CONCURRENT COCAINE WITHDRAWAL IS ASSOCIATED WITH REDUCED SEVERITY OF ALCOHOL-WITHDRAWAL

The purpose of this study was to implement an empirical assessment of the clinical response to standard alcohol detoxification during withdr awal from both alcohol and cocaine. One hundred forty-nine males conse cutively admitted in acute alcohol withdrawal to a hospital-based deto xification unit were studied. All subjects completed a 4-day chlordiaz epoxide detoxification, Patients who used drugs other than cocaine wer e excluded, Fifty-five subjects withdrawing only from alcohol and 94 s ubjects withdrawing from both alcohol and cocaine, as evidenced by pos itive urinalysis and history, were studied. Both groups reported simil ar amounts of daily alcohol intake and had a similar age of onset of a lcohol dependence. Parental alcoholism was equally frequent in both gr oups. Statistically, several variables were directly related to severi ty of alcohol withdrawal, including associated cocaine abuse, age, abn ormal laboratory values, and duration of homelessness. As measured by the Alcohol Withdrawal Scale (AWS), alcohol withdrawal was less severe among cocaine users, not only at intake but throughout the 4-day deto xification. Singly addicted alcoholics were older and had longer drink ing histories, more prior detoxifications, and more abnormal laborator y values than cocaine users. A multiple regression analysis demonstrat ed a significant relationship between cocaine and severity of alcohol withdrawal. Cocaine users more frequently requested reductions in chlo rdiazepoxide dosages than singly addicted alcoholics, complaining of d ysphoria, sedation, and weakness. The severity of alcohol withdrawal w as associated with recent cocaine use, age, laboratory abnormalities, and duration of homelessness. Concurrent cocaine withdrawal in the sam ple was associated with reduced severity of alcohol withdrawal. Possib le neurobiological mechanisms, as well as study limitations affecting interpretation of the findings, are discussed. Tailored detoxification as opposed to standard detoxification regimens may be more appropriat e for the clinical management of combined alcohol-cocaine withdrawal. Copyright (C) 1995 by W.B. Saunders Company