Core Topics > Alcohol & Tobacco

Home detox to overcome alcohol addiction

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Chip:
Helping a patient through home alcohol detoxification has high patient satisfaction rates and is hugely rewarding for the GP.

The majority of dependent drinkers can detox safely and successfully at home and do not require hospital admission.

Daily review by a GP or nurse is important for at least the first four days.

Prescribing acamprosate, naltrexone or disulfiram is advised to maintain abstinence after detox but should only be used with ongoing support.

Ongoing psychosocial support is essential for recovery.

Go to https://www.nps.org.au/australian-prescriber/articles/home-detox-supporting-patients-to-overcome-alcohol-addiction

Alcohol is the most dangerous addictive drug in the world and kills 15 Australians every day. The harms related to alcohol dependence are undisputed, yet discussing alcohol consumption with patients still seems to be a difficult conversation.

One could argue that, as well as alcohol’s cultural acceptability, this is partly due to the lack of options in primary care for treating alcohol dependency.

Patients with alcohol dependency are often referred to over-burdened tertiary services, or are given a potentially dangerous prescription of diazepam without the support required for a safe detox process. GPs are well placed to offer a structured home alcohol detox service for their patients.

Home detox is the process of safely withdrawing a dependent drinker from alcohol without admission to an inpatient unit. A recent systematic review of 20 studies found that community detoxification was safe with high completion rates. It proved that detox in the community, as compared to an inpatient unit, had better drinking outcomes, good acceptability and was between 10.6 and 22.7 times cheaper.

It is often difficult for a patient to ask for help due to the cultural stigma around being branded an ‘alcoholic’. A non-judgemental approach and the use of motivational interviewing techniques are essential. Once you have built rapport, a thorough assessment can be undertaken.

Table - Possible diazepam regimen for home detox based on severity of alcohol dependence

Mild Moderate Severe Complicated Daily standard drinks 10–14 15–25 30–40 >50 SADQ score <16 16–30 >30 >30 plus medical problems Setting Home Home Inpatient services Inpatient services Suggested prescribing regimen – diazepam Day 1 Symptomatic –
5 mg 4 times a day and
5 mg when required 10 mg 4 times a day and 10 mg when required Day 2 5 mg 3 times a day 5 mg 4 times a day Day 3 5 mg twice a day 5 mg 3 times a day Day 4 5 mg at night 5 mg twice a day Day 5 5 mg at night 5 mg at night Day 6 5 mg at night

g:
@Chip not trying to step on your extremely well written post but the preferred medication for detoxing from alcohol is phenobarbital. here’s a great comparative study on its usage, now while this may be the preferred method in America it could be different elsewhere; however, phenobarbital is the way to go because it prevents seizures a lot more efficiently than diazepam. also, again not to step on any toes, but if you’re wanting to detox from alcohol or benzodiazepines please do it in a medical setting, it is extremely dangerous to do this at home.


use of phenobarbital in alcohol withdrawal management - a retrospective comparison study of phenobarbital and benzodiazepines for acute alcohol withdrawal management in general medical patients

Chip:
@g, that is most interesting but unfortunately it is not done in Australia.

Your advice is excellent but I have done 2 in-patient detoxes so I know the routine.

Yes, it's best done in a very supervised situation like a proper detox unit.

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