Inpatient treatment for alcoholism - new life for the Minneapolis plan

Article Abstract:

In 1949, a plan for the treatment of alcoholism was begun which subsequently came to be known as the Minneapolis plan. The treatment plan usually consisted of 28 days of inpatient care. Over subsequent years, many research studies presented evidence suggesting that the plan was ineffective and that programs such as Alcoholics Anonymous (AA) were just as effective at a much lower cost. Some health insurance companies reduced the reimbursement they were willing to provide for inpatient treatment of alcoholism; some ceased reimbursing such treatment entirely. In the September 12, 1991 issue of The New England Journal of Medicine, researchers report the outcome of a study comparing inpatient treatment with other forms of treatment, including mandatory AA attendance, in 227 industrial workers. They found that the inpatient treatment was significantly more effective in reducing alcohol-related symptoms and in reducing future requirements for treatment. Although the AA treatment was cheaper, more patients treated in this fashion required future inpatient treatment, thereby eliminating most of the cost savings. It might be asked, however, why this study should indicate a benefit for inpatient treatment when so many previous studies have found no such benefit. There may be several reasons, but an important factor may be the patients in this study. All were employed, and all were required to participate or risk losing their jobs to alcohol-related problems. Thus, the patient population in the present study may be more motivated than some others. It is clear that the patients in the present study probably cannot be considered representative of all alcoholics. The lesson, however, is that we known very little about what sorts of treatment programs are successful with what sorts of patients. Therefore, it would be premature to rule out any sort of treatment program until more is understood about matching patients with treatment. (Consumer Summary produced by Reliance Medical Information, Inc.)

Employee alcoholism, Alcoholism, Alcoholism treatment, editorial

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Comparative effectiveness and costs of inpatient and outpatient detoxification of patients with mild-to-moderate alcohol withdrawal syndrome

Article Abstract:

Detoxification of alcoholic patients is ordinarily performed within the confines of a hospital. Recent studies, however, suggest that detoxification can be accomplished successfully either outside the hospital entirely, or in an outpatient clinic, which would reduce costs. The relative costs, safety, and effectiveness of both outpatient and inpatient detoxification were examined among 164 male veterans of low socioeconomic status. The treatments were similar: outpatients were evaluated both psychiatrically and medically and then put on decreasing doses of oxazepam, an antianxiety drug. Inpatients were given comprehensive physical and mental evaluation, oxazepam, and were put into rehabilitation treatment. Although the average time of treatment was much shorter for the outpatients compared to inpatients, 95% of the hospital patients underwent complete detoxification compared to 72% of the outpatients. Neither group suffered any critical medical complications. Evaluation of the success of the treatment at one and six months showed substantial improvement in both groups. There were fewer alcohol-linked problems among the hospitalized patients, but there were fewer medical difficulties among the outpatients at the one month follow-up. At six months, the outcomes of both groups were similar. The cost differences, however, were substantially different: averaging $3,500 per inpatient, versus under $400 per outpatient. Thus, outpatient detoxification is a safe, effective, and significantly lower cost method for patients with symptoms of alcohol withdrawal that are mild-to-moderate.

Evaluation, Economic aspects, Medical care, Cost of, Health care costs, Hospitals, Ambulatory medical care, Ambulatory care, Alcoholics, Drug withdrawal symptoms, Substance withdrawal syndrome, Hospital rehabilitation services

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Microbial detoxification of superoxide: The non-heme iron reductive paradigm for combating oxidative stress

Article Abstract:

A reductive paradigm has emerged for detoxification of superoxide and other redox active diatomic molecules in air-sensitive bacteria and archaea. An adventitiously generated superoxide in many anaerobic or microaerophillic bacteria andacrhaea is scavenged by superoxide reductase (SOR) rather than the classical superoxide dismutases characteristic of aerobic microbes.

Science & research, Research, Methods, Oxidation-reduction reaction, Oxidation-reduction reactions, Superoxide, Superoxides, Anaerobic bacteria, Chemical properties

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