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Vol. 10, No. 4, 2004
Issue release date: 2004

Outpatient Alcohol Detoxification: Implementation Efficacy and Outcome Effectiveness of a Model Project

Soyka M. · Horak M.
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Abstract

Background: The aim of the study was to examine the practicability and implementation efficacy of an alcohol outpatient detoxification model and the concomitant ‘motivational’ psychotherapeutic approach. Method: This was an open prospective study to examine the implementation efficacy, practicability and medical safety of a novel psychotherapy-based, integrated outpatient detoxification model in alcohol-dependent patients. Patients were carefully screened for relevant neuropsychiatric disorders and other exclusion criteria and then seen on a daily outpatient basis for 5–7 days. Patients received psychotropic or other medication, if necessary (CIWA-A score >16). Beside management of withdrawal symptoms, psychotherapeutic interventions were conducted to motivate the patient for further alcohol therapy. Results: Of 557 patients screened 331 entered the program. For medical reasons 226 patients had to be admitted for inpatient detoxification, 122 patients in a special alcohol unit, 101 patients in a general hospital. 198 (60%) of the outpatients received psychotropic medication during treatment. 312 (94%) of these patients successfully completed treatment. 301 (91% of the initial sample) patients entered a consecutive 3-month motivational phase of a two-phase alcohol treatment program. 139 (46%) patients successfully completed the 1-year consecutive outpatient treatment. Conclusions: Outpatient detoxification, at least in a highly structured frame, can be considered as a safe and efficient therapeutic approach. The data of this study also indicate that psychotherapeutic interventions and motivation for further abstinence and treatment may work in alcohol-dependent patients on an outpatient basis. Further controlled trials are necessary to compare the effects of outpatient versus inpatient withdrawal.



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References

  1. Alsen M: Outpatient treatment of acute withdrawal states. Br J Addict Alcohol Other Drugs 1975;70(suppl 1):53–63.
  2. Alterman AI, Hayashida M, O’Brien CP: Treatment response and safety of ambulatory medical detoxification. J Stud Alcohol 1998;49:160–166.
  3. American Psychiatric Association: Diagnostic and Statistic Manual of Mental Disorders, ed 4 (DSM-IV). Washington, American Psychiatric Press, 1994.
  4. Benkert O, Hippius H: Psychiatrische Pharmakotherapie, ed 6. Berlin, Springer, 1996.
  5. Bjorkquist SE, Isohanni M, Makela R, et al: Ambulant treatment of alcohol withdrawal symptoms with carbamazepine: A formal multicentre double-blind comparison with placebo. Acta Psychiatr Scand 1976;53:333–342.
  6. Collins MN, Burns T, Van den Berk PAH, Tubman GF: A structured programme for out-patient alcohol detoxification. Br J Psychiatry 1990;56:871–874.
  7. Cornwall A, Blood L: Inpatients versus day treatment for substance abusing adolescents. J Nerv Ment Dis 1998;186:580–582.
  8. Dilling H, Mombour W, Schmidt MH, Schulte-Warkwort E (eds): WHO: Internationale Klassifikation psychischer Störungen ICD-10 Kapitel V (F) Forschungskriterien. Bern, Huber, 1994.
  9. Ehrenreich H, Krampe H, Wagner T, Jahn H, Jacobs S, Maul O, Sieg S, Driessen M, Schneider U, Kunze H, Rusteberg W, Havemann-Reinecke U, Rüther E, Poser W: Outpatient long-term intensive therapy for alcoholics, ‘OLITA’: Re-considering severe alcoholism, disease and treatment. Suchtmed 2000;2:221–222.
  10. Feldman DJ, Pattison EM, Sobell LC, et al: Out-patient alcohol detoxification: Initial findings on 564 patients. Am J Psychiatry 1975;132:407–412.
  11. Feuerlein W, Küfner H, Soyka M: Alkoholismus – Missbrauch und Abhängigkeit, 5. Aufl. Stuttgart, Thieme, 1998.
  12. Fiellin DA, Reid MC, O’Connor PG: Outpatient management of patients with alcohol problems. Ann Intern Med 2000;133:815–827.
  13. Finney JW, Hahn AC, Moos RH: The effectiveness of inpatient treatment and outpatient treatment for alcohol abuse: The need to focus on mediators and moderators of setting effects. Addiction 1996;91:1773–1796.
  14. Hayashida M, Alterman AI, McLellan AT, et al: Comparative effectiveness and costs of inpatient and outpatient detoxification of patients with mild-to-moderate alcohol withdrawal syndrome. N Engl J Med 1989;320:358–365.
  15. John U: A motivational approach to the treatment of alcoholism in the Federal Republic of Germany. Alcohol Treat Q 1991;8:83–92.
  16. John U, Veltrup C, Driessen M, Wetterling T, Dilling H: Motivationsarbeit mit Alkoholabhängigen. Freiburg, Lambertus, 2000.
  17. Longo LP, Campbell T, Hubatch S: Divalproex sodium (Depakote) for alcohol withdrawal and relapse prevention. J Addict Dis 2002;21:55–64.
  18. Malcolm R, Myrick H, Roberst J, Wang W, Anton RF: The differential effects of medication on mood, sleep disturbance, and work ability in outpatient alcohol detoxification. Am J Addict 2002;11:141–150.
  19. Mann KF: Neue ärztliche Aufgaben bei Alkoholproblemen. Von der Behandlungskette zum Behandlungsnetz. Dt Ärzteblatt 2002;99:B515–B521.
  20. Mayo-Smith MF: Pharmacological management of alcohol withdrawal. A meta-analysis and evidence-based practice guideline. American Society of Addiction Medicine, Working Group on Pharmacological Management of Alcohol Withdrawal. JAMA 1997;278:144–151.
  21. McCrady BS, Langenbucher JW: Alcohol treatment and health care system reform. Arch Gen Psychiatry 1996;53:737–746.
  22. McKay JR, Alterman AI, McLellan T, Snider EC, O’Brien CP: Effect of random versus nonrandom assignment in a comparison of inpatient and day hospital rehabilitation for male alcoholics. J Consult Clin Psychol 1995;63:70–78.
  23. McKay JR, McLellan AT, Alterman AI, Cacciola JS, Rutherford MJ, O’Brien CP: Predictors of participation in aftercare sessions and self-help groups following completion of intensive outpatient treatment for substance abuse. J Stud Alcohol 1998;59:152–162.
  24. Miller WR, Rollnick S: Motivational Interviewing. New York, Guilford, 1991.
  25. Miller WR, Rollnick S: Motivierende Gesprächsführung. Freiburg, Lambertus, 1999.
  26. O’Connor PG, Gottlieb LD, Kraus ML, Segal SR, Horwitz RI: Social and clinical features as predictors of outcome in outpatient alcohol withdrawal. J Gen Intern Med 1991;6:312–316.
  27. Pettinati HM, Meyers K, Jensen JM, Kaplan F, Evans BD: Inpatient vs outpatient treatment for substance dependence revisited. Psychiatr Q 1993;64:173–182.
  28. Prater CD, Miller KE, Zylstra RG: Outpatient detoxification of the addicted or alcoholic patient. Am Fam Physician 1999;60:1175–1183.
  29. Schwoon DR: Motivationsbehandlung bei Alkoholkranken; in Schwoon DR, Krausz M (eds): Suchtkranke: Die ungeliebten Kinder der Psychiatrie. Stuttgart, Enke, 1990, pp 166–181.
  30. Sellers EM, Naranjo CA, Harrison M, Devenyi P, Roach C, Sykora K: Diazepam loading: Simplified treatment of alcohol withdrawal. Clin Pharmacol Ther 1983;34:822–826.
  31. Shaw JM, Kolesar GS, Sellers EM, Kaplan HL, Sandor P: Development of optimal treatment tactics for alcohol withdrawal. I. Assessment and effectiveness of supportive care. J Clin Psychopharmacol 1981;1:382–389.
  32. Soyka M, Hasemann S, Scharfenberg CD, Löhnert B, Bottlender M: Prospektive Untersuchung zur Effizienz der ambulanten Entwöhnungstherapie bei Alkoholabhängigen: Ergebnisse zur Haltequote und Katamnese. Nervenarzt 2003;74:226–234.
  33. Soyka M, Horak M, Löhnert B, Löhnert E, Rüster P, Möller HJ: Ambulante Entgiftung Alkoholabhängiger – Ein Modellversuch. Nervenheilkunde 1999;8:147–152.
  34. Soyka M, Horak M, Morhart V, Möller HJ: Modellprojekt ‘qualifizierte ambulante Entgiftung’. Nervenarzt 2001;72:565–569.
  35. Soyka M, Kirchmayer C, Kotter G, John C, Löhnert E, Möller HJ: Neue Möglichkeiten der Therapie und Rehabilitation alkoholabhängiger Patienten – Katamnestische Untersuchung zur Effizienz ambulanter Entwöhnungstherapien am Beispiel einer Modelleinrichtung. Fortschr Neurol Psychiatr 1997;65:407–412.
  36. Soyka M, Morhart-Klute V, Horak M: A combination of carbamazepine/tiapride in outpatient alcohol detoxification – Results from an open clinical study. Eur Arch Psychiatry Clin Neurosci 2002;252:197–200.
  37. Stinnett JL: Outpatient detoxification of the alcoholic. Int J Addict 1982;17:1031–1046.
  38. Stockwell T, Bolt E, Hooper J: Detoxification from alcohol at home managed by general practitioners. Br Med J 1986;292:733–735.
  39. Stuppaeck CH, Barnas C, Falk M, Guenther V, Hummer M, Oberbauer H, Pycha R, Whitworth B, Fleischhacker WW: Assessment of the alcohol withdrawal syndrome – Validity and reliability of the translated and modified Clinical Institute Withdrawal Assessment for Alcohol scale (CIWA-A). Addiction 1994;89:1287–1292.
  40. Sullivan JT, Sykora K, Schneiderman J, Neranjo CA, Sellers EM: Assessment of alcohol withdrawal: The revised clinical institute withdrawal scale (CIWA-Ar). Br J Addict 1989;84:1353–1357.
  41. Webb M, Unwin A: The outcome of outpatient withdrawal from alcohol. Br J Addict 1988;83:929–934.
  42. Wetterling T: Lübecker Alkoholentzugs-Risiko-Skala (LARS); Med Thesis, Lübeck, 1995a.
  43. Wetterling T: Skala zur Erfassung des Schweregrads eines Alkoholentzugssyndroms (AES-Scale) – Erste klinische Erfahrungen. Sucht 1995a(suppl 1):41–43.
  44. Willenbring ML, Olson DH, Bielinski J: Integrated outpatients treatment for medically ill alcoholic men: Results from a quasi-experimental study. J Stud Alcohol 1995;56:337–343.
  45. Wiseman EJ, Henderson KL, Briggs MJ: Individualized treatment for outpatients withdrawing from alcohol. J Clin Psychiatry 1998;59:289–293.
  46. Wiseman EJ, Henderson KL, Briggs MJ: Outcomes of patients in a VA ambulatory detoxification program. Psychiatry Serv 1997;48:200–203.


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