Nonpharmacologic intervention in acute alcohol withdrawal

Abstract

The importance of nonpharmacologic and pharmacologic interventions in the treatment of alcohol withdrawal is not known. A randomized, double-blind, placebo-controlled trial was conducted with 41 patients in alcohol withdrawal in an emergency department. The patients received either supportive care (10 min of standardized assessments, reassurance, reality orientation, and nursing care an hour) with three doses of sublingual lorazepam 2 mg every 2 hr (21 patients, drug group) or supportive care with three doses of sublingual placebo every 2 hr (20 patients, no-drug group). Immediately before each drug dose, the clinical course of alcohol withdrawal was assessed hourly by the Clinical Institute Withdrawal Assessment for Alcohol (CIWA-A). Interraters reliability in using CIWA-A was high. After each assessment, supportive care was given for 10 min before each dose. After completion of a 7-hr initial phase, patients were discharged and reassessed daily for 5 days. Thirty-seven patients (90.2%) improved in the initial phase. Treatment failures (CIWA-A greater than 10) were more common in the patients treated without drug (3/20, 15%) than in those treated with drug (1/21, 4.8%). Overall variations in intergroup CIWA-A scores during the initial phase were not significant. The rate of improvement of CIWA-A scores over the first 2 hr after drug was slightly faster in patients receiving lorazepam than in the control group. CIWA-A scores were the same during follow-up. These results indicate that most outpatients in mild to moderate alcohol withdrawal without medical complications improve without drug therapy in the emergency department setting.

Comparison of Clomethiazole and Diazepam in the Treatment of Alcohol Withdrawal Syndrome in Clinical Practice

“…They have established efficacy in reducing symptom severity and preventing seizures and delirium tremens [18,19,20]. In 2 Cochrane reviews, superiority over placebo especially in preventing seizures was documented [21,22].…”

Symptom-Triggered versus Standard Chlormethiazole Treatment of Inpatient Alcohol Withdrawal: Clinical Implications from a Chart Analysis

“…It has been reported that general supportive nursing care combined with frequent monitoring of withdrawal symptoms alone without the use of psychoactive drugs may be effective in two-thirds of patients with mild AWS [22]. In various other settings, minor symptoms of AWS also responded to measures of supportive care [23,24]. Since an average assessment in our case only takes about 2 min and may save time elsewhere, there was no significant interference with clinical routine in the symptom-triggered group.…”

A double-blind comparison of abecarnil and diazepam in the treatment of uncomplicated alcohol withdrawal

“…The results of this study are limited by the lack of a placebo treatment group. While it is known that social support alone can markedly reduce alcohol withdrawal symptoms (Shaw et al 1981;Naranjo et al 1983), some may Þnd it not medically or ethically justiÞable to utilize a placebo in moderate to severe alcohol withdrawal syndromes. At least one author has suggested that all clinical pharmacology trials of alcohol withdrawal utilize a benzodiazepine treatment group as a comparison group against which to measure the e¤ectiveness and safety of compounds being tested (Moskowitz et al 1983).…”

“…Although many of the symptoms of alcohol withdrawal are benign and may be treated with only supportive measures (Shaw et al 1981;Naranjo et al 1983), moderate-to-severe alcohol withdrawal is best treated pharmacologically (Moskowitz et al 1983;Sellers et al 1983;Anton and Becker 1995). The goals of the treatment of alcohol withdrawal are to minimize physiologic disturbance, to inhibit the emergence of more serious withdrawal symptoms, such as seizures and delirium tremens, and to promote the initiation of alcoholism rehabilitation.…”