Hayashida M, Alterman A I, McLellan A T, O'Brien C P, Purtill J J, Volpicelli J R, Raphaelson A H, Hall C P
Veterans Administration Medical Center, Philadelphia, PA 19104.
N Engl J Med. 1989 Feb 9;320(6):358-65. doi: 10.1056/NEJM198902093200605.
We compared the effectiveness, safety, and costs of outpatient (n = 87) and inpatient (n = 77) detoxification from alcohol in a randomized, prospective trial involving 164 male veterans of low socioeconomic status. The outpatients were evaluated medically and psychiatrically and then were prescribed decreasing doses of oxazepam on the basis of daily clinic visits. The inpatient program combined comprehensive psychiatric and medical evaluation, detoxification with oxazepam, and the initiation of rehabilitation treatment. The mean duration of treatment was significantly shorter for outpatients (6.5 days) than for inpatients (9.2 days). On the other hand, significantly more inpatients (95 percent) than outpatient (72 percent) completed detoxification. There were no serious medical complications in either group. Outcome evaluations completed at one and six months for 93 and 85 percent of the patients, respectively, showed substantial improvement in both groups at both follow-up periods. At one month there were fewer alcohol-related problems among inpatients and fewer medical problems among outpatients. However, no group differences were found at the six-month follow-up, nor were differences found in the subsequent use of other alcoholism-treatment services. Costs were substantially greater for inpatients ($3,319 to $3,665 per patient) than for outpatients ($175 to $388). We conclude that outpatient medical detoxification is an effective, safe, and low-cost treatment for patients with mid-to-moderate symptoms of alcohol withdrawal.
在一项涉及164名社会经济地位较低的男性退伍军人的随机前瞻性试验中，我们比较了门诊（n = 87）和住院（n = 77）酒精戒断治疗的有效性、安全性和成本。对门诊患者进行医学和精神科评估，然后根据每日门诊就诊情况为其开具逐渐减量的奥沙西泮。住院治疗方案包括全面的精神科和医学评估、奥沙西泮戒断治疗以及康复治疗的启动。门诊患者的平均治疗时长（6.5天）显著短于住院患者（9.2天）。另一方面，完成戒断治疗的住院患者（95%）明显多于门诊患者（72%）。两组均未出现严重的医学并发症。分别对93%和85%的患者在1个月和6个月时进行的结局评估显示，两组在两个随访期均有显著改善。1个月时，住院患者中与酒精相关的问题较少，门诊患者中的医学问题较少。然而，在6个月随访时未发现组间差异，在后续使用其他酒精成瘾治疗服务方面也未发现差异。住院患者的成本（每位患者3319美元至3665美元）大幅高于门诊患者（175美元至388美元）。我们得出结论，门诊药物戒断治疗对于有中度至重度酒精戒断症状的患者是一种有效、安全且低成本的治疗方法。
