Social and clinical features as predictors of outcome in outpatient alcohol withdrawal

Objective:To identify patient features — both social and clinical — that may be associated with treatment failure in outpatient alcohol withdrawal. Design:A prospective observational cohort study of patients who underwent outpatient management of the alcohol withdrawal syndrome. Setting:Community hospital-based outpatient alcohol treatment program. Patients:The 179 patients who were eligible for and participated in a clinical trial of drug therapy for outpatient management of the alcohol withdrawal syndrome. Main results:Treatment failure occurred for 45% (80/179) of the patients. Failure rating did not vary according to diverse sociodemographic features such as age, level of education, income, medical insurance status, and marital status. Persons who were homeless did as well as those who were not. In contrast, two clinical features of withdrawal were associated with significantly higher rates of treatment failure: craving and withdrawal symptom severity. High cravers had a treatment failure rate of 56% (22/39), compared with 36% (41/115) for those with lower scores (p<0.03). Among those with moderate-to-high withdrawal symptom severity, 49% (74/151) represented treatment failures, compared with 22% (6/27) of those in the low-symptom group (p<0.01). Conclusions:While these data do not confirm that socially disadvantaged persons are at increased risk for withdrawal treatment failure, two clinical features — craving and withdrawal symptom severity — may help identify high-risk patients. Presented in part at the annual meeting of the Society of General Internal Medicine, April 27 – 29, 1988, Arlington, VA, and at the annual meeting of the Robert Wood Johnson Clinical scholars Program, October 2 – 5, 1988, Miami Lakes, FL. Supported in part by a grant from the Robert Wood Johnson Foundation.