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Evaluation of a symptom-triggered front-loading detoxification technique for alcohol dependence: A pilot study

  • Ed Day (a1), Jaimin Patel (a2) and George Georgiou (a2)
Abstract
Aims and Methods

A pilot study was set up to compare a symptom-triggered ‘front-loading’ detoxification technique with the usual fixed dosage method. A group of 23 in-patients with alcohol dependence were randomised to receive either the intervention technique using diazepam or the standard chlordiazepoxide taper over 10 days.

Results

The intervention group received a mean dosage of 74 mg diazepam (equivalent to 222 mg chlordiazepoxide) compared with 700 mg chlordiazepoxide in those receiving usual treatment. There was no statistical difference in the severity of alcohol withdrawal symptoms in the two groups, and the intervention group were slightly more satisfied with their treatment than the group undergoing the usual detoxification treatment. Feedback from the nursing staff was positive towards the new approach but highlighted some potential problems for its wider implementation.

Clinical Implications

It was possible to use a simple randomised trial design to introduce a new technique for alcohol detoxification to a specialist unit. Symptom-triggered front-loading detoxification using diazepam was as effective as a standard taper technique in terms of withdrawal severity reduction, and was acceptable to both patients and staff. This is potentially a useful technique for busy acute psychiatric wards.

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Copyright
This is an Open Access article, distributed under the terms of the Creative Commons Attribution (CC-BY) license (http://creativecommons.org/licenses/by/4.0/), which permits unrestricted re-use, distribution, and reproduction in any medium, provided the original work is properly cited.
References
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Bazire, S. (2000) Psychotropic Drug Directory. Snow Hill: Quay Books.
Devenyi, P. & Harrison, M. L. (1985) Prevention of alcohol withdrawal seizures with oral diazepam loading. Canadian Medical Association Journal, 132, 798800.
Heinala, P., Piepponen, T. & Heikkinen, H. (1990) Diazepam loading in alcohol withdrawal: clinical pharmacokinetics. International Journal of Clinical Pharmacology, Therapy and Toxicology, 28, 211217.
Lange-Asschenfeldt, C., Muller, M. J., Szegedi, A., et al (2003) Symptom-triggered versus standard chlormethiazole treatment of inpatient alcohol withdrawal: clinical implications from a chart analysis. European Addiction Research, 9, 17.
Mayo-Smith, M. F. (1997) Pharmacological treatment of alcohol withdrawal: a meta-analysis and evidence-based practice guideline. American Society of Addiction Medicine Working Group on Pharmaceutical Management of Alcohol Withdrawal. JAMA, 278, 144151.
Reoux, J. P. & Miller, K. (2000) Routine hospital alcohol detoxification practice compared to symptom triggered management with an objective withdrawal scale. American Journal on Addictions, 9, 135144.
Saitz, R., Mayo-Smith, M. F., Roberts, M. S., et al (1994) Individualized treatment for alcohol withdrawal: a randomized double-blind controlled trial. JAMA, 272, 519523.
Saitz, R., Friedman, L. S. & Mayo-Smith, M. F. (1995) Alcohol withdrawal: a nationwide survey of inpatient treatment practices. Journal of General Internal Medicine, 10, 479487.
Sellers, E. M., Naranjo, C. A., Harrison, M., et al (1983) Diazepam loading: simplified treatment of alcohol withdrawal. Clinical Pharmacology and Therapeutics, 34, 822826.
Silpakit, C., Silpakit, O. & Kumyan, S. (1999) Treatment of alcohol withdrawal: a fixed schedule regimen versus symptom-triggered regimen. International Medical Journal, 6, 287289.
Stockwell, T., Murphy, D. & Hodgson, R. (1983) The Severity of Alcohol Dependence Questionnaire: its use, reliability and validity. British Journal of Addiction, 78, 145155.
Sullivan, J.T., Sykora, K., Schniderman, J., et al (1989) Assessment of alcohol withdrawal: the Revised Clinical Institute Withdrawal Assessment for Alcohol Scale (CIWA-Ar). British Journal of Addiction, 84, 13531357.
Wartenberg, A. A., Nirenberg, T. D., Liepman, M. R., et al (1990) Detoxification of alcoholics: improving care by symptom-triggered sedation. Alcoholism: Clinical and Experimental Research, 14, 7175.
Wasilewski, D., Matsumoto, H., Kur, E., et al (1996) Assessment of diazepam loading dose therapy of delirium tremens. Alcohol and Alcoholism, 31, 273278.
Williams, S. (2001) Introducing an in-patient treatment for alcohol detoxification into a community setting. Journal of Clinical Nursing, 10, 635642.
Williams, D. & Mcbride, A. J. (1998) The drug treatment of alcohol withdrawal symptoms: a systematic review. Alcohol and Alcoholism, 33, 103115.
World Health Organization (1992) The ICD–10 Classification of Mental and Behavioural Disorders. Clinical Description and Diagnostic Guidelines. Geneva: WHO.
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BJPsych Bulletin
  • ISSN: 0955-6036
  • EISSN: 1472-1473
  • URL: /core/journals/bjpsych-bulletin
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Evaluation of a symptom-triggered front-loading detoxification technique for alcohol dependence: A pilot study

  • Ed Day (a1), Jaimin Patel (a2) and George Georgiou (a2)
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