Outpatient Alcohol Withdrawal Management in a Substance Use Disorder Bridge Clinic: An Opportunity for Low-barrier Engagement and Shared Decision-making.

Abstract

Objective: To describe the implementation of outpatient alcohol withdrawal management in a low-barrier substance use disorder (SUD) bridge clinic and short-term clinical outcomes.

Methods: A bridge clinic in Boston, MA implemented outpatient benzodiazepine tapers for alcohol withdrawal in patients at low risk of alcohol withdrawal seizures or delirium tremens. We conducted a retrospective chart review of patients who received one or more benzodiazepine doses between April 2021 and January 2023. We described patient characteristics and evaluated rates of taper completion, clinical complications, and medication for alcohol use disorder (AUD) initiation.

Results: Forty-six patients with alcohol withdrawal were treated during the study period. Their mean age was 43 years and the majority identified as male (76%); ∼30% were Black/African American and 30% Hispanic/Latinx, and 24% spoke a primary language other than English. Most had severe AUD (76%), and 30% had a history of complicated withdrawal, counter to typical clinical eligibility criteria. Over a third of patients (19/46, 41.6%) completed their planned withdrawal treatment course, 18 (39.1%) patients did not follow up in the bridge clinic within the first 3 days, and 1 (2%) experienced a documented seizure during treatment. Twenty-four patients (52%) initiated medication for AUD.

Conclusion: Outpatient alcohol withdrawal management in a bridge clinic provides an opportunity to engage patients from marginalized groups, including those at higher risk for complicated alcohol withdrawal who decline inpatient care. More work is needed to improve patient follow-up and assess treatment outcomes.