Who Needs Inpatient Detox? Development and Implementation of a Hospitalist Protocol for the Evaluation of Patients for Alcohol Detoxification

Use of Pharmacotherapies in the Treatment of Alcohol Use Disorders and Opioid Dependence in Primary Care

“…The US Preventive Task Force recommends screening all patients for alcohol misuse and addressing hazardous or harmful use through a brief intervention [ 10 ]. Screening instruments and evaluation protocols are important initial tools needed in addressing alcohol use/dependence and drug abuse [ 2 , 3 , 11 , 12 ]. Screening instruments such as the AUDIT, ASSIST, CAGE questionnaire, or other validated tool can be utilized to determine hazardous or harmful alcohol use, as well as identifying drug abuse and opioid dependence to help inform the primary care provider in determining the level of care and treatment setting for the patient [ 13 – 15 ].…”

“…Medically managed withdrawal serves to palliate otherwise intolerable withdrawal symptoms and reduce the risk of serious medical consequences. Inpatient medically managed withdrawal is appropriate for patients at risk for severe withdrawal, delirium tremens, or with significant medical and psychiatric comorbidities [ 3 , 12 , 30 ]. Institutional protocols can be developed to assist in determining inpatient versus outpatient detoxification [ 12 , 30 , 31 ].…”

“…Inpatient medically managed withdrawal is appropriate for patients at risk for severe withdrawal, delirium tremens, or with significant medical and psychiatric comorbidities [ 3 , 12 , 30 ]. Institutional protocols can be developed to assist in determining inpatient versus outpatient detoxification [ 12 , 30 , 31 ]. Regardless of the setting, medically managed withdrawal is not by itself addiction treatment but rather a bridge to treatment.…”

Personalized Medicine Without the “Omics”

“…In an entirely different clinical realm, Stephens et al ask similar questions about alcoholic detoxification, specifically evaluating a new, more patientspecific, protocol. 3 Finally, the paper by Singh et al applies the "individualization principle" at the policy level. In their analysis of hospital readmission rates, only a small amount of between-hospital variation could be ascribed to the hospitals themselves; patient characteristics were far more important.…”

Capsule Commentary on Stephens et al., Who Needs Inpatient Detox? Development and Implementation of a Hospitalist Protocol for the Evaluation of Patients for Alcohol Detoxification

“…I n this paper, Stephens et al 1 describe the development, implementation, and outcomes of a protocol to determine which patients presenting to an academic health center emergency department (ED) requesting alcohol detoxification require inpatient admission. Their interdisciplinary group synthesized existing evidence and developed a protocol that recommended admission for patients with a Clinical Institute Withdrawal Assessment (CIWA) score> 15, or for those with CIWA scores 8-15 and a prior history delirium tremens (DT).…”