Relative Kindling Effect of Detoxification and Non-Detoxification Admissions in Alcoholics

Lechtenberg, Richard; Worner, Theresa M.

doi:10.1093/oxfordjournals.alcalc.a045104

Cited by 82 publications

(31 citation statements)

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“…It is well established that the amount and duration of ethanol exposure prior to abstinence is an important determinant of withdrawal severity, and there is striking evidence in the literature that the experience of repeated withdrawal is associated with enhancements in withdrawal symptomatology (Brown et al 1988;Lechtenberg and Worner 1991;Booth and Blow 1993;Becker 1999). For example, in a large national study of alcoholic men it was found that the occurrence of seizures during detoxification was associated with significantly greater numbers of prior withdrawals (Booth and Blow 1993).…”

Section: Discussionmentioning

confidence: 99%

Excessive Ethanol Drinking Following a History of Dependence Animal Model of Allostasis

Roberts

Heyser

Cole

et al. 2000

Neuropsychopharmacology

318

325

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Self-administration Excessive drinking of ethanol in animals can be produced by a number of factors including altering palatability, genetics, and history of consumption. There is evidence that certain symptoms of withdrawal can persist for a number of weeks or even months following chronic ethanol exposure in humans (Kissin 1979;Begleiter and Porjesz 1979;Alling et al. 1982;Roelofs 1985;Grant et al. 1987) as well as in animals (Begleiter and Porjesz 1979). In human alcoholics, one of the factors leading to excessive drinking is the use of alcohol to relieve or avoid withdrawal symptoms (U.S. Department of Health and Human Services 1990). Fatigue and tension persisted for approximately five weeks following withdrawal in a group of 68 chronic alcoholics (Alling et al. 1982), and periods of hyperventilatory symptomology and anxiety (as determined by the Spielberger State-Trait Anxiety Inventory, a self-report inventory), which correlated with intensity of alcohol craving, were reported for up to nine months following withdrawal in a group of 37 chronic alcoholics (Roelofs 1985).In a larger cohort of 312 abstinent alcoholics, 20-25% of them showed signs of anxiety and depression, as determined from the Symptom Check-List 90 (self-report inventory with coverage of areas of symptomology and psychopathology) six months to two years following withdrawal (De Soto et al. 1985). In a follow-up study, it was shown that distress-related symptoms correlated with relapse in alcoholics who were abstinent for less than two years (De Soto et al. 1989). The more pro- Received March 2, 1999; revised August 25, 1999; accepted December 6, 1999. 582 A.J. Roberts et al. N EUROPSYCHOPHARMACOLOGY 2000 -VOL . 22 , NO . 6 tracted symptoms tended to be subacute, were often affective in nature, and appeared to precede relapses into uncontrolled alcohol drinking. For example, depression and anxiety associated with withdrawal were found to provoke drinking in 83 of 100 male alcoholics who experienced these symptoms (Hershon 1977). These patients reported that they drank alcoholic beverages when they experienced anxiety and depressed mood. In another study, both male and female alcoholics reported negative emotions as the most common trigger of relapse (Annis et al. 1998). The clinical literature suggests that alterations in affective state persist for quite some time following alcohol withdrawal and may actually be partly responsible for some relapse episodes in alcoholics.Potential rodent models of excessive ethanol drinking include the alcohol deprivation effect in nondependent animals, ethanol self-administration in dependent withdrawing animals, and ethanol self-administration in animals with a history of dependence following periods of abstinence. The alcohol deprivation effect is a transient increase in ethanol self-administration in animals following periods of abstinence from ethanol for several days to several weeks (Sinclair and Senter 1967;Spanagel et al. 1996;Heyser et al. 1997;Hölter et al. 1998). This increase in e...

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Section: Discussionmentioning

confidence: 99%

Excessive Ethanol Drinking Following a History of Dependence Animal Model of Allostasis

Roberts

Heyser

Cole

et al. 2000

Neuropsychopharmacology

318

325

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“…Given the evidence of the neurotoxic nature of withdrawal and the kindling effect of repeated withdrawals, [21] the relative neuroprotective features of drugs used in withdrawal is crucial. Similarly, the role of aggressive treatment of episodes in delaying the onset on early withdrawal seizures, must be investigated.…”

Section: Discussionmentioning

confidence: 99%

Trends in pharmacotherapy selection for the treatment of alcohol withdrawal in the Free State Province, South Africa

et al. 2013

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Corresponding author: P M van Zyl (vzylpm@ufs.ac.za) Background. The selection of pharmacotherapy for the treatment of alcohol withdrawal remains a clinical challenge. Research continues into the underlying pathophysiology of dependence and withdrawal. A spectrum of clinical presentations of alcohol dependence is emerging, yet recommendations and guidelines have remained unchanged for some time. Objectives. To engage with the problem of translating research into practice, as reflected by the selection of pharmacotherapy for alcohol withdrawal by medical practitioners in the Free State Province, South Africa. Methods. A questionnaire-based survey and interviews were conducted among 121 professionals in both the private and public sectors across the province. A subgroup was formed comprising the 58 doctors who indicated that they prescribe for alcohol withdrawal. Participants worked in private general practice, specialist psychiatry practice, in a state hospital or in a treatment centre. Results. Prescribing practices varied based on practitioners' geographical distribution and professional capacity. Deviation from standard recommendations included the routine use of clothiapine and antidepressants in withdrawal regimens. Prescribing clothiapine appears to be a local custom. While prescription of antidepressants may indicate unrealistic expectations of therapeutic benefit, there are clear indications that this is maintained to mask the diagnosis of an alcohol-related condition. Prescribing for alcohol withdrawal is therefore not necessarily determined by pathophysiology or efficacy of medication. Conclusion. Withdrawal regimens need to be reassessed by researchers, policy makers and funders, balancing new developments with the real-life experiences and challenges of prescribers and their patients.

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“…An emerging issue in the treatment of alcohol withdrawal is the apparent sensitization or kindling caused by repeated episodes of alcohol withdrawal (Ballenger and Post 1978;Brown et al 1988;Lechtenberg and Worner 1991;Becker 1994;Anton and Becker 1995). While it is not yet clear whether this phenomenon warrants speciÞc pharmacological intervention, there is some evidence that benzodiazepines may not prevent the development of alcohol withdrawal sensitization (Brown et al 1988).…”

Section: Discussionmentioning

confidence: 99%

“…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. An additional potential advantage to pharmacotherapy (Ballenger and Post 1978), for which evidence continues to accumulate (Brown et al 1988;Lechtenberg and Worner 1991;Becker and Hale 1993;Becker 1994), is the possible need to reduce the sensitization or kindling of more serious alcohol withdrawal symptoms in the future by appropriate pharmacologic remediation of withdrawal symptoms during initial detoxiÞcations. The ideal medication for treatment of alcohol withdrawal would be one that is safe, especially given the potential for alcohol-induced impairments in hepatic function, and that has minimal potential for abuse, cognitive impairment, or behavioral disinhibition.…”

Section: Introductionmentioning

confidence: 99%

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

Anton

Kranzler

McEvoy³

et al. 1997

Psychopharmacology

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Treatment of the alcohol withdrawal syndrome is best accomplished using pharmacologic agents that have minimal interaction with alcohol, have limited adverse effects, and are without abuse potential. The partial benzodiazepine receptor agonist beta-carboline compound, abecarnil, has been shown in animal and human studies to possess a number of these characteristics and to be useful in the reduction of alcohol withdrawal convulsions in mice. In this study, 49 alcohol-dependent inpatients who exhibited at least moderate symptoms of uncomplicated alcohol withdrawal were treated over a 5-day detoxification period with abecarnil or diazepam and rated daily for alcohol withdrawal symptoms and adverse events. Both the abecarnil and diazepam treatment groups exhibited a similar marked reduction in withdrawal symptoms over time. In addition, similar rates of successful treatment and improvement were observed after 1 day of treatment and at termination in alcoholics treated with either medication. Overall, rates of adverse events and changes in liver enzymes were similar in both treatment groups and were generally benign. Because of the unique pharmacologic profile of abecarnil in animal and in non-clinical human studies, including anticonvulsant action, low abuse liability, and a favorable side effect profile, further study of compounds of the partial benzodiazepine receptor agonist type in the treatment of alcohol withdrawal syndromes seems warranted.

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Relative Kindling Effect of Detoxification and Non-Detoxification Admissions in Alcoholics

Cited by 82 publications

References 0 publications

Excessive Ethanol Drinking Following a History of Dependence Animal Model of Allostasis

Excessive Ethanol Drinking Following a History of Dependence Animal Model of Allostasis

Trends in pharmacotherapy selection for the treatment of alcohol withdrawal in the Free State Province, South Africa

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

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