1-08-06. Criteria to determine that social detoxification is not necessary.

Social detoxification will not be necessary if:
1. The client exhibits no withdrawal symptoms at a blood alcohol level of 0.0 percent;
2. The client has no medical complications present;
3. The client's nutritional status is moderate to good;
4. The client has a relative, friend, or other support system who can stay with the client for the
time necessary to complete detoxification; or
5. The client prefers outpatient detoxification.
History: Effective October 26, 2004.
General Authority: NDCC 50-06-16, 50-31
Law Implemented: NDCC 50-31
