Soravia Leila M, Wopfner Alexander, Pfiffner Luzius, Bétrisey Sophie, Moggi Franz
University Hospital of Psychiatry, University of Bern, Switzerland.
Suedhang Clinic, Center for Treatment of Addictive Disorders, Suedhang 1, 3038 Kirchlindach, Switzerland.
Alcohol Alcohol. 2018 Jan 1;53(1):71-77. doi: 10.1093/alcalc/agx080.
As there are only a few existing experimental studies on symptom-triggered therapy for patients with alcohol withdrawal, we investigated the effectiveness of symptom-triggered detoxification regarding the use and dosage of benzodiazepine and withdrawal complications in a naturalistic clinical setting of a specialized treatment center for alcohol use disorder.
In total, 301 charts of patients who entered residential treatment for alcohol withdrawal were included in the retrospective analysis. Charts of 176 patients treated with the Alcohol Withdrawal-Scale (AWS) were compared to the charts of 125 patients treated with treatment as usual (TAU) before the implementation of AWS. Sociodemographical and clinical variables, previous detoxifications and complications, duration of treatment, use and dose of benzodiazepine and other withdrawal medication, complications and premature discontinuation of treatment were abstracted from the patients' medical records.
The two groups did not differ in any demographical or clinical variables measured upon treatment admission. The total percentage of patients being treated with benzodiazepines during detoxification decreased from 78.4 to 38.6% after the implementation of the AWS. The implementation of the AWS significantly reduced the duration of the acute detoxification from 136 to 66 h, and the use, duration and dose of benzodiazepine by nearly two-thirds while complications and treatment discontinuation remained unvaryingly. Healthcare costs for detoxification were reduced by half per patient.
The findings indicate that symptom-triggered treatment for alcohol withdrawal is safe and effective in a naturalistic clinical setting and significantly reduces healthcare costs and the risk for overmedicating patients.
由于关于酒精戒断患者症状触发疗法的现有实验研究较少，我们在一家酒精使用障碍专科治疗中心的自然临床环境中，研究了症状触发脱毒在苯二氮䓬使用和剂量以及戒断并发症方面的有效性。
总共301例进入住院酒精戒断治疗的患者病历纳入回顾性分析。将176例使用酒精戒断量表（AWS）治疗的患者病历与AWS实施前125例接受常规治疗（TAU）的患者病历进行比较。从患者病历中提取社会人口统计学和临床变量、既往脱毒情况和并发症、治疗持续时间、苯二氮䓬和其他戒断药物的使用及剂量、并发症和治疗提前终止情况。
两组在治疗入院时测量的任何人口统计学或临床变量上均无差异。AWS实施后，脱毒期间接受苯二氮䓬治疗的患者总百分比从78.4%降至38.6%。AWS的实施显著缩短了急性脱毒的持续时间，从136小时降至66小时，苯二氮䓬的使用、持续时间和剂量减少了近三分之二，而并发症和治疗中断情况保持不变。每位患者的脱毒医疗费用降低了一半。
研究结果表明，在自然临床环境中，酒精戒断的症状触发治疗是安全有效的，可显著降低医疗成本和患者用药过量的风险。
