The Manchester detoxification service. Description and evaluation

The service of Manchester's hospital-based purpose-built alcohol detoxification centre is described, together with demographic data, drinking history, findings on admission, disposal arrangements, and outcome of 235 police referrals. Police referrals under-used the centre, which now accepts from magistrates' courts, the local alcoholism council, accident and emergency departments, and general practice. Police referrals, mostly homeless and without family support, contained many episodic drinkers; this explains the low incidence of severe withdrawal symptoms. Prophylactic treatment was not routine. Very high blood alcohol levels were recorded from some conscious patients. There was little serious medical morbidity. Many discharged themselves within 24 hours. Few accepted the recommended treatment, medical or social; prolonged abstinence was achieved by only 1% but substantially more had short abstinent periods and some social betterment, especially if offered follow-up help. Visits to general practitioners' surgeries fell during the follow-up period, as did admissions to general units for withdrawal symptoms, though not from all causes. Almost half had readmissions to the centre. Referrals from other sources were more likely to stay for assessment and accept help. More referrals from medical sources had severe withdrawal symptoms. Detoxification centres need not be in hospitals but must have close and rapid links with specialist medical services. They must be integrated into the total provision of alcoholism services and assessed in relation to them.