Detoxification protocols and withdrawal scales

1. CLINICAL CONDITION TO WHICH THE PROTOCOL APPLIES

Medication as described in this protocol is for use in planned community alcohol detoxification of patients who are under the care of the specialist team consultant.

The inclusion criteria are a diagnosis of alcohol dependence syndrome and a pre-detoxification assessment which supports the indication of community alcohol detoxification on clinical grounds.

Exclusion criteria for treatment under the protocol are:

A: Chlordiazepoxide specific exclusion criteria

• A history of respiratory depression or acute pulmonary insufficiency.
• Severe hepatic impairment.
• Sleep apnoea syndrome.
• Myaestenia Gravis.
• Concurrent pregnancy or breast feeding.
• Concomitant prescription of medication other than described in this protocol.
• Concomitant use of illicit substances or any CNS depressant drug (including alcohol) during detoxification.

B: General exclusion criteria

• Inadequate degree of social support (a responsible adult will need to be present on a 24 hour basis with the client for the duration of the detoxification).
• A history of repeated failure to complete community detoxification.
• Severe concurrent medical or psychiatric illness, or potential for detoxification-induced relapse of such illness.
• A history of Delirium Tremens or alcohol withdrawal fits.
• Concurrent suicidal risk.
• Cognitive deficits.

The consultant should be contacted to advise on an appropriate alcohol detoxification regime if any of these exclusion criteria are present.

Patients will be fully assessed by their key-worker / carecoordinator in the Community Drug and Alcohol Team (CDAT) before community detoxification. Patients not wishing to receive chlordiazepoxide, or other medications named in this protocol, will be offered alternative means of planned detoxification if this is clinically feasible.The consultant should be contacted in case of patients refusing to comply with care as stated in the protocol after detoxification has commenced.

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Alcohol Guidelines index

The above information is copyright of Dr Bruce Trathen MBBS MRCPsych (2006). ISBN 0-9545164-0-0. The author grants permission for these guidelines to be downloaded, copied and distributed freely, but does not grant permission for their sale.