Alcohol withdrawal syndrome: symptom-triggered versus fixed-schedule treatment in an outpatient setting.

AIMS: To investigate whether, in the treatment with chlordiazepoxide for outpatient alcohol withdrawal, there are advantages of symptom-triggered self-medication over a fixed-schedule regimen. METHODS: A randomized controlled trial in outpatient clinics for people suffering from alcohol dependence (AD) and alcohol-related problems; 165 adult patients in an outpatient setting in a specialized alcohol treatment unit were randomized 1:1 to either a symptom-triggered self-medication or tapered dose, using chlordiazepoxide. Alcohol withdrawal symptoms, amount of medication, duration of symptoms, time to relapse and patient satisfaction were measured. Patients assessed their symptoms using the Short Alcohol Withdrawal Scale (SAWS). Patient satisfaction was monitored by the Diabetes Treatment Satisfaction Questionnaire. We used the Well-Being Index and the European addiction severity index for the 1-year follow-up. RESULTS: We found no differences in the quantity of medication consumed, time to relapse, well being or treatment satisfaction. CONCLUSION: Symptom-triggered self-medication was as safe as fixed-schedule medication in treating outpatients with AD and mild to moderate symptoms of AWS. The SAWS is a powerful monitoring tool, because it is brief and permits the subject to log the withdrawal symptoms.

A psychometric validation of the Short Alcohol Withdrawal Scale (SAWS).

AIMS: The study aimed to evaluate psychometrically a Danish translation of the Short Alcohol Withdrawal Scale (SAWS) in an outpatient setting in patients with Alcohol Dependence (AD) and Alcohol Withdrawal Symptoms/Syndrome (AWS). METHODS: One hundred and twenty-two patients with AD and AWS filled in a 10-item rating scale to describe their symptoms with four graduations on five physical and five psychological items. The question of dimensionality of the construct was addressed in three different ways. First, a scree plot was constructed based on the polychoric correlations between items. Second, promax factor loadings were calculated for a two-factor model. These two steps were based on exploratory factor analysis. Third, specific violations such as local dependence and differential item functioning were investigated under the one-factor model in a confirmatory factor analysis. RESULTS: The scree plot supported one or two dimensions while the promax rotations gave little support for a two-factor model. The confirmatory analysis also supported a one-factor model. CONCLUSION: The decomposition of the polychoric correlation matrix into eigenvalues and vectors suggested that there was most likely one factor underlying the 10 items in the SAWS. This was confirmed by a confirmative factor analysis with only one component when specific model violations such as local dependence and differential item findings were investigated. The SAWS is easy to use.

The Gotland Male Depression Scale: a validity study in patients with alcohol use disorder.

The Gotland Male Depression Scale has been developed to improve the recognition of major depression in males. The Gotland Male Depression Scale was compared to the Major Depression Inventory in a population of male patients treated for alcohol dependency at the Alcohol Outpatients Clinic of Copenhagen University Hospital. The prevalence of depression as well as the prescription of antidepressants were used as indices of validation. The Gotland Male Depression Scale was shown to have an adequate internal validity. The prevalence of depression according to the Major Depression Inventory was 17% and according to the Gotland Male Depression Scale 39% of the patients had a probable or definite depression and should be considered for treatment with antidepressants. The Gotland Depression Subscale was found to be better than the Gotland Distress Subscale at discriminating between patients treated and not treated with antidepressants.

[Substance abuse by health personnel]. / Misbrugende sundhedspersonale.

This paper is a review of the literature on health professionals with substance abuse and it deals with the epidemiology, treatment, and results. A similar study has been carried out on health professionals in Denmark. Very few data are available for this group. The prevalence of substance abuse in health personnel seems to be equal to that in the general population, and from these data it is estimated that 3300 doctors/nurses in Denmark have an active alcohol abuse whereas the prevalence of other drug abuse is not known. The National Board of Health receives 150 new cases a year, in which decisions about specific treatment are made. Not all these cases are about substance abuse. Today, no organised treatment is on offer to health personnel with substance abuse, and they are forced to find their own. Results from abroad indicate that treatment with some degree of monitoring gives better results for health personnel than no monitoring, perhaps because of the risk of losing their authorisation, which is the penalty in this group, if substance abuse continues. From the results of a Danish study, the treatment in Greater Copenhagen seems less effective than the treatment given abroad. It is, therefore, recommended that the treatment of health personnel should be centralised in three or four places in Denmark, each with capacity for 30 outpatients. It is furthermore recommended that inpatient treatment of health personnel in work, which, generally speaking will be that needed in connection with detoxification, takes place in departments with a special interest in treating this kind of patient. Inpatient treatment is furthermore recommended for patients with psychiatric or somatic co-morbidity in addition to the substance abuse, or where repeated attempts at outpatient treatment have been unsuccessful. The estimated need is the possibility of admittance to two psychiatric beds per centre. Lastly, it is recommended that structured treatment in this group of patients should be established in close co-operation with the unions for advisory or legal assistance in the case of early retirement or change of job.