Community detoxification for alcohol dependence: A systematic review

Abstract

Although the current evidence base to some extent supports the case for community detoxification there is a need for more randomised controlled trials testing the cost effectiveness of community detoxification in comparison with inpatient detoxification. [Nadkarni A, Endsley P, Bhatia U, Fuhr DC, Noorani A, Naik A, Murthy P, Velleman R. Community detoxification for alcohol dependence: A systematic review Drug Alcohol Rev 2017;36:389-399].

Home-detoxification and relapse prevention for alcohol dependence in low resource settings: An exploratory study from Goa, India

“…The detoxification process was largely clinically uneventful, patients and their carers adhered to the protocol, and there were no serious adverse events resulting directly from the detoxification. This is consistent with findings reported in other studies (Nadkarni et al, 2017a). The impact of home detoxification has been examined using a range of study designs.…”

“…Such a program, based on the principle of collaborative care, overcomes challenges related to accessibility and acceptability of treatment, that are often found in low resource settings (Nadkarni & Bhatia, 2019;Wright et al, 2018). However, there is no robust evidence about the acceptability, feasibility and effectiveness of community-based detoxification in lowand middle-income countries (LMICs) (Nadkarni et al, 2017a).…”

“…Home-based detoxification has several potential benefits for low resource settings-continued routine life and social ties, detoxification within a familiar setting, with family support, continuation of work, support to family members, and less stigma (Fleeman, 1997). Finally, there is evidence from HICs that community detoxification as outlined above (fixed dose medication regimens, a carer overseeing the process, daily monitoring by trained staff, and psychosocial support) can be delivered by well-trained non-specialist health workers (Nadkarni et al, 2017a), and that well-trained non-specialist health workers can be recruited and utilised effectively within LMICs to undertake a range of health-and psychosocial-related tasks (Nadkarni et al, 2017b;van Ginneken et al, 2013).…”

“…This paper describes the case series, one of the phases of the intervention development process, which aimed to demonstrate the acceptability, feasibility, and safety of the CONTAD package of care for alcohol dependence. The package of care was developed through a rigorous process developed in the study setting (Nadkarni et al, 2014) and included a) a systematic review to identify evidence-based components for the home-detoxification intervention (Nadkarni et al, 2017a), b) utilisation of a systematic review conducted in a different study which developed an intervention for harmful drinkers in the same setting (Nadkarni et al, 2015), c) qualitative interviews with patients with alcohol dependence, their family members, and clinicians, and d) intervention development workshops at two de-addiction centres of excellence in India.…”

Update on the management of alcohol use disorders

“…Although many patients can be successfully withdrawn from alcohol in community settings (Nadkarni 2017), withdrawal is best undertaken as part of a planned treatment package based on local protocols with good monitoring and support, to minimise risks and optimise treatment outcomes. Unplanned medically assisted withdrawal for patients presenting in crisis is not advised in the community (NICE 2011).…”