Individualized Treatment for Outpatients Withdrawing From Alcohol

Wiseman, Eve J.; Henderson, Kathy; Briggs, Margaret J.

doi:10.4088/jcp.v59n0603

Cited by 17 publications

(18 citation statements)

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“…The study was performed in an outpatient alcohol clinic which already offered a comprehensive outpatient rehabilitation program [Soyka et al, 1997] and had expressed its interest in a collaboration in this area. The results of this treatment program with a 94% completion rate of outpatient detoxification support the positive results reported by Wiseman et al [1997Wiseman et al [ , 1998] and others [Collins et al, 1990;Alterman et al, 1998;Bjorkquist et al, 1976; , 1989] and suggest that outpatient alcohol detoxification can be considered a safe and effective treatment option for a subgroup of alcoholic patients.…”

Section: Discussionsupporting

confidence: 82%

“…The clinical management of withdrawal symptoms on an outpatient basis, including adequate dosages of appropriate medications and treatment of comorbid psychiatric or medical disorders, deserves future attention. In most of the studies quoted about hypnotics, benzodiazepines were predominantly used for treatment of withdrawal symptoms either in a fixed dosage regime [Collins et al, 1990] or on an individualized, symptom-oriented basis [Wiseman et al, 1998]. Other authors favor the use of anticonvulsants [Longo et al, 2002], especially carbamazepine [Malcolm et al, 2002].…”

Section: Discussionmentioning

confidence: 99%

“…While favorable results of outpatient or day-hospital rehabilitation programs for substance use have been reported by Cornwall and Blood [1998], McKay et al [1995McKay et al [ , 1998], Ehrenreich et al [2000] and Willenbring et al [1995], among others, outpatient detoxification is still a widely neglected issue in alcohol therapy [Fiellin et al, 2000;Prater et al, 1999]. Wiseman et al [1998] reported that 85% of 108 patients enrolled in an outpatient detoxification program successfully completed detoxification without medical complications. Using a symptom-triggered pharmacological treatment approach, only 38% of patients received medication (chlordiazepoxide).…”

Section: Introductionmentioning

confidence: 99%

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

Soyka¹,

Horak²

2004

Eur Addict Res

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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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Section: Discussionsupporting

confidence: 82%

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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

Soyka¹,

Horak²

2004

Eur Addict Res

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“…s Key words alcohol · alcoholism · outpatient detoxification · carbamazepine · pharmacotherapy · tiapride Introduction While outpatient rehabilitation of alcoholism is widely accepted [12,29] outpatient detoxification is still a widely neglected issue although a number of studies suggest its practicability and safety [7,40]. The pharmacotherapy of outpatient alcohol detoxification has not been extensively studied.…”

mentioning

confidence: 99%

A combination of carbamazepine/tiapride in outpatient alcohol detoxification

Soyka

Morhart-Klute

Horak

2002

European Archives of Psychiatry and Clinical Neuroscience

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This was an open, prospective study to examine the efficacy, practicability and medical safety of a combination of carbamazepine and tiapride in outpatient detoxification of alcohol-dependent patients. Patients were carefully screened for relevant neuropsychiatric disorders and then seen on a daily outpatient basis. Patients received medication if the initial CIWA-A score exceeded 16 points. Fifty consecutively admitted patients entered the program; 49 (98 %) successfully ended treatment. The mean initial dose for carbamazepine was 628 mg or 332 mg for tiapride. No serious medical complications or adverse events were observed. In general, medication was well tolerated. Withdrawal symptomatology as indicated by CIWA-A scores clearly decreased over time. Most frequently named side effects were sedation (63 %), hyperhidrosis (49 %), lack of drive (38 %), dry mouth (31 %) and orthostatic dysregulation or vertigo (22 %). Results from this study suggest that a combination of the anticonvulsant carbamazepine and tiapride is an effective and safe treatment for outpatient alcohol detoxification in patients with moderate severity of withdrawal syndrome.

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“…Hierbei wird bei moderaten bis schweren Entzugssymptomen stündlich 20 mg Diazepam gegeben, bis eine klinische Verbesserung oder eine leichte Sedierung eintritt. Wegen der langen HWZ von Diazepam muss dann in der Regel nicht mehr nachdosiert werden, der Patient sollte aber trotzdem täglich gesehen werden.Von Wiseman et al[31] existiert ein symptomgesteuertes Dosierungsmodel mit Chlordiazepoxid. Hierbei wird die "Modified-Selective-Severity-Assessment"-Skala MSSA[4] (Tabelle 4) zugrunde gelegt.…”

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Ambulante Alkoholentgiftung

Scherle

Croissant²,

Heinz³

et al. 2003

Der Nervenarzt

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Increasing significance is being attributed to outpatient detoxification treatment of alcohol-dependent patients. Many patients want to undergo outpatient detoxification or even carry it out without professional supervision. In some Scandinavian countries and in the USA, outpatient detoxification under medical supervision has increased substantially. In these countries,numerous studies describe outpatient alcohol detoxification as a safe and cost-reducing method. These studies vary in many aspects, especially regarding the nature and dose of the withdrawal medication, but also concerning the inclusion criteria of patients. Medications to treat or prevent alcohol withdrawal symptoms are rather heterogeneous. Besides well-known standard medication established in inpatient treatment (e.g.,benzodiazepines and carbamazepine), interesting studies report the application of rather uncommon substances such as physostigmine and psychotropic analgesic nitrous oxide (PAN) for alcohol detoxification. This article provides an overview on outpatient alcohol detoxification and discusses its transfer to practical application.

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Individualized Treatment for Outpatients Withdrawing From Alcohol

Cited by 17 publications

References 0 publications

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

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

A combination of carbamazepine/tiapride in outpatient alcohol detoxification

Ambulante Alkoholentgiftung

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