An inmate booked in 3 days ago is pacing all night and acting erratically. He hasn’t slept at all and seems agitated. Should you be concerned?
Inmates brought into a jail from the street are suddenly cut off from their usual substance supply. This can lead to some dangerous situations that need quick medical intervention. Alcohol and drug withdrawal is an everyday fact of life for this population. Although all substance withdrawal can turn nasty, alcohol withdrawal has an increase potential to be life-threatening and, therefore, a greater need for medical attention. How do you know when to seek a medical evaluation for an oddly acting inmate?
Inmates are not always honest about their alcohol and drug habits on intake. Fear of criminal charges and lack of trust contribute to under-reporting substance use. Without honest information, health care staff may not detect a need for withdrawal monitoring. Officers therefore need to be on the lookout for symptoms of withdrawal that indicate a need for medical intervention.
According to jail medical expert, Jeff Keller, MD, the three primary indications of early alcohol withdrawal are pacing, sleeplessness, and elevated heart rate. In addition, withdrawing individuals are not interested in eating and often refuse meals. The inmate in the opening scenario definitely needed medical evaluation. If not caught early and treated with benzodiazepines (Valium, Librium), alcohol withdrawal can rapidly spiral into delirium tremens and death.
Health care staff in your facility should have a process in place to screen, monitor and treat alcohol withdrawing inmates. When high-risk patients are identified in booking, they can be more closely monitored during the crucial first 72 hours without the substance. This is a primary time for withdrawal to surface, although, some individuals take longer to withdraw and may not show symptoms until 4-7 days after the last drink.
Safety is a primary concern when an inmate is at high risk of alcohol withdrawal. Seizures can occur, as well as disorientation that can lead to falls. Individuals designated as having withdrawal potential should be assigned a lower bunk and placed in a high-visibility area. Some jails have infirmary or special observation units for this purpose. Others designate a particular cell-block for withdrawal monitoring and staff-up for increased observation ability.
Since our population often uses drugs and alcohol to self-medicate for psychic and physical pain, withdrawing inmates can be at high risk for suicide once the numbing effects of the substance wear off. Special attention to suicide potential during this period is wise.
Withdrawing patients entering into delirium tremens (DTs) may appear psychotic to even experienced health professionals. Yet, treatment for these two conditions are very different and, left untreated, DT’s end in death. If you see an inmate abruptly start exhibiting signs of being disoriented and having visual hallucinations, do not delay in seeking medical evaluation. The high rate of alcohol use in the jail population should result in a high suspicion of DT’s in this situation.
Have you experienced an unusual withdrawal situation in your setting? How do you routinely monitor for alcohol withdrawal? Share your stories and systems in the comments section of this post.
About the author
Dr. Schoenly has been a nurse for over 25 years and is currently specializing in correctional healthcare. She is a clinical education specialist and author actively advocating for excellence in this practice setting. Her web-presence www.correctionalnurse.net provides a forum to interpret correctional healthcare to the public and healthcare community. Lorry is a strong advocate for development of the specialty practice of correctional nursing. She speaks and writes frequently on correctional nursing practice issues. Her book, Essentials of Correctional Nursing, will be published in July, 2012.