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DETOXIFICATION FROM ALCOHOL: A COMPARISON OF HOME DETOXIFICATION AND HOSPITAL-BASED DAY PATIENT CARE

DETOXIFICATION FROM ALCOHOL: A COMPARISON OF HOME DETOXIFICATION AND HOSPITAL-BASED DAY PATIENT CARE Abstract An uncontrolled study was carried out to examine two types of ambulatory care for patients undergoing detoxification from alcohol. The safety, efficacy, and acceptability of home detoxification was compared to detoxification within a day hospital setting. Seventy-nine per cent of home detoxification patients, many of whom had major alcohol-related problems and were severely dependent on alcohol, were successfully detoxified at 10 days. The day hospital group overlapped in severity with the home group and 78% completed detoxification. At 60 days, 45% of home detoxification patients and 31% of the day hospital group showed significant improvements in a range of alcohol-related difficulties. Improved outcome was associated with attendance for further treatment for both groups. Both home and day hospital detoxifications were viable alternatives to in-patient detoxification for selected groups of patients. INTRODUCTION The following research looks at two types of ambulatory care for patients undergoing detoxification from alcohol. The first was carried out within the patient's own home and the second was on a day-patient basis undertaken within a hospital setting. The stimulus for this work was the establishment of a home detoxification service as an adjunct to the usual Alcohol Problems Treatment Unit (APTU) package for detoxification, which in the services to be examined were usually day care or in some instances in-patient care. General Practitioners (GPs) had access to the established detoxification packages or could choose to use the new home detoxification service. Referrals to the new service formed the home detoxification group. Patients referred to the APTU formed the second group which was used for comparative purposes. This provided an opportunity for an uncontrolled study to examine the home detoxification of problem drinkers and to compare the safety and efficacy of this procedure with a group of patients undergoing the same process within a day hospital setting. In a recent review, Fleeman (1997) concluded that home detoxification is only likely to be a suitable setting for those with mild to moderate withdrawal symptoms, strong social support, and no medical or psychiatric complications. This project seeks to complement and extend these boundaries by including a more representative sample of the type of patients who usually attend routine alcohol services, many of whom have poor social support, are severely dependent and have complex alcohol-related difficulties (Allan, 1991). It is important to be clear that this research does not constitute a controlled trial of home vs day hospital detoxification, but aims to look at the following issues: (1) the type of patients selected for home detoxification compared to those who attend a hospital day unit; (2) the safety and efficacy of both detoxification procedures during the first 10 days of treatment; (3) client satisfaction with each service; (4) involvement in further treatment once detoxification has been completed; (5) outcome at 60 days. SUBJECTS AND METHODS Subjects During the study period, which began in September 1994, a consecutive series of 29 patients formed the home detoxification group. Criteria for inclusion in the study were as follows: the patient wished to detoxify from alcohol at home and the GP was willing to take medical responsibility. Patients were excluded if they were currently in delirium tremens, actively psychotic, suicidal or had severe memory difficulties or had been in treatment during the previous 6 months. GPs were contacted by letter telling them about the home detoxification service and the criteria for referring patients. They were also reminded that the new service was an adjunct to the usual day patient or in-patient services, which were still available to them. Patients were seen on the day of referral, or the next day if this was not achievable. The GP carried out a physical examination and prescribed medication which was chlordiazepoxide. This was commenced in a dose range between 30 and 100 mg in a day depending on the patient's needs and tailed off over a 7–10-day period. During detoxification, the patient was visited by a specialist community psychiatric nurse (CPN) on a daily basis to monitor withdrawal symptoms using a standard scale (Gross et al., 1973) and to advise on use of medication. Patients were breathalysed daily and persistent failure to remain abstinent resulted in the termination of treatment. Support for patients and carers was considered very important and treatment planning was discussed at various points during detoxification. For purposes of comparison, a consecutive series of 36 patients referred to the APTU were recruited. Similar inclusion and exclusion criteria applied, except the day hospital doctor took medical responsibility. Patients had the support of a key worker (who was usually a psychiatric nurse) and received a reducing dose of chlordiazepoxide on the same basis as the home group during withdrawal. Patients were breathalysed on a daily basis and failure to remain abstinent resulted in exclusion. Key workers helped to plan further treatment and were willing to see and advise carers and relatives. There were generally between six to 15 other patients detoxifying at the same time forming a ‘peer’ group for patients. Follow-up interviews took place at 10 and 60 days after the start of detoxification and were carried out by a research assistant not involved in the delivery of treatment. This consisted of a standardized interview, which examined past and recent alcohol use and also contact with treatment services (Allan, 1991). Patients also completed a number of self-report questionnaires; the Severity of Alcohol Dependence Questionnaire (SADQ) (Stockwell et al., 1983), the Alcohol Problems Questionnaire (APQ) (Drummond, 1990), a measure of social disruption (Smart, 1979), and the Treatment Satisfaction Scale, which examined patient satisfaction with different aspects of the respective detoxification packages (Stockwell et al., 1990). A maximum score of 8 indicated complete satisfaction. The criteria for successful completion of detoxification were as follows: the patient had become abstinent, there had been a major reduction in withdrawal symptoms, and that detoxification took place within the original treatment setting. At 60 days, the following outcome categories were used: ‘good’ indicated complete abstinence from alcohol or drinking less than 8 U/week and no return to alcohol-related problems reported by direct interview with the patient and confirmed by breathalyser and an independent source (a relative, or, if none available, referral agent or treatment staff). A UK unit is equivalent to a glass of wine, or a public bar measure of spirits, or 0.5 pint of beer. Each unit contains approximately 1 cl/7.9 g of absolute alcohol. ‘Improved’ indicated that if drinking had occurred, this did not exceed 21 U/week, dependence was not reinstated and the APQ was zero. The final category was ‘unimproved’ and contained patients drinking in excess of 21 U/week or who were once more physically dependent and reporting alcohol-related problems. Repeated efforts were made to contact patients personally, but, in the event of failure to do this, outcome was examined by consulting referral agents, treatment staff, and carers who were in touch with particular patients. Because of a lack of rigour in this, a conservative approach was taken and patients were allocated in the following manner. Those reported to be abstinent were assigned to the ‘improved’ category. Patients who were reported to have resumed drinking were allocated to the ‘unimproved’ category. RESULTS Sociodemographic and clinical characteristics Using the χ2-test for sex, marital, and occupational status and Student's t-test for age, there were no significant differences between the two groups on sociodemographic features (Table 1). Two-thirds of the home detoxification patients scored above 30 on the SADQ, which is the cut-off point indicating severe dependence. Patients reported drinking a mean 178 U of alcohol (the equivalent of approximately 5.5 bottles of spirits) in the week before detoxification. Thirteen (45%) had required assistance to detoxify previously, and of these, six (21% of the total) had episodes of in-patient detoxification. It should, however, be noted that the day hospital group overlapped in severity with the home group. A higher proportion of the former patients were in the severe dependence category (81%) and analysis of subtest scores indicated that ‘quantity of alcohol consumed’ was significantly higher (P < 0.01) among them (Table 2). In terms of actual units, this group reported consuming a mean of 194 U (equivalent to six bottles of spirits) in the previous week. Twenty-six of them (72%) had previously required help to detoxify, 14 of whom had been detoxified as in-patients. On the APQ both groups reported major difficulties, although the day hospital group reported more problems. This reached statistical significance in the case of general problems, and also on a measure of social disruption (Table 3). Safety and efficacy of detoxification The acute management of withdrawal was problem-free, apart from a minority of patients. In the home group, detoxification took place over an average time of 8 days with five CPN visits. Twenty-six patients (79%) fulfilled the criteria for successful completion of detoxification at 10 days. Using the Severity of Withdrawal Symptom Checklist, the home group had a mean score of 11.3 (± 4.0 SD) at the beginning of detoxification. By the second day, there had been a significant decline in symptoms (P < 0.001) with a mean score of 8.0 (± 2.7 SD). The GP was asked to see two patients again and the CPN service was called out for three unscheduled visits. Three patients (10%) experienced complicated withdrawals and of these, two developed visual hallucinations and one patient had a withdrawal seizure. In the day hospital sample, detoxification took place over an 8-day period and 28 patients (78%) completed detoxification. This group had a higher mean score in terms of withdrawal symptoms of 13.2 (± 4.7 SD), but the difference did not reach statistical significance. No further data were available for withdrawal symptoms as data were not routinely kept by ward staff. Two patients had episodes of visual hallucinations and one had a withdrawal seizure, giving altogether a rate of 8% for complications. In neither group were patients involved in an episode of self-harm, nor was it necessary for them to be transferred to in-patient care. Satisfaction with treatment Treatment Satisfaction Scales were completed by 21 of the home detoxification group and 30 of the day hospital group at the 10-day follow-up interview, and by 19 and 20 patients respectively at the 60-day follow-up. Seven out of the nine scales achieved significant test–retest reliability coefficients (Spearman's ρ = 0.37 to 0.68, P < 0.03, n = 39). Only items shown to be reliable have been presented, and the data for the 10-day point are given in Table 4. For the home detoxification group, key elements including individual support from the CPN, support for carers and help to stay in the home environment were rated highly, as were support from the GP and the drugs prescribed. Overall satisfaction with the service was high. The day hospital detoxification group rated key worker support and the ward environment most highly. Overall satisfaction with the service was also relatively high. Uptake of treatment After the completion of detoxification, 52% of the home group and 53% of the day hospital group became involved in further treatment. For the home group, the most frequently used treatment resource was further individual work with the CPN. This was followed by attendance at a City Centre Alcohol Day Service. For the day hospital group, the most frequently used treatment was attendance at the Alcohol Day Programme, which operates within the same premises and with the same staff as the detoxification service. Outcome at 60 days Nineteen (65%) of home detoxification patients were successfully re-interviewed. Thirteen patients fulfilled criteria for a ‘good’ outcome and the remaining six patients reported a return to problem drinking and were therefore allocated to the ‘unimproved’ group. Of those not contacted directly, five were reported abstinent and without alcohol-related problems by referral agents and treatment staff, and were therefore allocated to the ‘improved’ category. A further two patients were categorized as ‘unimproved’, and no information was available for the remaining three patients. Taking the group as a whole, 45% of patients were categorized as having had a ‘good’ outcome (Table 5). Twenty (56%) day hospital detoxification patients were successfully re-interviewed. Eleven were placed in the ‘good’ outcome category, one was designated as ‘improved’ and nine patients were unimproved. Of those not re-interviewed in person, one was allocated as ‘improved’ and seven had returned to problematic drinking. One had died during the follow-up period and the remaining seven were untraceable. Taking the day hospital group as a whole, 31% were in the ‘good’ outcome category (Table 5). The relationships between treatment and outcome were calculated by amalgamating the ‘good’ and ‘improved’ groups together providing a dichotomous outcome category of ‘improved’ and ‘not improved’. Patients who had attended for treatment after the conclusion of detoxification had significantly superior outcomes (Fisher's Exact Test, P < 0.03; 2 × 2 contingency tables). A direct comparison with the period immediately prior to detoxification for subjects successfully interviewed at follow-up showed significant changes using paired t-tests (Table 6). There were significant reductions in weekly alcohol consumption, maximum daily consumption, SADQ, and APQ scores for both the home and hospital groups. DISCUSSION Both home and day detoxification provided safe and effective methods for withdrawing selected groups of patients from alcohol. Outcome at 10 days indicated high rates of completion and low rates of complications for both groups, which were similar to that reported for a home group (Stockwell et al., 1991) and also for an in-patient series (Metcalfe et al., 1995). Approximately half of the patients in both groups became involved in further treatment and this was associated with improved outcome at 60 days. Achieving a more sustained period of abstinence was much more difficult, as the outcome at 60 days indicated. By this point, 45% of the home group and 31% of the day hospital group were showing a ‘good’ outcome. When considering longer-term outcome, there is little value in direct comparisons with other studies, because of differing selection criteria, length of follow-up, type of treatment received, and measures of treatment outcome. However, the general indications are that, given the initial levels of treatment severity, outcome is similar to that reported for comparable studies (Stockwell et al., 1990; Bennie, 1998). In the past, researchers have adopted a conservative approach, particularly towards patients selected for out-patient detoxification, and, in particular, home detoxification. Patients typically have had histories of problem-free withdrawal, low levels of physical dependence and a carer willing to assist in detoxification. This in some ways has produced a paradoxical situation, as they require only minimal or even no help to detoxify. One of the original aims of this research was to examine the feasibility of treating a more severe group of drinkers than the target group described by Fleeman (1997), which is closer to current clinical practice (Stockwell et al., 1986). Our findings indicate that this has been achieved and that GPs were willing to refer more impaired and dependent drinkers. However, it should be noted that there are indications that the hospital sample contained a very severe group with very high rates of dependence, alcohol-related problems, and social instability. Caution must be exercised in interpreting the results from this study, because of the small numbers involved. However, there is now a growing body of evidence from this and other work that a wider range of patients can be safely and effectively detoxified outside an in-patient setting (Fleeman, 1997). What is lacking is a set of empirically based guidelines to aid decision-making about matching patients to particular types of detoxification services. In the absence of this, an unsystematic stepped care or treatment tiering approach is in operation, which is governed as much by the availability of resources as rational treatment planning (Breslin et al., 1997). An integrated service involving community links and hospital-based services may be a cost-effective and efficient way of dealing with a range of problems. Clearly there will still remain patients who will require in-patient care and who cannot be safely withdrawn from alcohol outside such a setting. The challenge is then to define the characteristics of these respective groups. Table 1. Sociodemographic indicators Indicator . Home group (%) . Day hospital group (%) . Married 35 37 Single 17 17 Separated 21 20 Divorced 10 23 Widowed 17 3 Employed 21 9 Unemployed 62 82 Retired/housewife 17 9 Mean age (years) (SD) 46.4 (12.2) 45.1 (9.8) Sex ratio (male/female) 2:1 2:1 Indicator . Home group (%) . Day hospital group (%) . Married 35 37 Single 17 17 Separated 21 20 Divorced 10 23 Widowed 17 3 Employed 21 9 Unemployed 62 82 Retired/housewife 17 9 Mean age (years) (SD) 46.4 (12.2) 45.1 (9.8) Sex ratio (male/female) 2:1 2:1 Open in new tab Table 1. Sociodemographic indicators Indicator . Home group (%) . Day hospital group (%) . Married 35 37 Single 17 17 Separated 21 20 Divorced 10 23 Widowed 17 3 Employed 21 9 Unemployed 62 82 Retired/housewife 17 9 Mean age (years) (SD) 46.4 (12.2) 45.1 (9.8) Sex ratio (male/female) 2:1 2:1 Indicator . Home group (%) . Day hospital group (%) . Married 35 37 Single 17 17 Separated 21 20 Divorced 10 23 Widowed 17 3 Employed 21 9 Unemployed 62 82 Retired/housewife 17 9 Mean age (years) (SD) 46.4 (12.2) 45.1 (9.8) Sex ratio (male/female) 2:1 2:1 Open in new tab Table 2. Comparison of subscale and total scores on the Severity of Alcohol Dependence Questionnaire for home and hospital groups Parameter . Home group (mean ± SD) . Day hospital group (mean ± SD) . t-test . Physical withdrawal 6.3 ± 3.1 7.5 ± 2.9 1.6 Affective symptoms 6.2 ± 3.4 6.6 ± 3.7 0.4 Relief drinking 7.8 ± 3.3 8.6 ± 4.0 0.9 Quantity drunk 6.5 ± 2.4 8.0 ± 2.2 2.6; P < 0.01 Reinstatement 7.4 ± 3.3 8.9 ± 3.1 1.8 Total score 34.4 ± 12.4 39.9 ± 11.9 1.8 Parameter . Home group (mean ± SD) . Day hospital group (mean ± SD) . t-test . Physical withdrawal 6.3 ± 3.1 7.5 ± 2.9 1.6 Affective symptoms 6.2 ± 3.4 6.6 ± 3.7 0.4 Relief drinking 7.8 ± 3.3 8.6 ± 4.0 0.9 Quantity drunk 6.5 ± 2.4 8.0 ± 2.2 2.6; P < 0.01 Reinstatement 7.4 ± 3.3 8.9 ± 3.1 1.8 Total score 34.4 ± 12.4 39.9 ± 11.9 1.8 Open in new tab Table 2. Comparison of subscale and total scores on the Severity of Alcohol Dependence Questionnaire for home and hospital groups Parameter . Home group (mean ± SD) . Day hospital group (mean ± SD) . t-test . Physical withdrawal 6.3 ± 3.1 7.5 ± 2.9 1.6 Affective symptoms 6.2 ± 3.4 6.6 ± 3.7 0.4 Relief drinking 7.8 ± 3.3 8.6 ± 4.0 0.9 Quantity drunk 6.5 ± 2.4 8.0 ± 2.2 2.6; P < 0.01 Reinstatement 7.4 ± 3.3 8.9 ± 3.1 1.8 Total score 34.4 ± 12.4 39.9 ± 11.9 1.8 Parameter . Home group (mean ± SD) . Day hospital group (mean ± SD) . t-test . Physical withdrawal 6.3 ± 3.1 7.5 ± 2.9 1.6 Affective symptoms 6.2 ± 3.4 6.6 ± 3.7 0.4 Relief drinking 7.8 ± 3.3 8.6 ± 4.0 0.9 Quantity drunk 6.5 ± 2.4 8.0 ± 2.2 2.6; P < 0.01 Reinstatement 7.4 ± 3.3 8.9 ± 3.1 1.8 Total score 34.4 ± 12.4 39.9 ± 11.9 1.8 Open in new tab Table 3. Comparison of subscale scores on the Alcohol Problems Questionnaire and the Social Disruption Scale Parameter . Home group . Day hospital group . t-test . General 9.3 12.5 3.1; P < 0.003 Partner 4.6 6.1 1.6 Children 2.4 3.9 2.4 Work 3.4 3.2 0.1 Total score 15.5 20.0 2.2; P < 0.03 Social disruption scale 3.2 5.0 2.1; P < 0.03 Parameter . Home group . Day hospital group . t-test . General 9.3 12.5 3.1; P < 0.003 Partner 4.6 6.1 1.6 Children 2.4 3.9 2.4 Work 3.4 3.2 0.1 Total score 15.5 20.0 2.2; P < 0.03 Social disruption scale 3.2 5.0 2.1; P < 0.03 Open in new tab Table 3. Comparison of subscale scores on the Alcohol Problems Questionnaire and the Social Disruption Scale Parameter . Home group . Day hospital group . t-test . General 9.3 12.5 3.1; P < 0.003 Partner 4.6 6.1 1.6 Children 2.4 3.9 2.4 Work 3.4 3.2 0.1 Total score 15.5 20.0 2.2; P < 0.03 Social disruption scale 3.2 5.0 2.1; P < 0.03 Parameter . Home group . Day hospital group . t-test . General 9.3 12.5 3.1; P < 0.003 Partner 4.6 6.1 1.6 Children 2.4 3.9 2.4 Work 3.4 3.2 0.1 Total score 15.5 20.0 2.2; P < 0.03 Social disruption scale 3.2 5.0 2.1; P < 0.03 Open in new tab Table 4. Ratings of treatment satisfaction scale 10 days after detoxification Parameter . Home group (mean ± SD) . Day hospital group (mean ± SD) . Community nurse/key worker support 7.9 ± 0.2 7.2 ± 1.5 Support for carer 7.1 ± 1.8 5.7 ± 1.7 Home/hospital environment 7.0 ± 1.4 7.0 ± 1.2 Drugs prescribed 6.8 ± 1.7 5.9 ± 2.0 Physical 6.8 ± 1.0 6.3 ± 1.9 GP/hospital support 6.8 ± 1.9 5.7 ± 2.5 Overall satisfaction 7.5 ± 0.6 6.8 ± 1.2 Parameter . Home group (mean ± SD) . Day hospital group (mean ± SD) . Community nurse/key worker support 7.9 ± 0.2 7.2 ± 1.5 Support for carer 7.1 ± 1.8 5.7 ± 1.7 Home/hospital environment 7.0 ± 1.4 7.0 ± 1.2 Drugs prescribed 6.8 ± 1.7 5.9 ± 2.0 Physical 6.8 ± 1.0 6.3 ± 1.9 GP/hospital support 6.8 ± 1.9 5.7 ± 2.5 Overall satisfaction 7.5 ± 0.6 6.8 ± 1.2 Open in new tab Table 4. Ratings of treatment satisfaction scale 10 days after detoxification Parameter . Home group (mean ± SD) . Day hospital group (mean ± SD) . Community nurse/key worker support 7.9 ± 0.2 7.2 ± 1.5 Support for carer 7.1 ± 1.8 5.7 ± 1.7 Home/hospital environment 7.0 ± 1.4 7.0 ± 1.2 Drugs prescribed 6.8 ± 1.7 5.9 ± 2.0 Physical 6.8 ± 1.0 6.3 ± 1.9 GP/hospital support 6.8 ± 1.9 5.7 ± 2.5 Overall satisfaction 7.5 ± 0.6 6.8 ± 1.2 Parameter . Home group (mean ± SD) . Day hospital group (mean ± SD) . Community nurse/key worker support 7.9 ± 0.2 7.2 ± 1.5 Support for carer 7.1 ± 1.8 5.7 ± 1.7 Home/hospital environment 7.0 ± 1.4 7.0 ± 1.2 Drugs prescribed 6.8 ± 1.7 5.9 ± 2.0 Physical 6.8 ± 1.0 6.3 ± 1.9 GP/hospital support 6.8 ± 1.9 5.7 ± 2.5 Overall satisfaction 7.5 ± 0.6 6.8 ± 1.2 Open in new tab Table 5. Outcome categories at 60 days Category . Home group n (%) . Day hospital group n (%) . Good 13 (45) 11 (31) Improved 5 (17) 1 (3) Unimproved 8 (28) 16 (44) Unknown 3 (10) 7 (19) Dead 0 1 (3) Category . Home group n (%) . Day hospital group n (%) . Good 13 (45) 11 (31) Improved 5 (17) 1 (3) Unimproved 8 (28) 16 (44) Unknown 3 (10) 7 (19) Dead 0 1 (3) Open in new tab Table 5. Outcome categories at 60 days Category . Home group n (%) . Day hospital group n (%) . Good 13 (45) 11 (31) Improved 5 (17) 1 (3) Unimproved 8 (28) 16 (44) Unknown 3 (10) 7 (19) Dead 0 1 (3) Category . Home group n (%) . Day hospital group n (%) . Good 13 (45) 11 (31) Improved 5 (17) 1 (3) Unimproved 8 (28) 16 (44) Unknown 3 (10) 7 (19) Dead 0 1 (3) Open in new tab Table 6. Drinking and alcohol-related problems at pre-detoxification (Pre-detox) and 60 days . Home group (n = 19) . Day hospital group (n = 20) . Measure . Pre-detox (mean ± SD) . 60 days (mean ± SD) . t/P (Sig) . Pre-detox (mean ± SD) . 60 days (mean ± SD) . t/P . aSee text for definition of a UK unit. Units in past weeka 180.3 ± 117.4 14.7 ± 34 5.36 196.9 ± 98.6 33.7 ± 63.5 8.1 P < 0.0001 P < 0.000 Maximum daily unitsa 30.8 ± 15.4 3.2 ± 6.5 6.64 36.3 ± 16.1 12.0 ± 19.3 5.0 P < 0.001 P < 0.001 Severity of dependence 35.5 ± 13.1 11.3 ± 14.2 4.36 41.3 ± 12.8 26.4 ± 23.8 3.1 P < 0.0001 P < 0.0006 Alcohol problems (general) 9.4 ± 3.1 1.8 ± 3.2 5.6 13.9 ± 4.3 5.2 ± 5.4 7.5 P < 0.0001 P < 0.0001 . Home group (n = 19) . Day hospital group (n = 20) . Measure . Pre-detox (mean ± SD) . 60 days (mean ± SD) . t/P (Sig) . Pre-detox (mean ± SD) . 60 days (mean ± SD) . t/P . aSee text for definition of a UK unit. Units in past weeka 180.3 ± 117.4 14.7 ± 34 5.36 196.9 ± 98.6 33.7 ± 63.5 8.1 P < 0.0001 P < 0.000 Maximum daily unitsa 30.8 ± 15.4 3.2 ± 6.5 6.64 36.3 ± 16.1 12.0 ± 19.3 5.0 P < 0.001 P < 0.001 Severity of dependence 35.5 ± 13.1 11.3 ± 14.2 4.36 41.3 ± 12.8 26.4 ± 23.8 3.1 P < 0.0001 P < 0.0006 Alcohol problems (general) 9.4 ± 3.1 1.8 ± 3.2 5.6 13.9 ± 4.3 5.2 ± 5.4 7.5 P < 0.0001 P < 0.0001 Open in new tab Table 6. Drinking and alcohol-related problems at pre-detoxification (Pre-detox) and 60 days . Home group (n = 19) . Day hospital group (n = 20) . Measure . Pre-detox (mean ± SD) . 60 days (mean ± SD) . t/P (Sig) . Pre-detox (mean ± SD) . 60 days (mean ± SD) . t/P . aSee text for definition of a UK unit. Units in past weeka 180.3 ± 117.4 14.7 ± 34 5.36 196.9 ± 98.6 33.7 ± 63.5 8.1 P < 0.0001 P < 0.000 Maximum daily unitsa 30.8 ± 15.4 3.2 ± 6.5 6.64 36.3 ± 16.1 12.0 ± 19.3 5.0 P < 0.001 P < 0.001 Severity of dependence 35.5 ± 13.1 11.3 ± 14.2 4.36 41.3 ± 12.8 26.4 ± 23.8 3.1 P < 0.0001 P < 0.0006 Alcohol problems (general) 9.4 ± 3.1 1.8 ± 3.2 5.6 13.9 ± 4.3 5.2 ± 5.4 7.5 P < 0.0001 P < 0.0001 . Home group (n = 19) . Day hospital group (n = 20) . Measure . Pre-detox (mean ± SD) . 60 days (mean ± SD) . t/P (Sig) . Pre-detox (mean ± SD) . 60 days (mean ± SD) . t/P . aSee text for definition of a UK unit. Units in past weeka 180.3 ± 117.4 14.7 ± 34 5.36 196.9 ± 98.6 33.7 ± 63.5 8.1 P < 0.0001 P < 0.000 Maximum daily unitsa 30.8 ± 15.4 3.2 ± 6.5 6.64 36.3 ± 16.1 12.0 ± 19.3 5.0 P < 0.001 P < 0.001 Severity of dependence 35.5 ± 13.1 11.3 ± 14.2 4.36 41.3 ± 12.8 26.4 ± 23.8 3.1 P < 0.0001 P < 0.0006 Alcohol problems (general) 9.4 ± 3.1 1.8 ± 3.2 5.6 13.9 ± 4.3 5.2 ± 5.4 7.5 P < 0.0001 P < 0.0001 Open in new tab * Author to whom correspondence should be addressed. This Project was financed by a Chief Scientist's Office — Scottish Home and Health Department research grant. REFERENCES Allan, C. ( 1991 ) Psychological symptoms, psychiatric disorder and alcohol dependence amongst men and women attending a community-based voluntary agency and an Alcohol Treatment Unit. British Journal of Addiction 86 , 419 –427. Bennie, C. ( 1998 ) A comparison of home detoxification and minimal intervention strategies for problem drinkers. Alcohol and Alcoholism 33 , 157 –163. Breslin, C. F., Sobell, M. 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Alcohol and Alcoholism 26 , 645 –650. © 2000 Medical Council on Alcoholism http://www.deepdyve.com/assets/images/DeepDyve-Logo-lg.png Alcohol and Alcoholism Oxford University Press

DETOXIFICATION FROM ALCOHOL: A COMPARISON OF HOME DETOXIFICATION AND HOSPITAL-BASED DAY PATIENT CARE

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Oxford University Press
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© 2000 Medical Council on Alcoholism
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0735-0414
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1464-3502
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10.1093/alcalc/35.1.66
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Abstract

Abstract An uncontrolled study was carried out to examine two types of ambulatory care for patients undergoing detoxification from alcohol. The safety, efficacy, and acceptability of home detoxification was compared to detoxification within a day hospital setting. Seventy-nine per cent of home detoxification patients, many of whom had major alcohol-related problems and were severely dependent on alcohol, were successfully detoxified at 10 days. The day hospital group overlapped in severity with the home group and 78% completed detoxification. At 60 days, 45% of home detoxification patients and 31% of the day hospital group showed significant improvements in a range of alcohol-related difficulties. Improved outcome was associated with attendance for further treatment for both groups. Both home and day hospital detoxifications were viable alternatives to in-patient detoxification for selected groups of patients. INTRODUCTION The following research looks at two types of ambulatory care for patients undergoing detoxification from alcohol. The first was carried out within the patient's own home and the second was on a day-patient basis undertaken within a hospital setting. The stimulus for this work was the establishment of a home detoxification service as an adjunct to the usual Alcohol Problems Treatment Unit (APTU) package for detoxification, which in the services to be examined were usually day care or in some instances in-patient care. General Practitioners (GPs) had access to the established detoxification packages or could choose to use the new home detoxification service. Referrals to the new service formed the home detoxification group. Patients referred to the APTU formed the second group which was used for comparative purposes. This provided an opportunity for an uncontrolled study to examine the home detoxification of problem drinkers and to compare the safety and efficacy of this procedure with a group of patients undergoing the same process within a day hospital setting. In a recent review, Fleeman (1997) concluded that home detoxification is only likely to be a suitable setting for those with mild to moderate withdrawal symptoms, strong social support, and no medical or psychiatric complications. This project seeks to complement and extend these boundaries by including a more representative sample of the type of patients who usually attend routine alcohol services, many of whom have poor social support, are severely dependent and have complex alcohol-related difficulties (Allan, 1991). It is important to be clear that this research does not constitute a controlled trial of home vs day hospital detoxification, but aims to look at the following issues: (1) the type of patients selected for home detoxification compared to those who attend a hospital day unit; (2) the safety and efficacy of both detoxification procedures during the first 10 days of treatment; (3) client satisfaction with each service; (4) involvement in further treatment once detoxification has been completed; (5) outcome at 60 days. SUBJECTS AND METHODS Subjects During the study period, which began in September 1994, a consecutive series of 29 patients formed the home detoxification group. Criteria for inclusion in the study were as follows: the patient wished to detoxify from alcohol at home and the GP was willing to take medical responsibility. Patients were excluded if they were currently in delirium tremens, actively psychotic, suicidal or had severe memory difficulties or had been in treatment during the previous 6 months. GPs were contacted by letter telling them about the home detoxification service and the criteria for referring patients. They were also reminded that the new service was an adjunct to the usual day patient or in-patient services, which were still available to them. Patients were seen on the day of referral, or the next day if this was not achievable. The GP carried out a physical examination and prescribed medication which was chlordiazepoxide. This was commenced in a dose range between 30 and 100 mg in a day depending on the patient's needs and tailed off over a 7–10-day period. During detoxification, the patient was visited by a specialist community psychiatric nurse (CPN) on a daily basis to monitor withdrawal symptoms using a standard scale (Gross et al., 1973) and to advise on use of medication. Patients were breathalysed daily and persistent failure to remain abstinent resulted in the termination of treatment. Support for patients and carers was considered very important and treatment planning was discussed at various points during detoxification. For purposes of comparison, a consecutive series of 36 patients referred to the APTU were recruited. Similar inclusion and exclusion criteria applied, except the day hospital doctor took medical responsibility. Patients had the support of a key worker (who was usually a psychiatric nurse) and received a reducing dose of chlordiazepoxide on the same basis as the home group during withdrawal. Patients were breathalysed on a daily basis and failure to remain abstinent resulted in exclusion. Key workers helped to plan further treatment and were willing to see and advise carers and relatives. There were generally between six to 15 other patients detoxifying at the same time forming a ‘peer’ group for patients. Follow-up interviews took place at 10 and 60 days after the start of detoxification and were carried out by a research assistant not involved in the delivery of treatment. This consisted of a standardized interview, which examined past and recent alcohol use and also contact with treatment services (Allan, 1991). Patients also completed a number of self-report questionnaires; the Severity of Alcohol Dependence Questionnaire (SADQ) (Stockwell et al., 1983), the Alcohol Problems Questionnaire (APQ) (Drummond, 1990), a measure of social disruption (Smart, 1979), and the Treatment Satisfaction Scale, which examined patient satisfaction with different aspects of the respective detoxification packages (Stockwell et al., 1990). A maximum score of 8 indicated complete satisfaction. The criteria for successful completion of detoxification were as follows: the patient had become abstinent, there had been a major reduction in withdrawal symptoms, and that detoxification took place within the original treatment setting. At 60 days, the following outcome categories were used: ‘good’ indicated complete abstinence from alcohol or drinking less than 8 U/week and no return to alcohol-related problems reported by direct interview with the patient and confirmed by breathalyser and an independent source (a relative, or, if none available, referral agent or treatment staff). A UK unit is equivalent to a glass of wine, or a public bar measure of spirits, or 0.5 pint of beer. Each unit contains approximately 1 cl/7.9 g of absolute alcohol. ‘Improved’ indicated that if drinking had occurred, this did not exceed 21 U/week, dependence was not reinstated and the APQ was zero. The final category was ‘unimproved’ and contained patients drinking in excess of 21 U/week or who were once more physically dependent and reporting alcohol-related problems. Repeated efforts were made to contact patients personally, but, in the event of failure to do this, outcome was examined by consulting referral agents, treatment staff, and carers who were in touch with particular patients. Because of a lack of rigour in this, a conservative approach was taken and patients were allocated in the following manner. Those reported to be abstinent were assigned to the ‘improved’ category. Patients who were reported to have resumed drinking were allocated to the ‘unimproved’ category. RESULTS Sociodemographic and clinical characteristics Using the χ2-test for sex, marital, and occupational status and Student's t-test for age, there were no significant differences between the two groups on sociodemographic features (Table 1). Two-thirds of the home detoxification patients scored above 30 on the SADQ, which is the cut-off point indicating severe dependence. Patients reported drinking a mean 178 U of alcohol (the equivalent of approximately 5.5 bottles of spirits) in the week before detoxification. Thirteen (45%) had required assistance to detoxify previously, and of these, six (21% of the total) had episodes of in-patient detoxification. It should, however, be noted that the day hospital group overlapped in severity with the home group. A higher proportion of the former patients were in the severe dependence category (81%) and analysis of subtest scores indicated that ‘quantity of alcohol consumed’ was significantly higher (P < 0.01) among them (Table 2). In terms of actual units, this group reported consuming a mean of 194 U (equivalent to six bottles of spirits) in the previous week. Twenty-six of them (72%) had previously required help to detoxify, 14 of whom had been detoxified as in-patients. On the APQ both groups reported major difficulties, although the day hospital group reported more problems. This reached statistical significance in the case of general problems, and also on a measure of social disruption (Table 3). Safety and efficacy of detoxification The acute management of withdrawal was problem-free, apart from a minority of patients. In the home group, detoxification took place over an average time of 8 days with five CPN visits. Twenty-six patients (79%) fulfilled the criteria for successful completion of detoxification at 10 days. Using the Severity of Withdrawal Symptom Checklist, the home group had a mean score of 11.3 (± 4.0 SD) at the beginning of detoxification. By the second day, there had been a significant decline in symptoms (P < 0.001) with a mean score of 8.0 (± 2.7 SD). The GP was asked to see two patients again and the CPN service was called out for three unscheduled visits. Three patients (10%) experienced complicated withdrawals and of these, two developed visual hallucinations and one patient had a withdrawal seizure. In the day hospital sample, detoxification took place over an 8-day period and 28 patients (78%) completed detoxification. This group had a higher mean score in terms of withdrawal symptoms of 13.2 (± 4.7 SD), but the difference did not reach statistical significance. No further data were available for withdrawal symptoms as data were not routinely kept by ward staff. Two patients had episodes of visual hallucinations and one had a withdrawal seizure, giving altogether a rate of 8% for complications. In neither group were patients involved in an episode of self-harm, nor was it necessary for them to be transferred to in-patient care. Satisfaction with treatment Treatment Satisfaction Scales were completed by 21 of the home detoxification group and 30 of the day hospital group at the 10-day follow-up interview, and by 19 and 20 patients respectively at the 60-day follow-up. Seven out of the nine scales achieved significant test–retest reliability coefficients (Spearman's ρ = 0.37 to 0.68, P < 0.03, n = 39). Only items shown to be reliable have been presented, and the data for the 10-day point are given in Table 4. For the home detoxification group, key elements including individual support from the CPN, support for carers and help to stay in the home environment were rated highly, as were support from the GP and the drugs prescribed. Overall satisfaction with the service was high. The day hospital detoxification group rated key worker support and the ward environment most highly. Overall satisfaction with the service was also relatively high. Uptake of treatment After the completion of detoxification, 52% of the home group and 53% of the day hospital group became involved in further treatment. For the home group, the most frequently used treatment resource was further individual work with the CPN. This was followed by attendance at a City Centre Alcohol Day Service. For the day hospital group, the most frequently used treatment was attendance at the Alcohol Day Programme, which operates within the same premises and with the same staff as the detoxification service. Outcome at 60 days Nineteen (65%) of home detoxification patients were successfully re-interviewed. Thirteen patients fulfilled criteria for a ‘good’ outcome and the remaining six patients reported a return to problem drinking and were therefore allocated to the ‘unimproved’ group. Of those not contacted directly, five were reported abstinent and without alcohol-related problems by referral agents and treatment staff, and were therefore allocated to the ‘improved’ category. A further two patients were categorized as ‘unimproved’, and no information was available for the remaining three patients. Taking the group as a whole, 45% of patients were categorized as having had a ‘good’ outcome (Table 5). Twenty (56%) day hospital detoxification patients were successfully re-interviewed. Eleven were placed in the ‘good’ outcome category, one was designated as ‘improved’ and nine patients were unimproved. Of those not re-interviewed in person, one was allocated as ‘improved’ and seven had returned to problematic drinking. One had died during the follow-up period and the remaining seven were untraceable. Taking the day hospital group as a whole, 31% were in the ‘good’ outcome category (Table 5). The relationships between treatment and outcome were calculated by amalgamating the ‘good’ and ‘improved’ groups together providing a dichotomous outcome category of ‘improved’ and ‘not improved’. Patients who had attended for treatment after the conclusion of detoxification had significantly superior outcomes (Fisher's Exact Test, P < 0.03; 2 × 2 contingency tables). A direct comparison with the period immediately prior to detoxification for subjects successfully interviewed at follow-up showed significant changes using paired t-tests (Table 6). There were significant reductions in weekly alcohol consumption, maximum daily consumption, SADQ, and APQ scores for both the home and hospital groups. DISCUSSION Both home and day detoxification provided safe and effective methods for withdrawing selected groups of patients from alcohol. Outcome at 10 days indicated high rates of completion and low rates of complications for both groups, which were similar to that reported for a home group (Stockwell et al., 1991) and also for an in-patient series (Metcalfe et al., 1995). Approximately half of the patients in both groups became involved in further treatment and this was associated with improved outcome at 60 days. Achieving a more sustained period of abstinence was much more difficult, as the outcome at 60 days indicated. By this point, 45% of the home group and 31% of the day hospital group were showing a ‘good’ outcome. When considering longer-term outcome, there is little value in direct comparisons with other studies, because of differing selection criteria, length of follow-up, type of treatment received, and measures of treatment outcome. However, the general indications are that, given the initial levels of treatment severity, outcome is similar to that reported for comparable studies (Stockwell et al., 1990; Bennie, 1998). In the past, researchers have adopted a conservative approach, particularly towards patients selected for out-patient detoxification, and, in particular, home detoxification. Patients typically have had histories of problem-free withdrawal, low levels of physical dependence and a carer willing to assist in detoxification. This in some ways has produced a paradoxical situation, as they require only minimal or even no help to detoxify. One of the original aims of this research was to examine the feasibility of treating a more severe group of drinkers than the target group described by Fleeman (1997), which is closer to current clinical practice (Stockwell et al., 1986). Our findings indicate that this has been achieved and that GPs were willing to refer more impaired and dependent drinkers. However, it should be noted that there are indications that the hospital sample contained a very severe group with very high rates of dependence, alcohol-related problems, and social instability. Caution must be exercised in interpreting the results from this study, because of the small numbers involved. However, there is now a growing body of evidence from this and other work that a wider range of patients can be safely and effectively detoxified outside an in-patient setting (Fleeman, 1997). What is lacking is a set of empirically based guidelines to aid decision-making about matching patients to particular types of detoxification services. In the absence of this, an unsystematic stepped care or treatment tiering approach is in operation, which is governed as much by the availability of resources as rational treatment planning (Breslin et al., 1997). An integrated service involving community links and hospital-based services may be a cost-effective and efficient way of dealing with a range of problems. Clearly there will still remain patients who will require in-patient care and who cannot be safely withdrawn from alcohol outside such a setting. The challenge is then to define the characteristics of these respective groups. Table 1. Sociodemographic indicators Indicator . Home group (%) . Day hospital group (%) . Married 35 37 Single 17 17 Separated 21 20 Divorced 10 23 Widowed 17 3 Employed 21 9 Unemployed 62 82 Retired/housewife 17 9 Mean age (years) (SD) 46.4 (12.2) 45.1 (9.8) Sex ratio (male/female) 2:1 2:1 Indicator . Home group (%) . Day hospital group (%) . Married 35 37 Single 17 17 Separated 21 20 Divorced 10 23 Widowed 17 3 Employed 21 9 Unemployed 62 82 Retired/housewife 17 9 Mean age (years) (SD) 46.4 (12.2) 45.1 (9.8) Sex ratio (male/female) 2:1 2:1 Open in new tab Table 1. Sociodemographic indicators Indicator . Home group (%) . Day hospital group (%) . Married 35 37 Single 17 17 Separated 21 20 Divorced 10 23 Widowed 17 3 Employed 21 9 Unemployed 62 82 Retired/housewife 17 9 Mean age (years) (SD) 46.4 (12.2) 45.1 (9.8) Sex ratio (male/female) 2:1 2:1 Indicator . Home group (%) . Day hospital group (%) . Married 35 37 Single 17 17 Separated 21 20 Divorced 10 23 Widowed 17 3 Employed 21 9 Unemployed 62 82 Retired/housewife 17 9 Mean age (years) (SD) 46.4 (12.2) 45.1 (9.8) Sex ratio (male/female) 2:1 2:1 Open in new tab Table 2. Comparison of subscale and total scores on the Severity of Alcohol Dependence Questionnaire for home and hospital groups Parameter . Home group (mean ± SD) . Day hospital group (mean ± SD) . t-test . Physical withdrawal 6.3 ± 3.1 7.5 ± 2.9 1.6 Affective symptoms 6.2 ± 3.4 6.6 ± 3.7 0.4 Relief drinking 7.8 ± 3.3 8.6 ± 4.0 0.9 Quantity drunk 6.5 ± 2.4 8.0 ± 2.2 2.6; P < 0.01 Reinstatement 7.4 ± 3.3 8.9 ± 3.1 1.8 Total score 34.4 ± 12.4 39.9 ± 11.9 1.8 Parameter . Home group (mean ± SD) . Day hospital group (mean ± SD) . t-test . Physical withdrawal 6.3 ± 3.1 7.5 ± 2.9 1.6 Affective symptoms 6.2 ± 3.4 6.6 ± 3.7 0.4 Relief drinking 7.8 ± 3.3 8.6 ± 4.0 0.9 Quantity drunk 6.5 ± 2.4 8.0 ± 2.2 2.6; P < 0.01 Reinstatement 7.4 ± 3.3 8.9 ± 3.1 1.8 Total score 34.4 ± 12.4 39.9 ± 11.9 1.8 Open in new tab Table 2. Comparison of subscale and total scores on the Severity of Alcohol Dependence Questionnaire for home and hospital groups Parameter . Home group (mean ± SD) . Day hospital group (mean ± SD) . t-test . Physical withdrawal 6.3 ± 3.1 7.5 ± 2.9 1.6 Affective symptoms 6.2 ± 3.4 6.6 ± 3.7 0.4 Relief drinking 7.8 ± 3.3 8.6 ± 4.0 0.9 Quantity drunk 6.5 ± 2.4 8.0 ± 2.2 2.6; P < 0.01 Reinstatement 7.4 ± 3.3 8.9 ± 3.1 1.8 Total score 34.4 ± 12.4 39.9 ± 11.9 1.8 Parameter . Home group (mean ± SD) . Day hospital group (mean ± SD) . t-test . Physical withdrawal 6.3 ± 3.1 7.5 ± 2.9 1.6 Affective symptoms 6.2 ± 3.4 6.6 ± 3.7 0.4 Relief drinking 7.8 ± 3.3 8.6 ± 4.0 0.9 Quantity drunk 6.5 ± 2.4 8.0 ± 2.2 2.6; P < 0.01 Reinstatement 7.4 ± 3.3 8.9 ± 3.1 1.8 Total score 34.4 ± 12.4 39.9 ± 11.9 1.8 Open in new tab Table 3. Comparison of subscale scores on the Alcohol Problems Questionnaire and the Social Disruption Scale Parameter . Home group . Day hospital group . t-test . General 9.3 12.5 3.1; P < 0.003 Partner 4.6 6.1 1.6 Children 2.4 3.9 2.4 Work 3.4 3.2 0.1 Total score 15.5 20.0 2.2; P < 0.03 Social disruption scale 3.2 5.0 2.1; P < 0.03 Parameter . Home group . Day hospital group . t-test . General 9.3 12.5 3.1; P < 0.003 Partner 4.6 6.1 1.6 Children 2.4 3.9 2.4 Work 3.4 3.2 0.1 Total score 15.5 20.0 2.2; P < 0.03 Social disruption scale 3.2 5.0 2.1; P < 0.03 Open in new tab Table 3. Comparison of subscale scores on the Alcohol Problems Questionnaire and the Social Disruption Scale Parameter . Home group . Day hospital group . t-test . General 9.3 12.5 3.1; P < 0.003 Partner 4.6 6.1 1.6 Children 2.4 3.9 2.4 Work 3.4 3.2 0.1 Total score 15.5 20.0 2.2; P < 0.03 Social disruption scale 3.2 5.0 2.1; P < 0.03 Parameter . Home group . Day hospital group . t-test . General 9.3 12.5 3.1; P < 0.003 Partner 4.6 6.1 1.6 Children 2.4 3.9 2.4 Work 3.4 3.2 0.1 Total score 15.5 20.0 2.2; P < 0.03 Social disruption scale 3.2 5.0 2.1; P < 0.03 Open in new tab Table 4. Ratings of treatment satisfaction scale 10 days after detoxification Parameter . Home group (mean ± SD) . Day hospital group (mean ± SD) . Community nurse/key worker support 7.9 ± 0.2 7.2 ± 1.5 Support for carer 7.1 ± 1.8 5.7 ± 1.7 Home/hospital environment 7.0 ± 1.4 7.0 ± 1.2 Drugs prescribed 6.8 ± 1.7 5.9 ± 2.0 Physical 6.8 ± 1.0 6.3 ± 1.9 GP/hospital support 6.8 ± 1.9 5.7 ± 2.5 Overall satisfaction 7.5 ± 0.6 6.8 ± 1.2 Parameter . Home group (mean ± SD) . Day hospital group (mean ± SD) . Community nurse/key worker support 7.9 ± 0.2 7.2 ± 1.5 Support for carer 7.1 ± 1.8 5.7 ± 1.7 Home/hospital environment 7.0 ± 1.4 7.0 ± 1.2 Drugs prescribed 6.8 ± 1.7 5.9 ± 2.0 Physical 6.8 ± 1.0 6.3 ± 1.9 GP/hospital support 6.8 ± 1.9 5.7 ± 2.5 Overall satisfaction 7.5 ± 0.6 6.8 ± 1.2 Open in new tab Table 4. Ratings of treatment satisfaction scale 10 days after detoxification Parameter . Home group (mean ± SD) . Day hospital group (mean ± SD) . Community nurse/key worker support 7.9 ± 0.2 7.2 ± 1.5 Support for carer 7.1 ± 1.8 5.7 ± 1.7 Home/hospital environment 7.0 ± 1.4 7.0 ± 1.2 Drugs prescribed 6.8 ± 1.7 5.9 ± 2.0 Physical 6.8 ± 1.0 6.3 ± 1.9 GP/hospital support 6.8 ± 1.9 5.7 ± 2.5 Overall satisfaction 7.5 ± 0.6 6.8 ± 1.2 Parameter . Home group (mean ± SD) . Day hospital group (mean ± SD) . Community nurse/key worker support 7.9 ± 0.2 7.2 ± 1.5 Support for carer 7.1 ± 1.8 5.7 ± 1.7 Home/hospital environment 7.0 ± 1.4 7.0 ± 1.2 Drugs prescribed 6.8 ± 1.7 5.9 ± 2.0 Physical 6.8 ± 1.0 6.3 ± 1.9 GP/hospital support 6.8 ± 1.9 5.7 ± 2.5 Overall satisfaction 7.5 ± 0.6 6.8 ± 1.2 Open in new tab Table 5. Outcome categories at 60 days Category . Home group n (%) . Day hospital group n (%) . Good 13 (45) 11 (31) Improved 5 (17) 1 (3) Unimproved 8 (28) 16 (44) Unknown 3 (10) 7 (19) Dead 0 1 (3) Category . Home group n (%) . Day hospital group n (%) . Good 13 (45) 11 (31) Improved 5 (17) 1 (3) Unimproved 8 (28) 16 (44) Unknown 3 (10) 7 (19) Dead 0 1 (3) Open in new tab Table 5. Outcome categories at 60 days Category . Home group n (%) . Day hospital group n (%) . Good 13 (45) 11 (31) Improved 5 (17) 1 (3) Unimproved 8 (28) 16 (44) Unknown 3 (10) 7 (19) Dead 0 1 (3) Category . Home group n (%) . Day hospital group n (%) . Good 13 (45) 11 (31) Improved 5 (17) 1 (3) Unimproved 8 (28) 16 (44) Unknown 3 (10) 7 (19) Dead 0 1 (3) Open in new tab Table 6. Drinking and alcohol-related problems at pre-detoxification (Pre-detox) and 60 days . Home group (n = 19) . Day hospital group (n = 20) . Measure . Pre-detox (mean ± SD) . 60 days (mean ± SD) . t/P (Sig) . Pre-detox (mean ± SD) . 60 days (mean ± SD) . t/P . aSee text for definition of a UK unit. Units in past weeka 180.3 ± 117.4 14.7 ± 34 5.36 196.9 ± 98.6 33.7 ± 63.5 8.1 P < 0.0001 P < 0.000 Maximum daily unitsa 30.8 ± 15.4 3.2 ± 6.5 6.64 36.3 ± 16.1 12.0 ± 19.3 5.0 P < 0.001 P < 0.001 Severity of dependence 35.5 ± 13.1 11.3 ± 14.2 4.36 41.3 ± 12.8 26.4 ± 23.8 3.1 P < 0.0001 P < 0.0006 Alcohol problems (general) 9.4 ± 3.1 1.8 ± 3.2 5.6 13.9 ± 4.3 5.2 ± 5.4 7.5 P < 0.0001 P < 0.0001 . Home group (n = 19) . Day hospital group (n = 20) . Measure . Pre-detox (mean ± SD) . 60 days (mean ± SD) . t/P (Sig) . Pre-detox (mean ± SD) . 60 days (mean ± SD) . t/P . aSee text for definition of a UK unit. Units in past weeka 180.3 ± 117.4 14.7 ± 34 5.36 196.9 ± 98.6 33.7 ± 63.5 8.1 P < 0.0001 P < 0.000 Maximum daily unitsa 30.8 ± 15.4 3.2 ± 6.5 6.64 36.3 ± 16.1 12.0 ± 19.3 5.0 P < 0.001 P < 0.001 Severity of dependence 35.5 ± 13.1 11.3 ± 14.2 4.36 41.3 ± 12.8 26.4 ± 23.8 3.1 P < 0.0001 P < 0.0006 Alcohol problems (general) 9.4 ± 3.1 1.8 ± 3.2 5.6 13.9 ± 4.3 5.2 ± 5.4 7.5 P < 0.0001 P < 0.0001 Open in new tab Table 6. Drinking and alcohol-related problems at pre-detoxification (Pre-detox) and 60 days . Home group (n = 19) . Day hospital group (n = 20) . Measure . Pre-detox (mean ± SD) . 60 days (mean ± SD) . t/P (Sig) . Pre-detox (mean ± SD) . 60 days (mean ± SD) . t/P . aSee text for definition of a UK unit. Units in past weeka 180.3 ± 117.4 14.7 ± 34 5.36 196.9 ± 98.6 33.7 ± 63.5 8.1 P < 0.0001 P < 0.000 Maximum daily unitsa 30.8 ± 15.4 3.2 ± 6.5 6.64 36.3 ± 16.1 12.0 ± 19.3 5.0 P < 0.001 P < 0.001 Severity of dependence 35.5 ± 13.1 11.3 ± 14.2 4.36 41.3 ± 12.8 26.4 ± 23.8 3.1 P < 0.0001 P < 0.0006 Alcohol problems (general) 9.4 ± 3.1 1.8 ± 3.2 5.6 13.9 ± 4.3 5.2 ± 5.4 7.5 P < 0.0001 P < 0.0001 . Home group (n = 19) . Day hospital group (n = 20) . Measure . Pre-detox (mean ± SD) . 60 days (mean ± SD) . t/P (Sig) . Pre-detox (mean ± SD) . 60 days (mean ± SD) . t/P . aSee text for definition of a UK unit. Units in past weeka 180.3 ± 117.4 14.7 ± 34 5.36 196.9 ± 98.6 33.7 ± 63.5 8.1 P < 0.0001 P < 0.000 Maximum daily unitsa 30.8 ± 15.4 3.2 ± 6.5 6.64 36.3 ± 16.1 12.0 ± 19.3 5.0 P < 0.001 P < 0.001 Severity of dependence 35.5 ± 13.1 11.3 ± 14.2 4.36 41.3 ± 12.8 26.4 ± 23.8 3.1 P < 0.0001 P < 0.0006 Alcohol problems (general) 9.4 ± 3.1 1.8 ± 3.2 5.6 13.9 ± 4.3 5.2 ± 5.4 7.5 P < 0.0001 P < 0.0001 Open in new tab * Author to whom correspondence should be addressed. This Project was financed by a Chief Scientist's Office — Scottish Home and Health Department research grant. REFERENCES Allan, C. ( 1991 ) Psychological symptoms, psychiatric disorder and alcohol dependence amongst men and women attending a community-based voluntary agency and an Alcohol Treatment Unit. British Journal of Addiction 86 , 419 –427. Bennie, C. ( 1998 ) A comparison of home detoxification and minimal intervention strategies for problem drinkers. Alcohol and Alcoholism 33 , 157 –163. Breslin, C. F., Sobell, M. 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Journal

Alcohol and AlcoholismOxford University Press

Published: Jan 1, 2000

References