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. 2025 May 1:10.1097/ADM.0000000000001491.
doi: 10.1097/ADM.0000000000001491. Online ahead of print.

Symptom-Triggered Alcohol Withdrawal Management Delivered Over Telemedicine

Matthew E Sloan, Anthony Ngoy, Ke Bin Xiao, Bryce Barker, Leslie Buckley, Marina Fodor, Kate Hardy, Christian S Hendershot, Meldon Kahan, Sandra La Fleur, Bernard Le Foll, Mitchell Manicone, Marcos Sanches, Emily Simpkin, Lena C Quilty, Jennifer Wyman, Victor M Tang, Nikki Bozinoff

Symptom-Triggered Alcohol Withdrawal Management Delivered Over Telemedicine

Matthew E Sloan et al. J Addict Med. .

Abstract

Objectives: Alcohol use is one of the leading causes of death and disability globally; however, access to evidence-based care for alcohol use disorder (AUD) is limited. Although telemedicine-based interventions promise to expand treatment access, there are no validated telemedicine-based interventions for alcohol withdrawal management. In this single-arm study, we sought to determine the feasibility of delivering symptom-triggered alcohol withdrawal management over telemedicine.

Methods: Thirty actively drinking participants with AUD and a history of alcohol withdrawal were recruited to participate. Participants were scheduled for 3 days of symptom-triggered withdrawal management using the Clinical Institute Withdrawal Assessment for Alcohol Scale Revised delivered by a trained clinician over a telemedicine platform. Primary outcomes were retention in treatment and need for transfer to a higher level of care (eg, the emergency room). Satisfaction with the treatment protocol and relapse to any alcohol use 30 days following treatment initiation were also assessed.

Results: In total, 93.3% of participants completed all 3 days of alcohol withdrawal management. No participants required transfer to a higher level of care. Satisfaction with treatment was high, with an average Client Satisfaction Questionnaire-8 score of 30.9 (SD = 1.5) out of 32. After the follow-up period, 56.7% of participants remained abstinent from alcohol.

Conclusions: Our study provides preliminary evidence that symptom-triggered alcohol withdrawal management over telemedicine is feasible and satisfactory for patients. If these findings are replicated, they could have important implications for access to alcohol withdrawal management services, especially in remote, rural, and underserved regions that lack specialized withdrawal management facilities.

Keywords: alcohol detoxification; alcohol use disorder; alcohol withdrawal; benzodiazepines; telemedicine.

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Conflict of interest statement

M.E.S. has received research support from the Canadian Institutes of Health Research, the Ontario Ministry of Health and Longterm Care, the CAMH Foundation, and the Academic Health Sciences Centre AFP Innovation Fund. M.E.S. is also supported in part by an Academic Scholar Award from the Department of Psychiatry, University of Toronto. M.E.S. has received travel support from the Society of Biological Psychiatry and the International Society for CNS Clinical Trials and Methodology. He has received an honorarium for giving a talk at the McGill University Health Centre. N.B. has received salary support from the US National Institute on Drug Abuse (NIDA) grant R25-DA037756, unrelated to this work. B.L.F. has obtained funding from Indivior for a clinical trial sponsored by Indivior. B.L.F. has received in-kind donations of placebo edibles from Indivia. B.L.F. has obtained industry funding from Canopy Growth Corporation (through research grants handled by the Centre for Addiction and Mental Health and the University of Toronto). He has participated in a session of a National Advisory Board Meeting (Emerging Trends BUP-XR) for Indivior Canada and is part of the Steering Board for a clinical trial for Indivior. He has been a consultant for Shinogi and ThirdBridge. He received travel support to attend an event by Bioprojet. He is supported by CAMH, Waypoint Centre for Mental Health Care, a clinician-scientist award from the Department of Family and Community Medicine of the University of Toronto and a Chair in Addiction Psychiatry from the Department of Psychiatry of the University of Toronto. The remaining authors report no conflicts of interest.

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