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Hoffman R. Is it time to reconsider the medical use of ethanol in patients with alcohol use disorder? Clin Toxicol (Phila) 2024; 62:409-411. [PMID: 39034847 DOI: 10.1080/15563650.2024.2377886] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/23/2024]
Affiliation(s)
- Robert Hoffman
- Clinical Toxicology Division of Medical Toxicology, Ronald O. Perelman Department of Emergency Medicine, NYU Grossman School of Medicine, New York, NY, USA
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Parappilly BP, Garrod E, Longoz R, Eligh E, van Heukelom H, Fairgrieve CK, Pauly B. Exploring the experience of inpatients with severe alcohol use disorder on a managed alcohol program (MAP) at St. Paul's Hospital. Harm Reduct J 2020; 17:28. [PMID: 32398062 PMCID: PMC7216705 DOI: 10.1186/s12954-020-00371-6] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2020] [Accepted: 04/28/2020] [Indexed: 11/15/2022] Open
Abstract
Background Managed alcohol programs are a harm reduction approach for people with severe alcohol use disorder that provide alcohol in a structured setting. We examined the patient experience of receiving alcohol after the implementation of a hospital-based managed alcohol program. Methods Using an interpretative descriptive methodology, we conducted interviews with five patients. The criteria for enrollment included continuation of community managed alcohol program or provision of alcohol for stabilization in hospital and ability to provide consent. Results Five themes emerged in the analysis: (1) Reasons for alcohol use highlighting factors leading to alcohol consumption; (2) I’m very appreciative indicating participant’s perception of hospital-based managed alcohol program; (3) From just vibrating to calm and It’s kinda like a pacifier for me recognizing the impact of hospital-based managed alcohol program on managing withdrawal and on psychological health; (4) I have no need to go anywhere at all demonstrating engagement in healthcare; and (5) Might be nice to have a selection for other people indicating the need for a broader selection of alcohol. Conclusions This study helped to explore the effectiveness of a hospital-based managed alcohol program as experienced by the patients. Overall, participants had a positive experience on hospital-based managed alcohol program. Their perceptions can be used to inform implementation of managed alcohol programs in other hospital settings.
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Affiliation(s)
- Beena P Parappilly
- Acute Medicine Program, Providence Health Care, St. Paul's Hospital, 1081 Burrard Street, Vancouver, BC, V6Z 1Y6, Canada.
| | - Emma Garrod
- Urban Health Program, St. Paul's Hospital, 1081 Burrard Street, Vancouver, BC, V6Z 1Y6, Canada
| | - Ryan Longoz
- Acute Medicine Program, Providence Health Care, St. Paul's Hospital, 1081 Burrard Street, Vancouver, BC, V6Z 1Y6, Canada
| | - Eric Eligh
- Urban Health Program, St. Paul's Hospital, 1081 Burrard Street, Vancouver, BC, V6Z 1Y6, Canada
| | - Holly van Heukelom
- Acute Medicine Program, Providence Health Care, St. Paul's Hospital, 1081 Burrard Street, Vancouver, BC, V6Z 1Y6, Canada
| | | | - Bernadette Pauly
- School of Nursing, University of Victoria, Scientist, Canadian Institute for Substance Use Research, University of Victoria, Box 1700 STN SCS, Victoria, BC, Canada
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Brooks HL, Kassam S, Salvalaggio G, Hyshka E. Implementing managed alcohol programs in hospital settings: A review of academic and grey literature. Drug Alcohol Rev 2018; 37 Suppl 1:S145-S155. [DOI: 10.1111/dar.12659] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2017] [Revised: 12/06/2017] [Accepted: 12/13/2017] [Indexed: 11/27/2022]
Affiliation(s)
- Hannah L. Brooks
- Inner City Health and Wellness Program; Royal Alexandra Hospital; Edmonton Canada
- School of Public Health; University of Alberta; Edmonton Canada
| | - Shehzad Kassam
- Inner City Health and Wellness Program; Royal Alexandra Hospital; Edmonton Canada
- Faculty of Medicine and Dentistry; University of Alberta; Edmonton Canada
| | - Ginetta Salvalaggio
- Inner City Health and Wellness Program; Royal Alexandra Hospital; Edmonton Canada
- Department of Family Medicine; University of Alberta; Edmonton Canada
| | - Elaine Hyshka
- Inner City Health and Wellness Program; Royal Alexandra Hospital; Edmonton Canada
- School of Public Health; University of Alberta; Edmonton Canada
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Gordon AJ, Olstein J, Conigliaro J. Identification and treatment of alcohol use disorders in the perioperative period. Postgrad Med 2015; 119:46-55. [PMID: 16961052 DOI: 10.3810/pgm.2006.07.1743] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
Patients with alcohol use disorders who undergo surgery face added risks and longer recovery time. Identification of such patients may reduce these risks, allow physicians to increase awareness of surgical requirements, and minimize postoperative complications. This article defines the alcohol problems encountered, describes preoperative screening tests and treatments, and discusses postoperative assessment and management of complications such as alcohol withdrawal syndrome.
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Affiliation(s)
- Adam J Gordon
- University of Pittsburgh School of Medicine, Center for Health Equity Research and Promotion, Pennsylvania 15240, USA.
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Makdissi R, Stewart SH. Care for hospitalized patients with unhealthy alcohol use: a narrative review. Addict Sci Clin Pract 2013; 8:11. [PMID: 23738519 PMCID: PMC3679958 DOI: 10.1186/1940-0640-8-11] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2012] [Accepted: 05/24/2013] [Indexed: 12/31/2022] Open
Abstract
There is increasing emphasis on screening, brief intervention, and referral to treatment (SBIRT) for unhealthy alcohol use in the general hospital, as highlighted by new Joint Commission recommendations on SBIRT. However, the evidence supporting this approach is not as robust relative to primary care settings. This review is targeted to hospital-based clinicians and administrators who are responsible for generally ensuring the provision of high quality care to patients presenting with a myriad of conditions, one of which is unhealthy alcohol use. The review summarizes the major issues involved in caring for patients with unhealthy alcohol use in the general hospital setting, including prevalence, detection, assessment of severity, reduction in drinking with brief intervention, common acute management scenarios for heavy drinkers, and discharge planning. The review concludes with consideration of Joint Commission recommendations on SBIRT for unhealthy alcohol use, integration of these recommendations into hospital work flows, and directions for future research.
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Affiliation(s)
- Regina Makdissi
- Division of General Internal Medicine, University at Buffalo State University of New York, Buffalo, NY, USA
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Abstract
This article reviews the pathophysiology, diagnosis, and treatment of alcohol withdrawal syndromes in the intensive care unit as well as the literature on the optimal pharmacologic strategies for treatment of alcohol withdrawal syndromes in the critically ill. Treatment of alcohol withdrawal in the intensive care unit mirrors that of the general acute care wards and detoxification centers. In addition to adequate supportive care, benzodiazepines administered in a symptom-triggered fashion, guided by the Clinical Institute Withdrawal Assessment of Alcohol scale, revised (CIWA-Ar), still seem to be the optimal strategy in the intensive care unit. In cases of benzodiazepine resistance, numerous options are available, including high individual doses of benzodiazepines, barbiturates, and propofol. Intensivists should be familiar with the diagnosis and treatment strategies for alcohol withdrawal syndromes in the intensive care unit.
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Abstract
Alcohol abuse and dependence disorders are common in the 10% of hospitalised patients who need admission to the intensive care unit (ICU), but these disorders are often undiagnosed. The systemic effects from the excessive use of alcohol increase susceptibility to, or directly cause various important disorders in the critically ill. Early recognition of alcohol abuse and dependence is necessary and should prompt consideration of several alcohol-specific diagnoses that have important prognostic and therapeutic implications for these patients. We discuss the use of screening tests to improve the identification of alcohol abuse and dependence disorders, the epidemiology and pathogenesis of important alcohol-related disorders, differences in the presentation of several common alcohol-related diagnoses in the ICU, and important alcohol-specific therapies.
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Affiliation(s)
- Marc Moss
- Divison of Pulmonary Sciences and Critical Care Medicine, University of Colorado at Denver and Health Sciences Center, Denver, CO 80262, USA.
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Sattar SP, Qadri SF, Warsi MK, Okoye C, Din AU, Padala PR, Bhatia SC. Use of alcoholic beverages in VA medical centers. SUBSTANCE ABUSE TREATMENT PREVENTION AND POLICY 2006; 1:30. [PMID: 17052353 PMCID: PMC1624810 DOI: 10.1186/1747-597x-1-30] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 06/23/2006] [Accepted: 10/19/2006] [Indexed: 11/10/2022]
Abstract
Background Benzodiazepines are the first-line choice for the treatment of alcohol withdrawal syndrome. However, several hospitals continue to provide alcoholic beverages through their formulary for the treatment of alcohol withdrawal. While there are data on the prevalence of this practice in academic medical centers, there are no data on the availability of alcoholic beverages at the formularies of the hospitals operated by the department of Veteran's Affairs. Methods In this study, we surveyed the Pharmacy managers at 112 Veterans' Affairs Medical Centers (VAMCs) to ascertain the availability of alcohol on the VAMC formularies, and presence or lack of a policy on the use of alcoholic beverages in their VA Medical Center. Results Of the pharmacy directors contacted, 81 responded. 8 did not allow their use, while 20 allowed their use. There was a lack of a consistent policy across the VA medical centers on availability and use of alcoholic beverages for the treatment of alcohol withdrawal syndrome. Conclusion There is lack of uniform policy on the availability of alcoholic beverages across the VAMCs, which may create potential problems with difference in the standards of care.
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Affiliation(s)
- S Pirzada Sattar
- Substance Use Disorders Program, Omaha VA Medical Center, 4101 Woolworth Ave, # 116A, Omaha, Nebraska, USA 68105
- Department of Psychiatry, Creighton University School of Medicine, 3528 Dodge Street, Omaha, Nebraska, USA 68131
- Department of Psychiatry, Sanford School of Medicine, University of South Dakota, 4400 West 69th Street, Suite 1500, Sioux Falls, South Dakota, USA 57108
- Avera Research Institute, 2020 Norton Street S, Sioux Falls, South Dakota, USA 57105
- Department of Psychiatry, University of Nebraska College of Medicine, 988470 Nebraska Medical Center, Omaha, Nebraska, USA 68198-8470
| | - S Faiz Qadri
- Substance Use Disorders Program, Omaha VA Medical Center, 4101 Woolworth Ave, # 116A, Omaha, Nebraska, USA 68105
- Department of Psychiatry, Creighton University School of Medicine, 3528 Dodge Street, Omaha, Nebraska, USA 68131
| | - Mustafa K Warsi
- Substance Use Disorders Program, Omaha VA Medical Center, 4101 Woolworth Ave, # 116A, Omaha, Nebraska, USA 68105
- Department of Psychiatry, Creighton University School of Medicine, 3528 Dodge Street, Omaha, Nebraska, USA 68131
| | - Cordelia Okoye
- Substance Use Disorders Program, Omaha VA Medical Center, 4101 Woolworth Ave, # 116A, Omaha, Nebraska, USA 68105
| | - Amad U Din
- Substance Use Disorders Program, Omaha VA Medical Center, 4101 Woolworth Ave, # 116A, Omaha, Nebraska, USA 68105
- Department of Psychiatry, University of Kansas Medical Center, 3901 Rainbow Blvd., 1012 Olathe, Kansas City, Kansas, USA 66160
| | - Prasad R Padala
- Substance Use Disorders Program, Omaha VA Medical Center, 4101 Woolworth Ave, # 116A, Omaha, Nebraska, USA 68105
- Department of Psychiatry, University of Nebraska College of Medicine, 988470 Nebraska Medical Center, Omaha, Nebraska, USA 68198-8470
| | - Subhash C Bhatia
- Substance Use Disorders Program, Omaha VA Medical Center, 4101 Woolworth Ave, # 116A, Omaha, Nebraska, USA 68105
- Department of Psychiatry, Creighton University School of Medicine, 3528 Dodge Street, Omaha, Nebraska, USA 68131
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