assessment for assisted alcohol withdrawal
Last reviewed 10/2020
For people who are alcohol dependent, the next stage of treatment may require medically-assisted alcohol withdrawal (if necessary with medication to control the symptoms and complications of withdrawal).
Minor degrees of alcohol withdrawal are commonly managed with information, reassurance, and adequate fluid intake
Consider offering a community-based assisted withdrawal programme or inpatient and residential assisted withdrawal to patients who typically drink over 15 units of alcohol per day, and/or who score 20 or more on the AUDIT.
- community-based assisted withdrawal
- managed in the community either as part of shared care with the patient's GP or in an outpatient or home-based assisted alcohol withdrawal programme, with appropriate professional and family support
- intensity of the programme may vary according to the severity of the dependence, available social support and co-morbidities
- for people with mild to moderate dependence, offer an outpatient-based assisted withdrawal programme in which contact between staff and patient averages 2–4 meetings per week over the first week
- for people with mild to moderate dependence and complex needs, or severe dependence, offer an intensive community programme following assisted withdrawal in which the patient may attend a day programme lasting between 4 and 7 days per week over a 3-week period.
- outpatient-based community assisted withdrawal programmes should consist of a drug regimen and psychosocial support including motivational interviewing
- intensive community programmes following assisted withdrawal should consist of a drug regimen supported by psychological interventions including individual treatments, group treatments, psychoeducational interventions, help to attend self-help groups, family and carer support and involvement, and case management
- inpatient and residential assisted withdrawal
- considered if patients meet one or more of the following criteria. They:
- drink over 30 units of alcohol per day
- have a score of more than 30 on the SADQ
- have a history of epilepsy or experience of withdrawal-related seizures or delirium tremens during previous assisted withdrawal programmes
- need concurrent withdrawal from alcohol and benzodiazepines
- regularly drink between 15 and 20 units of alcohol per day and have:
- significant psychiatric or physical comorbidities (for example, chronic severe depression, psychosis, malnutrition, congestive cardiac failure, unstable angina, chronic liver disease) or
- a significant learning disability or cognitive impairment
- consider a lower threshold for inpatient or residential assisted withdrawal in vulnerable groups, for example, homeless and older people (1)
It should be noted that treatment of alcohol withdrawal is only the beginning of rehabilitation and, for many, a necessary precursor to a longer-term treatment process. Withdrawal management should not be considered as a standalone treatment.
Reference: