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‘The most rewarding thing I’ve ever done’: GP-led alcohol detox


Amanda Lyons


5/03/2019 2:43:03 PM

Dr Chris Davis talks about his model of GP-led home detox for mild-to-moderate alcohol dependency, and his hopes for its wider adoption in Australia.

Dr Chris Davis has found GPs can be incredibly effective in helping mild-to-moderate drinkers to detox at home.
Dr Chris Davis has found GPs can be incredibly effective in helping mild-to-moderate drinkers to detox at home.

Dr Chris Davis, a Sydney-based GP originally from the UK, is passionate about helping people detoxify from alcohol dependency. That’s why he has established a successful GP-led home detox and alcohol management service in Australia.
 
‘It’s definitely the most rewarding thing I’ve ever done, because there’s not much that we can do as GPs that makes such an immediate and such a huge impact,’ he told newsGP.
 
‘It’s such a privilege to be able to help people with this.’
 
Dr Davis’ involvement in treatment of alcohol dependency began back in England, when he agreed to take part in a health-related radio program on Brixton Prison FM, a radio station run by inmates.
 
‘I thought the prisoners would want to talk about infectious diseases, but what they really wanted to know about was drugs and alcohol and I didn’t really have any of the answers,’ he said.
 
This led Dr Davis to complete a diploma in substance misuse and become a methadone prescriber. But what he tended to see more of in his practice, rather than drug use, was the damaging effects of alcohol.
 
In response, Dr Davis and some of his colleagues set up Fresh Start Clinics – GP-led home detox clinics – under the auspices of the National Health Service (NHS) in the UK.
 
‘Alcohol doesn’t discriminate and [we saw] people from all walks of life who really wanted help with their drinking and didn’t know where to go,’ he said. ‘Within a couple of weeks their whole lives had changed; they’d walk in looking better, their anxiety had gone, their wives or their husbands were talking to them again.
 
‘The difference you could actually make as a GP was huge – it very quickly became a huge passion of mine.’

When Dr Davis migrated to Australia four years ago, he was surprised at being unable to find a similar service in his area.
 
‘It was all referrals and in-patient services, so I very quickly set up the Clean Slate Clinic, which is a GP-led home detox and alcohol management service, just like I was running in the NHS,’ he said.
 
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Dr Davis describes his work in this area as ‘the most rewarding thing I’ve ever done’​.
 
The alcohol detox model practised by the Clean Slate Clinic is team-based, including psychologists, alcohol counsellors, dietitians and trained nurses, but is run and led by the GP.
 
‘There’s an assessment and a preparation process where we try and get people’s heads in the right place before we do a detox, which will be structured with daily breathalysers and a withdrawal scale,’ Dr Davis explained.
 
‘Then we have a recovery program afterwards which is individually tailored, so we offer patients medications and make sure they’ve got the supports that they need to have a successful recovery.’
 
The program is called a ‘home detox’ because patients do not need to enter an inpatient service and are instead monitored with daily visits to their treating GP.
 
‘There’s no fixed time. If I’ve assessed them as requiring a medicated detox, it can take anywhere from three to 10 days,’ Dr Davis explained.
 
‘They’ll have their last drink on a Sunday, usually, and then come and see me Monday morning. I breathalyse them, we do a withdrawal questionnaire and I give them Valium for that day, which I get them to diarise. And then I see them every morning and gradually wean them off over the week.
 
‘Then I get them back in the Monday which is the last day of detox. On that Monday, we do a post-detox review and I generally start them on Naltrexone.’
 
Dr Davis has found this model of treatment is extremely helpful and effective for the types of dependent drinkers GPs tend to see in consultations.
 
‘The vast majority of people don’t want to go to [Alcoholics Anonymous], they don’t want to go to a specialist service, they just want help with their drinking,’ he said. ‘And that’s why the GP model is, I think, essential if we’re going to reach that mild-to-moderate dependent group of drinkers.
 
‘The 5-10% of heavy, severe alcohol dependents who have withdrawal seizures and poly-drug use, they’re well serviced – that’s quite an obvious pathway, they need inpatient detox and maybe rehab.
 
‘But for your single mum who’s on a bottle of wine a night and just can’t cut down, they just need a little bit of guidance. Some of them need a home detox and a decent recovery plan and ongoing support.’
 
Dr Davis has found his model to be just as successful in Australia as it was in UK, partly because of its accessibility and its discretion.
 
‘It’s completely confidential. No-one has to know patients are going to a detox that they don’t want to know,’ he said.
 
‘They’re just coming in for a normal GP appointment, they don’t have to go to an outpatient unit or a specialist drug and alcohol service where, if they bump into someone, it’s obvious what they’re there for.’
 
This acceptability, Dr Davis believes, is key to providing successful treatment.
 
‘We can have these conversations [about the dangers of alcohol], but if there isn’t access to treatment that’s acceptable to the patient, they’re going to go away and keep trying to stop on their own, and fail, and then they lose confidence, and that’s where the cycle just gets worse,’ he said.

Dr Davis is currently in talks with the RACGP and Department of Health to produce a webinar focused on his alcohol detox model, tentatively scheduled for the end of May. More information will be provided closer to the date.
 



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Dr Fadzeela Kiran Sood   6/03/2019 7:21:38 AM

This is a fantastic idea. Chris - How would you like us to get in touch with you to learn more?

Warm regards,
Fazeela Sood


Dr Kathryn Elizabeth James   6/03/2019 7:45:27 AM

Great model for primary health care and much needed.


Dr Moh Abuarchid   6/03/2019 8:06:03 AM

Hi,
Could you please put me In touch with Dr Davis .
I am a GP Iin WA and very keen to set up the same service here.


Nick Cornish   6/03/2019 8:14:23 AM

What an excellent service! I’d be very interested in learning more/accessing dr Davis’s resources if possible.


Owen Lewis   6/03/2019 8:25:22 AM

Dear Chris, I am doing a few de-toxes in hospital under a anxiety depression label as officially our regional GP staffed hospital is not a detox facility. I’ve had less success with home detox but would like to receive your resources. I have shared my mobile phone and monitored at home that way. The step of sharing mobile number makes me a bit vulnerable. Perhaps I should have a work mobile. Owen Lewis, Port Pirie SA


Dr Johanna Kilmartin   6/03/2019 8:35:30 AM

Hi Chris,
That is absolutely fantastic that you have been able to do this. Can I contact you about further details please? I would be very interested in your program. Thank you.


GP   6/03/2019 8:54:34 AM

How do I contact Dr Davis to get that material?


Dr Shamima Akter   6/03/2019 10:02:26 AM

Interested in Dr Davis’s home detox. Can I get more info?


Claire   6/03/2019 10:08:53 AM

This sounds great! How can we contact Dr Davis to access his resources?
Thanks!


newsGPadmin   6/03/2019 10:36:36 AM

Thank you for all the comments seeking further information. We are currently contacting Dr Davis to discuss the best way to share his knowledge.


Dr Mina Hanna   6/03/2019 4:10:41 PM

It is wonderful to find such a service helping people with drinking problem. I'm also interested to get more information about the service.


Christopher Davis   6/03/2019 4:21:27 PM

Thank you so much for your interest in the article. I hope you will be able to join me in the interactive RACGP webinar which is penciled in for the 29th May. Registrations will open in April. I also wrote an article giving more information about the clinic in Australian Prescriber Vol 41 : Number 6 : Dec 2018.


Dr Deborah Uwa Sambo   6/03/2019 8:39:52 PM

looking forward to the webinar.
Great and timely information.
Hope your successful "no fuss" program catches on.
It will be helpful to a lot of GPs who know that the real epidemic is Alcohol dependence.


Sally Baker   20/05/2019 5:53:05 PM

Could you give me details of how to register for the webinar on 29th May? I'd be really keen to set up a similar programme in our area.


newsGP   21/05/2019 11:02:01 AM

Dr Chris Davis' free online webinar 'A practical guide to alcohol home detox' will take place from 7.30-8.30pm on Wednesday 29 May 2019. More information is available here - www.racgp.org.au/education/courses/racgpevents/nsw


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