Alcohol withdrawal syndrome: symptom-triggered versus fixed-schedule treatment in an outpatient setting

Alcohol Alcohol. May-Jun 2011;46(3):318-23. doi: 10.1093/alcalc/agr020. Epub 2011 Mar 17.


Aims: To investigate whether, in the treatment with chlordiazepoxide for outpatient alcohol withdrawal, there are advantages of symptom-triggered self-medication over a fixed-schedule regimen.

Methods: A randomized controlled trial in outpatient clinics for people suffering from alcohol dependence (AD) and alcohol-related problems; 165 adult patients in an outpatient setting in a specialized alcohol treatment unit were randomized 1:1 to either a symptom-triggered self-medication or tapered dose, using chlordiazepoxide. Alcohol withdrawal symptoms, amount of medication, duration of symptoms, time to relapse and patient satisfaction were measured. Patients assessed their symptoms using the Short Alcohol Withdrawal Scale (SAWS). Patient satisfaction was monitored by the Diabetes Treatment Satisfaction Questionnaire. We used the Well-Being Index and the European addiction severity index for the 1-year follow-up.

Results: We found no differences in the quantity of medication consumed, time to relapse, well being or treatment satisfaction.

Conclusion: Symptom-triggered self-medication was as safe as fixed-schedule medication in treating outpatients with AD and mild to moderate symptoms of AWS. The SAWS is a powerful monitoring tool, because it is brief and permits the subject to log the withdrawal symptoms.

Publication types

  • Randomized Controlled Trial
  • Research Support, Non-U.S. Gov't

MeSH terms

  • Adult
  • Aged
  • Alcohol Withdrawal Delirium / complications
  • Alcohol Withdrawal Delirium / diagnosis
  • Alcohol Withdrawal Delirium / drug therapy*
  • Alcohol Withdrawal Delirium / prevention & control
  • Alcohol-Induced Disorders / complications
  • Alcohol-Induced Disorders / diagnosis
  • Alcohol-Induced Disorders / drug therapy*
  • Alcoholism / complications
  • Alcoholism / drug therapy*
  • Ambulatory Care
  • Behavior, Addictive
  • Central Nervous System Depressants / administration & dosage
  • Central Nervous System Depressants / adverse effects
  • Central Nervous System Depressants / pharmacology
  • Chlordiazepoxide / administration & dosage
  • Chlordiazepoxide / therapeutic use*
  • Drug Administration Schedule
  • Ethanol / adverse effects
  • Ethanol / pharmacology
  • Female
  • Humans
  • Hypnotics and Sedatives / therapeutic use*
  • Male
  • Middle Aged
  • Outpatients
  • Substance Withdrawal Syndrome / diagnosis
  • Substance Withdrawal Syndrome / drug therapy*
  • Substance Withdrawal Syndrome / etiology
  • Substance Withdrawal Syndrome / prevention & control
  • Young Adult


  • Central Nervous System Depressants
  • Hypnotics and Sedatives
  • Ethanol
  • Chlordiazepoxide