Individualized treatment for outpatients withdrawing from alcohol

This prospective study addressed the applicability of symptom-triggered detoxification to the outpatient setting.

We studied 108 alcohol-dependent patients consecutively enrolled in an outpatient detoxification program between January 17, 1995, and October 17, 1995. The diagnosis was confirmed by verifying, through chart review, that patients met DSM-IV criteria for alcohol dependence. Patients were prescribed chlordiazepoxide according to a symptom-triggered detoxification protocol that utilized a standardized withdrawal scale. We compiled outcome data by reviewing the chart and the computerized medical record. Outcome was operationally defined to include completion of outpatient detoxification as well as outcome measures that were used in earlier studies of symptom-triggered detoxification in the hospital setting.

Chlordiazepoxide was administered to only 41 patients (38%), yet 92 (85%) of the 108 enrolled successfully completed outpatient detoxification without medical complications. The patients who took chlordiazepoxide received a mean+/-SD total of 167.2+/-123.5 mg administered over 2.7+/-1.4 days. Mean gamma-glutamyltransferase levels were higher for the group of patients who subsequently received chlordiazepoxide (132.8+/-312.1 IU/L compared with 56+/-80.3 IU/L; Wilcoxon rank sum test, t=2600.5, p < .01).

This study is the first to support the feasibility of symptom-triggered detoxification from alcohol in an outpatient setting. Our completion rate compared favorably with completion rates from previous studies of outpatient detoxification from alcohol using fixed-dose schedules. The percentage of patients receiving chlordiazepoxide and mean total amount of chlordiazepoxide administered in our study were also comparable to results from previous studies of symptom-triggered detoxification with hospitalized patients.