From the Guidelines
Alcohol cessation can be done on an outpatient basis for many individuals, particularly those with mild to moderate alcohol use disorder who don't have a history of severe withdrawal symptoms. According to a study published in 2013 1, outpatient treatment was found to be more cost-effective, with no difference in the alcohol abstinence rate at 6 months compared to inpatient treatment.
Key Considerations for Outpatient Detoxification
- Patients should be monitored regularly for withdrawal symptoms using tools like the CIWA-Ar scale
- Medications such as benzodiazepines (e.g., chlordiazepoxide, diazepam, or lorazepam) should be prescribed as needed to manage withdrawal symptoms
- Supportive medications like thiamine (100-300 mg/day) should be given to all patients with AWS to prevent diminished cognitive function due to thiamine deficiency 1
- Patients should have a supportive home environment, reliable transportation to appointments, and someone to monitor them between visits
When to Consider Inpatient Detoxification
- History of severe withdrawal symptoms
- Seizures or delirium tremens
- Significant medical comorbidities
- Lack of social support In such cases, inpatient treatment is recommended to ensure the patient's safety and provide close monitoring of their condition 1.
From the Research
Alcohol Cessation Outpatient Treatment
- Alcohol cessation can be done on an outpatient basis for patients with mild to moderate withdrawal symptoms without additional risk factors for developing severe or complicated withdrawal 2, 3.
- Patients with mild symptoms can be treated with carbamazepine or gabapentin, while benzodiazepines are first-line therapy for moderate to severe symptoms 2.
- Outpatient treatment should include supportive care and pharmacotherapy as appropriate, with daily monitoring for up to five days after the last drink to verify symptom improvement and evaluate the need for additional treatment 2.
- A responsible support person and arrangements to start an alcohol treatment program are necessary for outpatient detoxification 3.
- Long-acting benzodiazepines can be given on a fixed schedule or through "front-loading" or "symptom-triggered" regimens, with adjuvant sympatholytics used to treat hyperadrenergic symptoms that persist despite adequate sedation 3.
Assessment and Treatment
- The Clinical Institute Withdrawal Assessment for Alcohol Scale, Revised, and the Short Alcohol Withdrawal Scale are commonly used tools to assess withdrawal symptoms 2.
- The Alcohol Use Disorders Identification Test-Consumption and the Single Alcohol Screening Question instrument have the best accuracy for assessing unhealthy alcohol use in adults 18 years and older 2.
- Disulfiram, naltrexone, and acamprosate are pharmacotherapies that can be used in the treatment of alcohol dependence, with supervised disulfiram appearing superior in reducing heavy drinking days and increasing abstinent days 4.
- Anticonvulsants, such as baclofen, are of growing interest in the treatment of alcohol use disorder, although currently none are FDA approved for this indication 5.