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UNC hospitalists publish a study that describes the effectiveness of counseling hospitalized patients with alcohol withdrawal, using naltrexone.

John R. Stephens, MD

Hospitalist John R. Stephens, MD, is lead author for a study that describes the implementation and impact of a process for counseling hospitalized patients with alcohol withdrawal, using the drug naltrexone. The study was published in the Journal of Hospital Medicine earlier this year. Naltrexone is commonly prescribed to help people detox from alcohol, and it’s been shown to be effective in conjunction with comprehensive treatment.

“As a group, we realized we were admitting a fair number of patients to our services for treatment of acute withdrawal from alcohol, but we had no process to help prevent patients from returning to heavy drinking at discharge, despite good data on medications that could be useful,” said Stephens.

Hospital initiation of naltrexone has had limited review until now. The UNC hospitalist study identified 128 patient encounters before and 114 after implementation, and the counseling process was associated with lower 30-day ED revisits. Advanced Practice Providers are assisting in the training of new faculty on the process, now well established at UNC Medical Center.

Stephens says that after an initial education session and training about motivational interviewing, which includes a suggested script for counseling, individual providers can customize the specifics of counseling. Patients are approached near their time of discharge, with a review of the benefits of naltrexone in maintaining sobriety. The medication is then prescribed at discharge (90-day supply) for interested patients without contraindications.

“Given the substantial reductions of 30-day ED revisits and readmissions we observed among those counseled about naltrexone versus those not counseled, we believe this offers the potential for tremendous savings to the healthcare system. And more importantly, we hope that the results mean patients are enjoying better health outcomes.”

Others who participated from hospital medicine include Kelly Stepanek, ACNP-BC; Carlton Moore, MD, MS; and Allen Liles, MD. Dan Jonas, MD, MPH, from the division of general medicine, and James C. Garbutt, MD, and Britta Starke, LCSW, LCAS, CCS, from the department of psychiatry, were also involved in the project.