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Abstract
Patients with polysubstance dependence and co-occurring psychiatric and substance use disorders represent a growing population. This study investigates the safety and effectiveness of a single-scale, symptom-triggered protocol for patients undergoing inpatient detoxification from alcohol, opioids, sedatives, or polysubstance dependence. Medical records staff generated a list of all charts containing a principal discharge diagnosis of alcohol, sedative, opioid, or polysubstance dependence between 2002 and 2004, when the Butler Instrument for Withdrawal Assessment protocol was administered. This list was arranged by terminal digits of the medical record numbers to randomize the selection, and staff pulled the first 100 charts for review. De-identified medical data were recorded from the charts to obtain information about medications, length of stay, and adverse events during hospitalization. The main outcome measures were adverse events and length of stay. The average length of stay was 4.2 days (SD = 2.3), rate of discharge against medical advice was 4% (exactly 4 patients out of 100), and no seizures or delirium tremens were reported. The results of this study suggest that a single-scale, symptom-triggered detoxification protocol can facilitate safe and rapid detoxification and stabilization, even for patients with polysubstance dependence and co-occurring psychiatric and substance use disorders.
The authors wish to thank Daria Heslin, RNC, LCDP, for originally conceiving of the BIWA protocol and for overseeing its development and implementation at the hospital. They also wish to acknowledge the following individuals who were involved in the BIWA's development: Sheila Zangwill, RN, LCDP; Henry D. Abraham, MD; Mary Ella Dubreuil, RN, LCDP; Alan Gordon, MD; and Michael Fiori, MD.