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Article
Publication date: 7 January 2019

George Benson, Nicola Roberts, Jacqueline McCallum and Andrew McPherson

The purpose of this paper is to identify published literature from a general hospital setting that may highlight variables implicated in the development of severe alcohol…

Abstract

Purpose

The purpose of this paper is to identify published literature from a general hospital setting that may highlight variables implicated in the development of severe alcohol withdrawal syndrome (SAWS) in patients who have alcohol dependence syndrome (ADS).

Design/methodology/approach

A systematic literature review was carried out using the electronic databases: MEDLINE, Medline in Process, Cinahl, Embase and PsycINFO from 1989 to 2017. The focus of this search was on English language studies of individuals over 16 years admitted to general hospital with ADS, delirium tremens (DTs), alcohol-related seizure (ARS) or alcohol withdrawal syndrome (AWS).

Findings

Of the 205 studies screened, eight met the criteria for inclusion. Six studies were quantitative retrospective cohort and two were retrospective case-control. Six studies investigated risk factors associated with DTs, one examined SAWS and one alcohol kindling. Descriptive analysis was performed to summarise the empirical evidence from studies were 22 statistically significant risk factors were found; including the reason for admission to hospital, daily alcohol consumption, previous DTs and prior ARS. The last two factors mentioned appeared in two studies.

Research limitations/implications

Further research should consider the quality and completeness of the alcohol history data and competence of staff generating the data in retrospective studies.

Originality/value

The paper suggests that the factors linked to SAWS development from the literature may not fully explain why some individuals who have ADS develop SAWS, and others do not.

Details

Drugs and Alcohol Today, vol. 19 no. 4
Type: Research Article
ISSN: 1745-9265

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Article
Publication date: 6 July 2010

Liz Hughes

Abstract

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Advances in Dual Diagnosis, vol. 3 no. 2
Type: Research Article
ISSN: 1757-0972

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Article
Publication date: 18 June 2019

George Benson, Andrew McPherson, Jacqueline McCallum and Nicola Roberts

The purpose of this paper is to develop an alcohol withdrawal syndrome risk stratification tool that could support the safe discharge of low risk patients from the…

Abstract

Purpose

The purpose of this paper is to develop an alcohol withdrawal syndrome risk stratification tool that could support the safe discharge of low risk patients from the emergency department.

Design/methodology/approach

A retrospective cohort study that included all patients referred to the acute addiction liaison nursing service over one calendar month (n=400, 1–30 April 2016) was undertaken. Bivariate and multivariate modelling identified the significant variables that supported the prediction of severe alcohol withdrawal syndrome (SAWS) in the cohort population.

Findings

The Glasgow Modified Alcohol Withdrawal Scale (GMAWS), hours since last drink, fast alcohol screening test (FAST) and systolic blood pressure correctly identified 89 per cent of patients who developed SAWS and 84 per cent of patients that did not. Increasing each component by a score of one is associated with an increase in the odds of SAWS by a factor of 2.76 (95% CI 2.21, 3.45), 1.31 (95% CI 1.24, 1.37), 1.30 (95% CI 1.08, 1.57) and 1.22 (95% CI 1.10, 1.34), respectively.

Research limitations/implications

The research was conducted in a single healthcare system that had a high prevalence of alcohol dependence syndrome (ADS). Second, the developed risk stratification tool was unable to guarantee no risk and lastly, the FAST score previously aligned to severe ADS may have influenced the patients highest GMAWS score.

Practical implications

The tool could help redesign the care pathway for patients who attend the emergency department at risk of SAWS and link low risk patients with community alcohol services better equipped to deal with their physical and psychological needs short and long term supporting engagement, abstinence and prolongation of life.

Originality/value

The tool could help redesign the care pathway for emergency department patients at low risk of SAWS and link them with community alcohol services better equipped to deal with their physical and psychological needs, short and long term, supporting engagement, abstinence and prolongation of life.

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Abstract

Details

Drugs and Alcohol Today, vol. 2 no. 2
Type: Research Article
ISSN: 1745-9265

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Article
Publication date: 1 October 2001

John Foster, E. Marshall and T. Peters

Background: A consistent finding in alcohol research is that residential treatment gains tend to be cost inefficient and short‐lived. Yet this is often the only option…

Abstract

Background: A consistent finding in alcohol research is that residential treatment gains tend to be cost inefficient and short‐lived. Yet this is often the only option offered to alcohol‐dependent subjects who live alone, or who are entering into first time detoxification. Clinical implications: This paper outlines an extension of the services routinely provided by statutory services in the community, which would be community psychiatric nurse‐led. The prescribing responsibility should be with the specialist alcohol treatment agency. Suggestions are made to enhance the uptake of community services including measures to facilitate Alcoholics Anonymous (AA) attendance. Conclusion: Alcohol detoxification in the community is usually safe. If the recommendations are put into practice, a greater number of subjects could be treated in a community setting.

Details

Drugs and Alcohol Today, vol. 1 no. 1
Type: Research Article
ISSN: 1745-9265

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Article
Publication date: 15 February 2013

Annette T. Maruca and Desiree A. Diaz

Alcohol withdrawal syndrome (AWS) is a serious condition that can result in death if it is not recognized and treated appropriately. A high fidelity simulation scenario on…

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Abstract

Purpose

Alcohol withdrawal syndrome (AWS) is a serious condition that can result in death if it is not recognized and treated appropriately. A high fidelity simulation scenario on AWS was created for psychiatric nurses in an educational setting that focused on the recognition of alcohol withdrawal, implementation of the Clinical Institute Withdrawal Assessment (CIWA) and initiation of appropriate treatment and management of AWS.

Design/methodology/approach

A formative assessment teaching strategy was used to evaluate the development and implementation of a high fidelity simulation (HFS) on alcohol withdrawal syndrome. The HFS was part of a baccalaureate undergraduate psychiatric nursing education designed to reinforce classroom theory and clinical application. Results were measured using a self‐report survey completed by students that focused on the details of content and performance.

Findings

Feedback from the 38 nursing students who evaluated the HFS was overall positive. Survey results showed that the HFS scenario reinforced the classroom theory on addiction and mental disorders while translating and supporting student's learning to clinical practice. The HFS provided opportunity for students to practice skills when they had not had this experience during the clinical rotation. Only four students felt uncomfortable with decision making and initiating the CIWA scale after the HFS.

Originality/value

There is a gap in the development and use of standardized simulations for mental health and substance abuse scenarios as a teaching strategy in nursing programs. The results of this study supported using HFS as an educational strategy and set the stage for future complex simulations such as dual diagnosis and clients with comorbidities.

Details

Advances in Dual Diagnosis, vol. 6 no. 1
Type: Research Article
ISSN: 1757-0972

Keywords

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Article
Publication date: 1 October 2007

Alison

In this article Alison Cameron of Dual Recovery Anonymous talks about the complexity of dual diagnosis and tells the story of her experiences as a service user and her own…

Abstract

In this article Alison Cameron of Dual Recovery Anonymous talks about the complexity of dual diagnosis and tells the story of her experiences as a service user and her own journey of recovery.

Details

Drugs and Alcohol Today, vol. 7 no. 3
Type: Research Article
ISSN: 1745-9265

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Article
Publication date: 22 June 2009

Cheryl Simmill‐Binning, Ian Paylor and Alison Wilson

This article presents a review of the literature on alcohol and older people, noting that this subject has received very little research attention. In this short review…

Abstract

This article presents a review of the literature on alcohol and older people, noting that this subject has received very little research attention. In this short review, we offer a synopsis of the physical changes and health problems caused by alcohol use among older people. We then present a typology of drinking in later life, before discussing the findings and shortcomings of recent research knowledge. Reference is also made to the implications for alcohol policy, and solutions around training, health promotion and education are discussed.

Details

Drugs and Alcohol Today, vol. 9 no. 2
Type: Research Article
ISSN: 1745-9265

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Article
Publication date: 21 May 2010

Jeff Fernandez and Mark Jones

This paper examines a common presentation to primary care and specialist drug services. Often patients who are experiencing opioid dependencies when stabilising on…

Abstract

This paper examines a common presentation to primary care and specialist drug services. Often patients who are experiencing opioid dependencies when stabilising on methadone often increase their consumption of alcohol. Also, increasingly so, polydrug use is a growing presentation with heroin, crack and alcohol use used in dependent patterns when presenting for treatment.There is often a lack of alcohol detoxification treatment packages given to those who are on methadone, and often some prescribers in the area of substance use regard an alcohol detoxification programme when prescribing methadone as too risky. This has led to a reluctance in general to prescribe an alcohol detoxification programme for many patients who request it. This is the case in Islington, London.This paper looks at a new service set up in Islington, London and looks at the way it has treated the cohort of patients who have presented with polydrug use, including alcohol. It has seen that patients who were more stable on their methadone and had longer histories in treatment were more likely to complete an alcohol detoxification programme with some ‘dry’ time off alcohol. It proposes that while there is a risk of prescribing alcohol detoxification regimes with methadone, there is a cohort of patients were this can be prescribed with a favourable outcome.

Details

Drugs and Alcohol Today, vol. 10 no. 2
Type: Research Article
ISSN: 1745-9265

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Article
Publication date: 13 October 2020

Núria Riera-Oliver, Carmen Jiménez, Joan Rey, Ana Belén Calvo and Teresa Sanchez-Gutierrez

The use and abuse of alcohol is problematic for a person’s social and individual development. Maintenance of abstinence after detoxification programs is difficult for…

Abstract

Purpose

The use and abuse of alcohol is problematic for a person’s social and individual development. Maintenance of abstinence after detoxification programs is difficult for patients who experience a craving, and relapses during the course of the disorder are common. The purpose of this paper is to describe the socio-demographic and clinical features of alcohol-dependent patients by sex and alcohol use status and to analyze the percentage of patients who remained abstinent after 10 months of psychological treatment.

Design/methodology/approach

In total, 50 alcohol-dependent patients were enrolled (34 men and 16 women). The patients attended a psychological treatment program at a therapeutic community, Projecte Home Balears, Spain. This paper used the European Addiction Severity Index to collect socio-demographic data and data on alcohol and other drugs and the Trait Meta-Mood Scale-24 to measure emotional management.

Findings

Significant differences were observed in occupation (χ² = 9.9; p = 0.007) and duration of alcohol use (U = 137.000; p = 0.005) by sex and hospitalizations during the previous months (χ² = 15.477; p = 0.009) and type of chronic disorder (χ² = 7.6; p = 0.022) and duration (in months) of the longest period of abstinence after treatment in facilities (U = 219.500; p = 0.097) by alcohol use status. The survival analysis showed that 25% of relapses happened after 4.5 months of treatment; at 7.3 months, 50% of the sample remained abstinent.

Originality/value

Women had used alcohol for longer since age at onset than men. Furthermore, after 7.3 months of intensive therapy, 50% of alcohol-dependent patients were abstinent.

Details

Therapeutic Communities: The International Journal of Therapeutic Communities, vol. 41 no. 3/4
Type: Research Article
ISSN: 0964-1866

Keywords

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