Moore David Thomas, Fuehrlein Brian Scott, Rosenheck Robert Alan
Department of Psychiatry, Yale University, New Haven, Connecticut, 06511.
VA Connecticut Healthcare System, West Haven, Connecticut, 06516.
Am J Addict. 2017 Oct;26(7):722-730. doi: 10.1111/ajad.12603. Epub 2017 Aug 24.
Alcohol withdrawal-especially delirium tremens (DT)-is a potentially life-threatening condition. While short-term treatment regimens and factors that predispose to more severe symptomatology have been extensively studied, little attention has been paid to the clinical epidemiology and long-term care of the chronic medical, addictive, psychiatric, and psychosocial problems faced by these patients.
National Veterans Health Administration data from fiscal year 2012 were examined to identify veterans diagnosed with DT; with withdrawal but not DT (WNDT); and with Alcohol Use Disorder (AUD) but neither DT nor WNDT. They were compared on sociodemographic characteristics, psychiatric and medical co-morbidities, and health service and psychotropic medication use, first with bivariate analyses and then multiple logistic regression.
Among the 345,297 veterans diagnosed with AUD, 2,341 (0.7%) were diagnosed with DT and 6,738 (2.0%) with WNDT. Veterans diagnosed with either WNDT or DT were more likely to have been homeless, had more comorbid medical and psychiatric disorders, were more likely to be diagnosed with drug use disorders, utilized more health services, received more psychotropic medications, and were more likely to receive naltrexone. They were more likely to receive specialized legal, housing, vocational, and psychosocial rehabilitation services, as well as intensive case management.
Adults with WNDT and DT suffer from multiple chronic conditions and long-term service models are needed to coordinate the work of multiple specialists and to assure continuity of care.
This national study identifies sociodemographic characteristics, comorbidities, and service utilization patterns associated with WNDT and DT.(Am J Addict 2017;26:722-730).
酒精戒断——尤其是震颤谵妄（DT）——是一种潜在的危及生命的状况。虽然短期治疗方案以及易引发更严重症状的因素已得到广泛研究，但对于这些患者所面临的慢性医学、成瘾、精神及心理社会问题的临床流行病学和长期护理却鲜有关注。
对2012财年美国退伍军人健康管理局的全国数据进行检查，以确定被诊断为DT的退伍军人；有戒断症状但未患DT（WNDT）的退伍军人；以及患有酒精使用障碍（AUD）但既未患DT也未患WNDT的退伍军人。首先通过双变量分析，然后进行多因素逻辑回归，对他们在社会人口学特征、精神和医学共病情况以及卫生服务和精神药物使用方面进行比较。
在345,297名被诊断为AUD的退伍军人中，2341人（0.7%）被诊断为DT，6738人（2.0%）被诊断为WNDT。被诊断为WNDT或DT的退伍军人更有可能曾无家可归，有更多的医学和精神共病，更有可能被诊断为药物使用障碍，使用更多的卫生服务，接受更多的精神药物治疗，并且更有可能接受纳曲酮治疗。他们更有可能接受专门的法律、住房、职业和心理社会康复服务，以及强化个案管理。
患有WNDT和DT的成年人患有多种慢性病，需要长期服务模式来协调多名专科医生的工作，并确保护理的连续性。
这项全国性研究确定了与WNDT和DT相关的社会人口学特征、共病情况以及服务利用模式。（《美国成瘾杂志》2017年；26:722 - 730）
