Outpatient versus inpatient detoxification of alcohol use disorder: an observational cohort study

Alcohol detoxification can take place in outpatient or inpatient settings, however, clear criteria for allocation are lacking. This study compared patient characteristics between settings, identified predictors of treatment allocation, and compared treatment completion, relapse, adverse events, and costs.

This prospective cohort study included 75 patients with severe alcohol use disorder (AUD) between December 2022 and January 2024 (41 inpatient, 34 outpatient). Data collection covered demographic and medical characteristics. Multivariable logistic regression with forward stepwise selection (p < 0.1) identified predictors of treatment allocation. Secondary outcomes were treatment completion, relapse, adverse events, a composite 'any adverse outcome', and treatment costs.

Gender, marital status, psychiatric comorbidity, and a history of seizures or delirium differed significantly between the groups. A predictive model based solely on demographic characteristics (gender, marital status, and country of origin) achieved an area under the curve (AUC) of 0.789, outperforming a model based on medical characteristics (AUC 0.724) and a mixed model (AUC 0.766). Non-completion did not differ significantly between outpatient and inpatient detoxification (17.6% vs 14.6%; adjusted OR 0.591, p = 0.446), nor did the composite outcome (17.6% vs 24.4%; adjusted OR 1.06, p = 0.94). Relapse occurred only in the outpatient group (n = 6) and adverse events only in the inpatient group (n = 4). The average total cost of outpatient treatment was €3123 (SD ± €1621), compared with €6681 (SD ± €2200) for inpatient treatment.

Demographic factors appear to influence the allocation of detoxification setting more than medical factors, even though the Dutch national protocol lists predominantly medical criteria. While treatment completion did not differ significantly between settings, outpatient detoxification cost about half as much as inpatient detoxification. Relapses and adverse events did not occur frequently enough to draw conclusions about safety. Larger studies in more diverse populations should confirm these findings.