门诊戒毒从电话初次接触开始. 确定滥用药物、医疗状况和一种或多种ssp的供应情况. 如果患者有急性医疗问题，如胃肠道出血，则不住院. Patients are not admitted unless they bring a SSP. Every effort will be made to schedule admissions within 24 hours of a request for help; ideally on the day of the call for help. 未来的患者需要愿意将治疗作为他或她的全职活动至少一周. 他们必须提前到达(不能醉酒)，并且有一个SSP, SSP至少需要一整天的时间来陪伴他们, and then be easily available for the first week of treatment. Examples would be a parent who can take a day off from work, a sponsor who will host the patient over the first night, 或者一群朋友轮流照顾排毒病人.

在病人到达后的一小时内，他们会进行简短的评估，并根据需要开处方. A full psychiatric evaluation, vital signs and a physical examination (HEENT, 胸部, 腹部, 四肢, 皮肤, 神经, overall impression) are done on the first day by the psychiatrist. Any acute medical conditions are addressed by the psychiatrist, 或者病人被转到大学医院的急诊科. 病人, SSP and psychiatrist make a plan together; with parameters for calling the psychiatrist, who is available 24 hours per day and 7 days per week. 患者继续每天接受治疗，直到戒断综合征结束, 病人的情况稳定到可以接受较低水平的安全护理. The initial planning meeting of the first day serves as orientation of the patient and SSP to the program; rules, 程序, 活动, policies and philosophy.

Alcohol and urine drug screens 是否因为治疗是基于观察到的戒断症状而不是病史或尿液结果而不进行. 例如, a positive urine for opiates does not lead to prescription of Suboxone for opiate withdrawal; the positive urine result could represent a single use. 患者可能一直在使用氯硝西泮等药物，而这些药物不会在尿液筛查中显示出来, yet still be at risk of seizing. 血液酒精浓度测试的结果不能帮助确定戒酒的过程. 治疗的重点是客观的戒断症状，而不是主观的报告.

实验室测试 是否适用于每个病人，并在有必要时进行. 例如, liver functions are followed for patients on valproate, CBC for any patient at risk for a GI bleed, blood glucose monitoring for patients with diabetes, PPD适用于可能有结核病风险或需要转介到住院项目的患者. 血液是在一个街区外的大学医院实验室抽取的. 停药期间实验室检测的目的是确保患者停药期间的安全.

Primary care evaluations (comprehensive medical care) are NOT done. 当患者足够稳定，他们最初的初级保健评估预约可能被保留时，患者被转介进行初级保健评估, 并很可能导致我们治疗成瘾的伙伴关系, and the internists treatment of all medical issues .

酒精解毒 以丙戊酸、氯二氮环氧化物和双硫仑为主要药剂完成吗. 丙戊酸不会上瘾，也没有很好的镇静作用，对氯二氮环氧化物的需求最小. 在第一个治疗日采取“负荷”方法来抑制症状. Concomitant use of disulfiram means that the patient is unlikely to drink while at home; they are required to take an observed dose on day one to be allowed back for day two.

Benzodiazepine detoxification 以丙戊酸和氯二氮环氧化物为主要制剂完成吗. Benzodiazepine withdrawal comes on more slowly than alcohol withdrawal, 在大多数情况下，患者可以在出现戒断症状之前服用丙戊酸. 当使用丙戊酸时，要监测血液水平和肝功能检查.

鸦片撤军 是通过苏博松和辅助药物如可乐定来完成的, dicyclomine and trazodone. 舒波松与滥用的阿片类药物竞争，使海洛因、羟考酮等药物加入. 无效的. 患者应尽快改用非激动剂阿片受体阻滞剂纳曲酮.

在这种支持系统无法处理的特殊撤离情况下, patients are referred for 24 hour inpatient detoxification. 否则，如果需要，医生会通过电话与患者或SSP协商. In all cases the SSP involved with the treatment is informed of the need for the patient to stay on the blocker; disulfiram for alcohol and naltrexone for opiates, for the first year of sobriety. 在很多情况下, the rule will be suggested that if the family member in recovery (patient) will not take the blocker observed by the SSP or a family member; that the addicted person not be allowed to live at home because they are likely to use the home as a base for dangerous behaviors. 我们期望改变戒毒的环境，不再是将严重成瘾者与他们的支持隔离开来的住院病房, 将SSP作为解毒的核心行动者，并随着时间的推移继续参与，结果将得到改善. 治疗的排毒阶段通常在一周内完成, 除了长效苯二氮卓类药物，如氯硝西泮或地西泮, 停药两周后急性停药症状才缓解.