A homeless man requests detoxification for alcohol use. What factor most strongly influences whether he should be sent to inpatient or outpatient detoxification?

The determination of whether a patient, especially one with alcohol use disorder, should be sent for inpatient versus outpatient detoxification is significantly influenced by their history of delirium tremens (DTs). Delirium tremens is a severe and potentially life-threatening complication of alcohol withdrawal characterized by confusion, hallucinations, agitation, and autonomic instability. If a patient has a history of DTs, it suggests a higher risk for recurrence of severe withdrawal symptoms upon cessation of alcohol use.

Patients with a known history of DTs typically require more intensive monitoring and management, which inpatient detoxification can provide. In contrast, individuals without this history are generally at lower risk for severe complications during withdrawal and may be adequately managed in an outpatient setting, especially if they have social supports and a stable environment.

While factors like length of time living outdoors, social supports, and the source of alcohol can impact overall treatment strategies and long-term outcomes, the acute decision-making process concerning the safest detoxification setting most heavily relies on the risk of severe withdrawal symptoms, which is most clearly indicated by a prior history of delirium tremens.