Effects of Comorbid Opiate Dependency on Patients Admitted for Alcohol detoxification: Retrospective Chart Review and 2 Year Outcome

Abstract

IntroductionWorldwide alcohol related harm and dependence caused 4% of the global disease burden and the proportion is greatest in Europe and America [1]. The level of alcohol dependence in the UK population is 4% [2] but levels are much higher in opiate users for example 20-40% of patients undergoing opiate replacement therapy had alcohol dependence [3][4][5][6].There is evidence to suggest that chronic alcohol abuse is an important cause of medical complications during methadone treatment [7], which is frequently linked to premature discharge from treatment [8] and is associated with increased mortality rates [9]. Individuals with opiate dependence are at increased risk of developing Hepatitis C infection, the majority of which remain undiagnosed [9] and alcohol abuse further exacerbates disease progression.Within our locality, it was noted that a significant population requiring inpatient alcohol detoxification were also receiving opiate replacement therapy (ORT). We aimed to compare the outcomes of patients requiring alcohol detoxification not on ORT with those on ORT. MethodThis was a retrospective study comparing characteristics of patients requiring an alcohol detoxification with those who required an alcohol detoxification who were also on opiate replacement therapy. The data was collected over a 2 year period from the index episode of inpatient alcohol detoxification.Patients admitted for the first time for alcohol detoxification to our local acute psychiatric unit between the period of November 2003 and December 2006, were identified. Clinical and demographic details were extracted from their case records. In addition, clinical global impression scale (CGI) [10] severity and improvement subscales were retrospectively assigned at the time of initial detoxification, and after 2 years. Such retrospective assignment has been performed by others in assessing treatment response [11]. Patient records were examined by scrutinising case records and computer based patient information systems to monitor subsequent progress over a 2 year period. This included contact with medical or surgical wards, accident and emergency departments or psychiatric services within the local NHS (Lanarkshire) Health Board authority. The following clinical variables were recorded; time taken from the initial detoxification admission to the next admission (medical or psychiatric), whether admissions were planned, for example, a further detoxification, or were unplanned, patient's daily alcohol consumption (units per day) and whether patients were still engaged with psychiatric or addiction services at the end of the 2 year follow up period. It was also noted whether formal discharge from psychiatric or addiction services was planned or unplanned. The rationale for this being that planned discharges from psychiatric or addiction services were considered to be a positive health outcome indicating stability or recovery from addiction. Table 1 illustrates characteristics of those who required an alcohol detoxification (n=64) and those who...

Relationship between Entry Grades and Attrition Trends in the Context of Higher Education: Implication for Open Innovation of Education Policy

“…For society, student attrition results in a major waste of resources. This eventually translates into the loss of other educational training and projects in other parts of the economy and society [10].…”