Alcohol withdrawal: a nationwide survey of inpatient treatment practices.
OBJECTIVE
To describe current practices employed in the inpatient treatment for alcohol withdrawal.


METHODS
Survey.


METHODS
Inpatient alcoholism treatment programs in the United States.


METHODS
Medical directors of 176 (69%) of 257 eligible programs randomly selected from a national listing.


RESULTS
The medical directors estimated that of all inpatients treated for alcohol withdrawal at the programs, 68% received one of the following medications. Benzodiazepines, including the long-acting chlordiazepoxide (33%) and diazepam (16%), and less frequently the short-acting oxazepam (7%) and lorazepam (4%), were the most commonly used agents. Barbiturates (11%), phenytoin (10%), clonidine (7%), beta-blockers (3%), carbamazepine (1%), and antipsychotics (1%) were less frequently given. Drug was most often given on a fixed dosing schedule with additional medication "as needed" (52% of the programs). Only 31% of the programs routinely used a standardized withdrawal severity scale to monitor patients. Mean duration of sedative treatment was three days; inpatient treatment, four days. Use of fixed-schedule regimens was associated with longer sedative treatment (mean four vs three days, p < 0.01). Northeast census region location and psychiatrist program director were significantly associated with longer sedative and inpatient treatment duration.


CONCLUSIONS
The most commonly reported regimen for alcohol withdrawal included three days of long-acting benzodiazepines on a fixed schedule with additional medication "as needed." Standardized monitoring of the severity of withdrawal was not common practice. The directors reported using a variety of other regimens, some not known to prevent the major complications of withdrawal. Although geographic location and director specialty were significantly associated with treatment duration, much of the variation in treatment for alcohol withdrawal remains unexplained.
Section of General Internal Medicine, Boston City Hospital, Massachusetts 02118, USA.
R
R
Saitz
L S
LS
Friedman
M F
MF
Mayo-Smith
D000319:Adrenergic beta-Antagonists / Q000627:therapeutic use; D000437:Alcoholism / Q000188:drug therapy*; D001463:Barbiturates / Q000627:therapeutic use; D001569:Benzodiazepines / Q000008:administration & dosage*; D002707:Chlordiazepoxide / Q000627:therapeutic use; D003000:Clonidine / Q000627:therapeutic use; D003625:Data Collection; D003975:Diazepam / Q000627:therapeutic use; D004334:Drug Administration Schedule; D006993:Hypnotics and Sedatives / Q000627:therapeutic use*; D007297:Inpatients; D008140:Lorazepam / Q000627:therapeutic use; D010076:Oxazepam / Q000627:therapeutic use; D010672:Phenytoin / Q000627:therapeutic use; D013375:Substance Withdrawal Syndrome / Q000188:drug therapy*
D000319:Adrenergic beta-Antagonists; D001463:Barbiturates; D006993:Hypnotics and Sedatives; D001569:Benzodiazepines; D010672:Phenytoin; D010076:Oxazepam; D002707:Chlordiazepoxide; D003000:Clonidine; D008140:Lorazepam; D003975:Diazepam