What the experts say…

      American Family Physician (2004)

In most patients with mild to moderate withdrawal symptoms, outpatient detoxification is safe and effective, and costs less than inpatient detoxification.

Benzodiazepines have been shown to be safe and effective, particularly for preventing or treating seizures and delirium, and are the preferred agents for treating the symptoms of alcohol withdrawal syndrome.

Bayard M.D., M., Mcintyre, M.D., J., Hill, M.D., K.R., & Woodside, Jr., M.D., J. (2004, March). Alcohol withdrawal syndrome. American Family Physician, 69:1443-50

      TIP 45 Page 4

Detoxification is a set of interventions aimed at managing acute intoxication and withdrawal. Supervised detoxification may prevent potentially life-threatening complications that might appear if the patient were left untreated. At the same time, detoxification is a form of palliative care (reducing the intensity of a disorder) for those who want to become abstinent or who must observe mandatory abstinence as a result of hospitalization or legal involvement. Finally, for some patients it represents a point of first contact with the treatment system and the first step to recovery. Treatment/rehabilitation, on the other hand, involves a constellation of ongoing therapeutic services ultimately intended to promote recovery for substance abuse patients.

U.S. Department Of Health And Human Services, Substance Abuse and Mental Health Services Administration. (2006) Detoxification and substance abuse treatment: A Treatment Improvement Protocol TIP 45 (DHHS Publication No. (SMA) 06-4131.

      Canadian Medical Association Journal

Benzodiazepines appear to deserve a key role as first-line drug therapy for the management of acute alcohol withdrawal. The most important consideration is not which benzodiazepine to use, but to ensure that adequate doses are administered early in the course of withdrawal. Early treatment coupled with close and regular monitoring appears to be effective in avoiding prolonged withdrawal, sedation-related morbidity and extra resource utilization.

Holbrook AM, Crowther R, Lotter A, Cheng C, King D. Meta-analysis of benzodiazepine use in the treatment of acute alcohol withdrawal. CMAJ 1999;160:649–655.

      Journal of Family Practice

Patients with mild to moderate alcohol withdrawal symptoms and no serious psychiatric or medical comorbidities can be safely treated in the outpatient setting.

Patients with moderate withdrawal should receive pharmacotherapy to treat their symptoms and reduce their risk of seizures and delirium tremens during outpatient detoxification.

Asplund, MD, C. A., Aaronson, DO, J. W., Aaronson, DO, H. E. (July 2004). 3 Regimens for alcohol withdrawal and detoxification. Journal of Family Practice, (53), 7. Retrieved from http://www.jfponline.com/Pages.asp?AID=1730