Multiple previous detoxifications are associated with less responsive treatment and heavier drinking during an index outpatient detoxification

Investigators have found a relationship between the number of previous alco hol withdrawals (AWs) and severity of withdrawal. We evaluated patients wit h multiple previous AWs, as compared to those with 0-1 previous withdrawals , in an outpatient detoxification trial comparing lorazepam (LZ) to carbama zepine (CBZ). A mixed model analysis of covariance was used to analyze Clin ical Institute Withdrawal Assessment for Alcohol-Revised (CIWA-Ar) scores a s a function of detoxification history (0 - 1 vs. 2 or more), drug group (C BZ vs. LZ), assessment day, and hours since last drink. The mixed model ana lysis of covariance (ANCOVA) indicated a significant detoxification history by assessment day interaction (P less than or equal to .03). Least square means associated with this interaction suggested that the CIWA-Ar scores fo r the multiple deter patients declined more slowly than those with 0-1 prev ious detoxifications. Patients with multiple detoxes were 150% more likely to experience a heavy drinking day during treatment(P less than or equal to .03). The multiple deter group drank more each drinking day (P=.001) and a greater proportion of this group had early heavy drinking (P =.0002). In t he present study, intensity of AW symptoms and early heavy drinking were in dependent of treatment medications and were more common in patients who had previously undergone multiple treatments for AW. (C) 2001 Elsevier Science Inc. All rights reserved.