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Alcohol Detoxification — MRCPsych Paper B MCQ

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ModerateSubstance MisuseAlcohol DetoxificationMRCPsych Paper B

A 28-year-old non-pregnant woman with alcohol dependence requests planned assisted withdrawal. She drinks 20 UK units of alcohol daily and has a SADQ score of 22. She has no epilepsy, previous withdrawal seizures or delirium tremens, concurrent benzodiazepine dependence, significant physical or psychiatric comorbidity, cognitive impairment or malnutrition. Her home is safe and stable, and a supportive partner can remain with her. According to NICE CG115, which is the most appropriate withdrawal approach?

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Correct answer: A — Community-based withdrawal using a fixed-dose chlordiazepoxide regimen

Explanation lettering: B = shown as A · A = shown as B · E = shown as D · D = shown as E

NICE CG115 states that people needing assisted alcohol withdrawal should usually receive a community-based programme. Inpatient or residential withdrawal should be considered when alcohol consumption exceeds 30 units daily, SADQ exceeds 30, or there is epilepsy, previous withdrawal seizure or delirium tremens, concurrent benzodiazepine withdrawal, or significant comorbidity or cognitive impairment. This patient has moderate dependence, suitable social support and no stated inpatient indication, making B correct. Community withdrawal should use a fixed-dose regimen under a standard clinical protocol; chlordiazepoxide or diazepam is preferred. Inpatient treatment (A) is not indicated. Symptom-triggered treatment (C) requires the frequent skilled monitoring generally available in inpatient or residential settings. Clomethiazole (D) should not be used in the community because of overdose and misuse risk. Psychosocial support alone (E) does not provide medically assisted withdrawal.

Reference: National Institute for Health and Care Excellence. CG115, Alcohol-use disorders: diagnosis, assessment and management of harmful drinking and alcohol dependence, sections 1.3.4–1.3.5. Published 2011; updated 2014. https://www.nice.org.uk/guidance/cg115/resources/alcoholuse-disorders-diagnosis-assessment-and-management-of-harmful-drinking-highrisk-drinking-and-alcohol-dependence-pdf-35109391116229