Effective Outpatient Alcohol Detoxification on a Neuropsychoanalytic Service

Abstract Consumption of alcohol causes 3 million deaths per year worldwide.1 Detoxification is expensive in terms of personnel time and cost. Most patients do not engage in aftercare. We examined records from a neuropsychoanalytic addiction medicine service to determine whether severe alcohol withdrawal can be managed outpatient. Valproic acid 2000 mg was immediately given and chlordiazepoxide, if needed, was given every hour until withdrawal was in remission. 42 patients had a total of 69 detoxifications. The prediction of alcohol withdrawal symptom severity (PAWSS) rated moderate or severe withdrawal for 86%. For 78% withdrawal remitted in 3.5 hours or less. Completion was 97%. 100% of patients had at least 4 follow up visits. Valproate and chlordiazepoxide loading by the same outpatient providers who treat after detoxification is safe, cheap, effective, and humane. The requirement that a sober support person attend the initial assessment and accompany the patient during detoxification addresses denial of the need for help and in many cases, extends recovery to the family. Having observed disulfiram administration for the first year sober stabilizes patients who otherwise might respond to craving and drinking dreams with relapse. These results indicate that outpatient alcohol detoxification may be comparable or better than inpatient treatment in facilitating abstinence from alcohol.