CONTENTS

About This Course

Table of Contents

1. Introduction to the Issues
2. Understanding Alcohol Abuse
3. Understanding Violence Against Women
4. Alcohol and Domestic Violence
5. Alcohol, Sexual Assault, and Rape
6. Prevention and Early Intervention
7. Screening and Assessment
8. Diagnosis and Treatment
9. Legal and Ethical Issues

Supplements
Fact Sheets
Videos
Resources

Silence Hurts
Alcohol Abuse and Violence Against Women

Inpatient/Outpatient Detoxification Treatment

When detoxification is necessary, the clinician must decide whether to hospitalize the patient or manage the case on an outpatient basis. For a younger woman, detoxification follows a well researched and standardized procedure.

No studies or reports specifically assess the potential risks or benefits of outpatient detoxification among older adults. However, detoxification is generally seen as medically riskier for an older person. Until more research is available, best clinical judgment must guide such decisions. For more information on detoxification, see TIP 19, Detoxification From Alcohol and Other Drugs.

It is important to consider medical safety and potential access to the abused drugs. Factors indicating the need for inpatient detoxification include:

• A high potential for developing dangerous abstinence symptoms such as a seizure or delirium. This can happen if the dosage of alcohol or drug has been particularly high or prolonged and has been discontinued abruptly. It also can happen in patients who have experienced these serious symptoms at any time.
• Suicidal ideation or threats.
• The presence of other major psychopathology.
• Unstable or uncontrolled comorbid medical conditions requiring 24-hour care or parenterally administered medications (e.g., kidney disease, diabetes).
• Mixed addictions (e.g., alcohol, sedative-hypnotic drugs).
• A lack of social support at home or living alone with continued access to the abused substances.
• A failure to respond to outpatient treatment.¹

The clinician overseeing detoxification from alcohol or prescription drugs must decide on the level of care necessary to maintain abstinence. Patients with high relapse or withdrawal potential and patients with severe medical or psychiatric comorbidity will require hospitalization. Regular monitoring of the patient's vital signs and objective symptoms of withdrawal also is needed.

Short-acting benzodiazepines (e.g., oxazepam [Serax], lorazepam [Ativan]) are customarily used as detoxification agents because alcohol-addicted patients are cross-tolerant to these substances. The use of oxazepam or lorazepam is warranted in patients with severe liver disease. Metabolism of these benzodiazepines does not depend on hydroxylation by the liver. Thus, they do not accumulate in the liver and cause adverse effects.²

The benzodiazepine dosage is decreased daily over the course of the detoxification process. Medications should be used more cautiouslywith older women thanwith younger patients.

In general, older patients require lower doses of many medications. The principle of starting at a lower dose and titrating at a slower rate should be followed for detoxification. In addition to treating acute withdrawal symptoms, clinicians need to ensure that alcoholic patients take supplemental doses of thiamin, folate, and multivitamins. Such supplements counteract the vitamin depletion often associated with excessive alcohol use.

References

1. Finlayson, R.E. (1995). Misuse of prescription drugs. International Journal of the Addictions, 30(13-14), 1871-1901.
2. Brower, K.J., Mudd, S., Blow, F.C., Young, J.P., and Hill, E.M. (1994). Severity and treatment of alcohol withdrawal in elderly versus younger patients. Alcoholism: Clinical and Experimental Research, 18(1), 196-201.