Settings for Alcohol Withdrawal

Occur in the person’s ‘home’ environment or well supported accommodation. Also known as outpatient or home-based detoxification services. Requires: no history of severe withdrawal complications (seizures, delirium, hallucinations) or significant medical or psychiatric comorbidity a safe, alcohol-free environment reliable support ‘lay’ people that can regularly monitor (at least daily during the first 3 or 4 days) and support the patient regular monitoring by a suitably skilled health professional (such as alcohol and drug worker, nursing or medical professional). Daily review (face-to-face, telephone) for first 3 or 4 days medication should be closely supervised (for example, daily supplies). Benzodiazepines to be withheld if the patient resumes alcohol use. patient should have access to 24-hour telephone ‘crisis’ support.

Ambulatory withdrawal has the advantage of no ‘waiting lists’; nevertheless, it requires planning and mobilisation of the appropriate supports and services. Lower completion rates are generally reported than for residential withdrawal management, but patients who stop drinking at home may be better equipped for continuing abstinence.

Residential (non-hospital) units exist in a number of urban and regional centres. They typically:

• • • provide medical, nursing and support services for managing withdrawal, and facilitate post-withdrawal treatment options;

    • allow for 7 to 10 day admissions;

    • are for people: (a) with moderate alcohol withdrawal without a history of withdrawal complications (seizures, delirium, hallucinations); (b) withdrawing from multiple drugs; (c) unsuitable ‘home’ environment for attempting ambulatory withdrawal; or (d) for those that have repeatedly failed ambulatory withdrawal;

    • are unable to treat patients with significant medical or psychiatric comorbidity who require hospitalisation;

    • often have waiting lists for admission;

    • have higher completion rates than for ambulatory withdrawal.

General or psychiatric hospital admissions are required for people with significant medical (such as trauma or delirium) or psychiatric (such as psychosis, high-risk suicidal) conditions, or when the diagnosis is unclear (for example, seizures that require investigation). Further, many patients hospitalised for medical or surgical conditions will experience unplanned and often severe withdrawal

High dependency unit or intensive care unit admission may be required for complex and seriously ill patients. In some circumstances, patients may be able to ‘step-down’ to less intensive settings to complete withdrawal once medically stable

Specialist Addiction Medicine service (as the admitting specialist or via a consultation liaison model) should be accessible to manage inpatient post-discharge care.