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Clinical Management of Alcohol Withdrawal

Published online by Cambridge University Press:  07 November 2014

Hugh Myrick  and
Raymond F. Anton
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Abstract

It has been well known for a number of years that abrupt withdrawal from alcohol following chronic use is associated with adverse consequences, ranging from mild tremors to withdrawal seizures. The overall purposes of treating alcohol withdrawal (AW) are to relieve patient discomfort, to prevent the development of more serious withdrawal symptoms, and to initiate long-term alcohol rehabilitation. Several areas of controversy exist in the clinical management of AW, including the optimal treatment setting, the need for pharmacologic management, and the most appropriate agent to prescribe when medication is deemed necessary. This article reviews the clinical features, general management, and treatment of AW.

Type
Feature Articles
Information
CNS Spectrums , Volume 5 , Issue 2: Novel Pharmacotherapies for Alcoholism , February 2000 , pp. 22 - 32
Copyright
Copyright © Cambridge University Press 2000

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References

REFERENCES

1.Saitz, R, O'Malley, SS. Pharmacotherapies of alcohol abuse: withdrawal and treatment. Med Clin North Am. 1997;81:881–907.CrossRefGoogle ScholarPubMed
2.Mendelson, JH, LaDou, J. Experimentally induced chronic intoxication and withdrawal in alcoholics, II: psychological findings. Q J Stud Alcohol. 1963;2(suppl):14.Google Scholar
3.Sellers, EM, Kalant, H. Alcohol intoxication and withdrawal. N Engl J Med. 1976;294:757–762.Google Scholar
4.Victor, M. Alcohol withdrawal seizures: an overview. In: Porter, R, ed. Alcohol and Seizures. New York, NY: Davis; 1990:148–161.Google Scholar
5.Chan, AWK. Alcoholism and epilepsy. Epilepsia. 1985;26:323–333.CrossRefGoogle ScholarPubMed
6.Victor, M, Brausch, C. The role of abstinence in the genesis of alcoholic epilepsy. Epilepsia. 1967;8:1–20.CrossRefGoogle ScholarPubMed
7.Hillbrom, ME, Hjelm-Jager, M. Should alcohol withdrawal seizures be treated with anti-epileptic drugs? Acta Neurol Scand. 1984;69:39–42.CrossRefGoogle Scholar
8.Sullivan, JT, Swift, RM, Lewis, DC. Benzodiazepine requirements during alcohol withdrawal syndrome: clinical implications of using standardized withdrawal scale. J Clin Psychopharmacol. 1991;11:291–295.CrossRefGoogle ScholarPubMed
9.Foy, A, March, S, Drinkwater, V. Use of an objective clinical scale in the assessment and management of alcohol withdrawal in a large general hospital. Alcohol Clin Exp Res. 1988;12:360–364.CrossRefGoogle Scholar
10.Ballenger, JC, Post, RM. Kindling as a model for alcohol withdrawal syndromes. Br J Psychiatry. 1978;133:1–14.CrossRefGoogle Scholar
11.Brown, ME, Anton, RF, Malcolm, R, Ballenger, JC. Alcohol detoxification and withdrawal seizures: clinical support for a kindling hypothesis. Biol Psychiatry. 1988;23:507–514.CrossRefGoogle ScholarPubMed
12.Abbott, JA, Quinn, D, Knox, L. Ambulatory medical detoxification for alcohol. Am J Drug Alcohol Abuse. 1995;21:549–563.CrossRefGoogle ScholarPubMed
13.Hayashida, M, Alterman, AI, Mclellan, T. Comparative effectiveness and costs of inpatient and outpatient detoxification of patients with mild-to-moderate alcohol withdrawal syndrome. N Engl J Med. 1989;320:358–365.CrossRefGoogle ScholarPubMed
14.Whitfield, CL, Thompson, G, Lamb, A, Spencer, V, Pfeifer, M, Browning-Ferrando, M. Detoxification of 1,024 alcoholic patients without psychoactive drugs. JAMA. 1978;239:1409–1410.CrossRefGoogle Scholar
15.Shaw, JM, Kolesar, GS, Sellers, EM, Kaplan, HL, Sandors, P. Development of optimal treatment tactics for alcohol withdrawal, I: assessment and effectiveness of supportive care. J Clin Psychopharmacol. 1981;1:382–387.CrossRefGoogle ScholarPubMed
16.Becker, HC. Alcohol withdrawal: neuroadaption and sensitization. CNS Spectrums. 1999;4:38–65.CrossRefGoogle Scholar
17.American Psychiatric Association Task Force. Treatment of Psychiatric Disorders. Washington, DC: American Psychiatric Press; 1989:187.Google Scholar
18.Institute of Medicine. Prevention and Treatment of Alcohol Problems. Washington, DC: National Academy Press; 1990:268–269.Google Scholar
19.Moskowitz, G, Chalmers, TC, Sacks, HS, Fagerstrom, RM, Smith, H. Deficiencies of clinical trials of alcohol withdrawal. Alcohol Clin Exp Res. 1983;7:42–46.CrossRefGoogle ScholarPubMed
20.Anton, RF, Becker, HC. Pharmacology and pathophysiology of alcohol withdrawal. In: Kranzler, HR, ed. Handbook of Experimental Pharmacology: The Pharmacology of Alcohol Abuse. Vol 114. Berlin, Germany: Springer-Verlag; 1995:315–367.CrossRefGoogle Scholar
21.Kaim, SC, Klett, CJ, Pothfeld, B. Treatment of the acute alcohol withdrawal state: a comparison of four drugs. Am J Psychiatry. 1969;125:1640–1646.CrossRefGoogle Scholar
22.Sellers, EM, Naranjo, CA, Harrison, M, Devenyi, P, Roach, C, Sykora, K. Diazepam loading: simplified treatment of alcohol withdrawal. Clin Pharmacol Ther. 1983;34:822–826.CrossRefGoogle ScholarPubMed
23.Saitz, R, Mayo-Smith, MF, Roberts, MS, Redmond, HA, Bernard, DR, Catkins, DR. Individualized treatment for alcohol withdrawal: a randomized double-blind controlled trial. JAMA. 1994;272:519–523.CrossRefGoogle ScholarPubMed
24.Tyrer, PJ. Drugs in Psychiatric Practice. London, UK: Butterworths; 1982:360.Google Scholar
25.Gallant, DM. Improvements in treatment of alcohol withdrawal syndromes. Alcohol Clin Exp Res. 1989;13:721–722.Google ScholarPubMed
26.O'Brien, JE, Myer, RE, Thomas, DC. Double-blind comparison of lorazepam and diazepam in the treatment of the acute alcohol abstinence syndrome. Cur Ther Res, Clin Exp. 1983;34:825–831.Google Scholar
27.Mayo-Smith, MF. Pharmacological management of alcohol withdrawal: a meta-analysis and evidence-based practice guideline. JAMA. 1997;278:144–151.CrossRefGoogle ScholarPubMed
28.Wojnar, M, Bizon, Z, Wasilewski, D. Assessment of the role of kindling in the pathogenesis of alcohol withdrawal seizures and delirium tremens. Alcohol Clin Exp Res. 1999;23:204–208.CrossRefGoogle ScholarPubMed
29.Stuppaeck, CH, Pycha, R, Miller, C, Whitworth, AB, Oberbauer, H, Fleischhacker, WW. Carbamazepine vs oxazepam in the treatment of alcohol withdrawal: a double-blind study. Alcohol Alcohol. 1992;27:153–158.Google Scholar
30.Malcolm, R, Ballenger, JC, Sturgis, ET, Anton, R. Double blind controlled trial comparing carbamazepine to oxazepam treatment of alcohol withdrawal. Am J Psychiatry. 1989;146:617–621.Google ScholarPubMed
31.Myrick, H, Malcolm, R. Gabapentin in the treatment of alcohol withdrawal. Am J Psychiatry. 1998;155:1632.CrossRefGoogle ScholarPubMed
32.Koppi, S, Eberhardt, G, Haller, R, Konig, P. Calcium channel-blocking agent in the treatment of acute alcohol withdrawal-caroverine vs meprobamate in a randomized double-blind study. Neurospychobiology. 1987;17:49–52.Google Scholar
33.Banger, M, Benkert, O, Roschke, J, et al.Nimodipine in acute alcohol withdrawal state. J Psychiatr Res. 1992;26:117–123.CrossRefGoogle ScholarPubMed
34.Rothstein, L. Prevention of alcohol withdrawal seizures: the roles of diphenylhydantoin and chlorodiazepoxide. Am J Psychiatry. 1973;130:1381–1432.CrossRefGoogle Scholar
35.Chance, JF. Emergency department treatment of alcohol withdrawal seizures. Ann Emerg Med. 1991;20:520–522.CrossRefGoogle ScholarPubMed
36.Hersh, D, Kranzler, HR, Meyer, RE. Persistent delirium following cessation of heavy alcohol consumption: diagnostic and treatment implications. Am J Psychiatry. 1997;154:846–851.Google ScholarPubMed
37.Liskow, BI, Rinck, C, Campbell, J, DeSouza, C. Alcohol withdrawal in the elderly. J Stud Alcohol. 1989;50:414–421.CrossRefGoogle ScholarPubMed
38.Thompson, WL. Management of alcohol withdrawal syndromes. Arch Intern Med. 1975;138:278–283.CrossRefGoogle Scholar