INDIVIDUALIZED TREATMENT FOR OUTPATIENTS WITHDRAWING FROM ALCOHOL

Background: This prospective study addressed the applicability of symp tom-triggered detoxification to the outpatient setting. Method: We stu died 108 alcohol-dependent patients consecutively enrolled in an outpa tient 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 we re prescribed chlordiazepoxide according to a symptom-triggered detoxi fication protocol that utilized a standardized withdrawal scale. We co mpiled outcome data by reviewing the chart and the computerized medica l record. Outcome was operationally defined to include completion of o utpatient detoxification as well as outcome measures that were used in earlier studies of symptom-triggered detoxification in the hospital s etting. Results: Chlordiazepoxide was administered to only 41 patients (38%), yet 92 (85%) of the 108 enrolled successfully completed outpat ient detoxification without medical complications. The patients who to ok chlordiazepoxide received a mean +/- SD total of 167.2 +/- 123.5 mg administered over 2.7 +/- 1.4 days. Mean gamma-glutamyltransferase le vels were higher for the group of patients who subsequently received c hlordiazepoxide (132.8 +/- 312.1 IU/L compared with 56 +/- 80.3 IU/L; Wilcoxon rank sum test, t = 2600.5, p < .01). Conclusion: This study i s the first to support the feasibility of symptom-triggered detoxifica tion from alcohol in an outpatient setting. Our completion rate compar ed favorably with completion rates from previous studies of outpatient detoxification from alcohol using fixed-dose schedules. The percentag e of patients receiving chlordiazepoxide and mean total amount of chlo rdiazepoxide administered in our study were also comparable to results from previous studies of symptom-triggered detoxification with hospit alized patients.