Home based or outpatient alcohol withdrawal management is an area of medicine shrouded in mystery and confusion. It occurs quite often but usually in a haphazard and disorganised manner. The results of poor management of alcohol withdrawal can be dire and lead to complications such as delirum tremens, Wernicke's encephalopathy and other harms.
Home based or outpatient alcohol withdrawal management is a safe intervention when carried out in the right environment, with the right patient, the right protocols and the right safeguards in place.
Right environment A safe drug free environment is paramount with a place for safe storage of medications. It is also important that the patient is not geographically isolated and has access to a mobile phone and is able to make and receive calls on this mobile phone.
Right patient The patient should be over the age of 18 and be judged to only have mild to moderate alcohol dependency. The patient should be able to provide informed consent and be able to adequately follow medical instructions. Alcohol should be the only substance use disorder present and the patient should not be using any other substances as this might complicate withdrawal management and a patient using multiple substances might be better served with a residential withdrawal management admission. The patient should not have serious or significant medical or psychiatric comorbidities and no history of complex withdrawals.
Right protocols Usually a fixed dose regimen for diazepam is used for home based alcohol withdrawal management. Turning Point's Alcohol and Drug Withdrawal Guidelines provide a good template upon which to fashion home based withdrawal management. It is important that prior to commencing home based withdrawal management that both doctor and patient are clearly aware of the protocols and medication dosing regimen and the regularity of follow up-this might best be outlined in a written plan. If a complication arises or there are concerns it is important for the doctor to know where to seek help and liaising with your local Addiction Medicine service or specialist may be useful. Safety must be the foremost consideration and daily review and daily pick up of medications in a staggered manner is recommended.
Right safeguards As mentioned in an earlier section it is important that the patient is not geographically isolated and has access to a working phone. It is important that the patient is linked in with a general practitioner and that they can access this general practitioner daily and contact them freely. It is paramount that the patient not live alone and has a support person with them in the house whilst withdrawal management is occurring.
Author: Dr Thileepan Naren MBBS FACRRM FRACGP
Thileepan is an Addiction Medicine Advanced Trainee and experienced general practitioner with a demonstrated history of working with disadvantaged and marginalized groups.