Review of Abstinence Syndrome: A Comprehensive Analysis of Current Practices and Recommendations

Lolla Siddhartha *

Department of Pharmacy Practice, Pullareddy Institute of Pharmacy, Jawaharlal Nehru Technology University, Dundigal, Hyderabad-500043, India.

Jemini Charan

Department of Pharmacy Practice, Pullareddy Institute of Pharmacy, Jawaharlal Nehru Technology University, Dundigal, Hyderabad-500043, India.

Nanna Saraswathi

Department of Pharmacy Practice, Pullareddy Institute of Pharmacy, Jawaharlal Nehru Technology University, Dundigal, Hyderabad-500043, India.

Todima Deepika

Department of Pharmacy Practice, Pullareddy Institute of Pharmacy, Jawaharlal Nehru Technology University, Dundigal, Hyderabad-500043, India.

Kolupula Shireesha

Department of Pharmacy Practice, Pullareddy Institute of Pharmacy, Jawaharlal Nehru Technology University, Dundigal, Hyderabad-500043, India.

Sunkari Rachana

Department of Pharmacy Practice, Pullareddy Institute of Pharmacy, Jawaharlal Nehru Technology University, Dundigal, Hyderabad-500043, India.

*Author to whom correspondence should be addressed.


Abstract

Alcohol use disorder is frequently accompanied with the diverse and sometimes fatal consequence of alcohol withdrawal syndrome (AWS). Many patients with AUD may develop AWS during their Emergency Department stay, and AUD is one of the top causes of death worldwide. This study summarizes the etiology, epidemiology, and emergency management of Alcohol Withdrawal Syndrome and Alcohol Use Disorder.The influence of AWS on the therapy of ED is highlighted, along with its temporal course. Once AWS is diagnosed, the most common therapy is still symptom- triggered benzodiazepine injection; however, patients who have significant medical or psychiatric comorbidities or are about to be discharged may not be good candidates for this approachIn these circumstances, emergency department doctors can consider employing alternative regimens based on state-of-the-art anticonvulsants or shorter barbiturate durations. For clinical practice, specific treatment procedures are described. Lastly, in addition to managing acute patients' AWS, emergency physicians also need to provide the groundwork for effective AUD therapy. A strategy for the patient with AUD's disposition is offered.

Keywords: Phenobarbital, gabapentin, alcohol use disorder, benzodiazepines, and alcohol withdrawal syndrome


How to Cite

Siddhartha , L., Charan , J., Saraswathi , N., Deepika , T., Shireesha , K., & Rachana , S. (2024). Review of Abstinence Syndrome: A Comprehensive Analysis of Current Practices and Recommendations. International Journal of TROPICAL DISEASE & Health, 45(5), 1–11. https://doi.org/10.9734/ijtdh/2024/v45i51529

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References

Sachdeva A, Chowdary M, Chandra M. Alcohol Withdrawal Syndrome: Benzodiazepines and Beyond. J Clin Diagn Res. 2015 sept;9(9):VE01-VE 07 DOI:10.7860/JCDR/2015/13407.6538

Melson J, Kane M, Mooney R. Mc Williams J, Horton T5. Improving alcohol withdrawal outcomes in acute care. Prem J. 2014 Spring;18(2);e141-5 DOI:10.7812/TPP/13-099

Ito H. Intermediate to Long-term Results of Periacetabular Osteotomy in Patients Younger and older than 40years of Age. J Alcohol Drug Depend. 2016;4:235.

Zago P et al. Alcohol Use Disorder and Inflammatory Cytokinesis in a Population Sample of Young Adults. J Alcohol Drug Depend. 2016;4:236.

Montalto M. How Have Academic Theories of Domestic Violence Influenced Western 2016;4:237 .

HiranitaT.(-)-Trans-9 Tetrahydrocannabinol-Like Discrimitive-stimulus effects of Gabapentin in Cannabis Users . J Alcohol Drug Depend. 2016;4:e129.

Schmidt KJ, Doshi MR, Holzhausen JM et al. Treatment of Severe Alcohol Withdrawal. Ann Pharmacother 2016;50(5):389-401.

Awissi DK, Lebrun G, Coursin DB et al. Alcohol Withdrawal and Delirium tremens in the critically ill: A systematic review and commentary. Intensive Care Med. 2013;39(1):16-30.

Mckeon, Frye and Delanty; 2008.

White AM, Slater ME, Ng G, Hingson R, Breslow, R. Trends in alcohol related Emergency department visits in the United States:Results from Nationwide Emergence Department Sample, 2006-2014. Alcohol Clin Exp Res. 2018;42(2):352-359. DOI:10.1111/acer.2018.42.issue-2

Klein LR. Cole JB, Driver BE, Battista c, Jelinek R, Martel ML. Unsuspected critical illness among emergency Dept patients presenting for acute alcohol intoxication. Ann. Emerg Med. 2018;71(3):279- 288.

American Psychiatric Association. Diagnostic and Statistical Manual of Mental Disorders. 5th ed. Arlington VA; American Psychiatric Association. 2013;501.

Clinical Manifestations of Complicated Alcohol withdrawal and uncomplicated alcohol withdrawal: A comparative study- Alcohol Withdrawal Syndrome- American Family Physician 69,1443-1450.

WHO. Management of Substance Abuse Team. Global status report on alcohol and health; 2014 Available:http://apps.who.int/iris/bitstream/10665/112736/1/9798240692763-eng.pdf?ua=1 Accessed 20 Aug 2014

WHO Management of Substance Abuse Team. Global status report on alcohol and health. Geneva: WHO;2011.

Yanta JH. Swartzentruber GS Pizon AF. Alcohol Withdrawal Syndrome: Improving outcomes through early identification and aggression treatment strategies. Emerged Practical. 2015 June;17(6):1-18;quiz 19

Organization WHO Global status report on alcohol and health 2018, WHO :2019

Pession F, Ramond MJ, Peters et al. Five year survival predictive factors in patients with excessive alcohol intake and cirrhosis: Effect of alcoholic hepatitis smoking and absitenence. Liver Int 2003:23:4.5-53.

Voskoboinik A, Prabhu S, Ling LH, Kalman JM, Kistler J AM Coll Cardiol. 2016;2567-76.

Turner RC, Lichstein PR, Peden JG Jr, Busher JT, Waivwers LE, Alcohol Withdrawal Syndrome; A review of the pathophysiology, clinical presentation and treatment J. Gen Intern Med. 1989;4:432 444.

Clapp P, Bhave SV, Hoffman PL. How adaptation of the brain to alcohol leads to dependence; A pharmacological perspective. Alcohol Res Health. 2008;31:310-339.

Long D, Long B, Koyfman A. The emergence medicine management of server alcohol withdrawal. Am J Emergence Med; 2017.

Long D, Long B. Kolffman A. The emergency medicine management of severe alcohol withdrawal. Am J Emerg Med. 2014;35:1005-1011 DOI: 10.1016/j.ajem 2017.02.002

Cohen B. Theory & Practice ६ of physchraby. NewYork NY: Oxford University Prett 1; 2003.

Mingello A. D'Angelo (Ferrulle A et al. Identification & management of alcohol withdrawal Sy. Drug 2015 75 (u) 13153-365 DOI. 10.1007/s40265-015-0358-1

Stephane M Amarut B. Yoon & Alcohol withdrawal hallucination? In general population an epidemiological study Psychialty Res. 2018;262:129-134. DOI: 10.1016// psycheres. 2018.02.031 2

Maldonado J. Sher Y. Das S et al. Prospective Validation of Prediction of Alcohol withdrawal Severity Scale (PAWSs) in medically ill so patients a new scale for Prediction of complicated AWS alcohol alcoholism. 2015;50(5):509-5/8 DOI:10 1093/ alcohol / agv 043

Perry EC. Inpatient management of acute alcohol withdrawal syndrome. CNS Drugs. 2014;28:401–410.

EPUB 2014/05/02

Kattimani S, Bharadwaj B. Clinical management of alcohol withdrawal: A systematic review. Ind Psychiatry J. 2013;22:100–108.

EPUB 2014/07/12

Berggren U, Fahlke C, Berglund KJ, Blennow K, Zetterberg H, Balldin J. Thrombocytopenia in early alcohol withdrawal is associated with development of delirium tremens or seizures. Alcohol Alcohol. 2009;44:382–386.

EPUB 2009/03/1

Goodson CM, Clark BJ, Douglas IS. Predictors of severe alcohol withdrawal syndrome: A systematic review and meta-analysis. Alcohol Clin Exp Res. 2014;38:2664–2677.

EPUB 2014/10/28.

Monte R, Rabunal R, Casariego E, Bal M, Pertega S. Risk factors for delirium tremens in patients with alcohol withdrawal syndrome in a hospital setting. Eur J Intern Med. 2009;20:690–694.

EPUB 2009/10/13.

Chelsea Wolf, Ashley Curry, Jacob Nacht, Scott A Simpson Management of Alcohol Withdrawal in the Emergency Department: Current Perspectives, Open Access Emergency Medicine. 2020; 53-65.

DOI: 10.2147/OAEM.S235288

Rathlev NK, Ulrich AS, Delanty N, D’Onofrio G. Alcohol-related seizures. J Emerg Med. 2006;31:157–163.

EPUB 2006/10/19.

Alcohol’s Effects on the Brain: Neuroimaging Results in Humans and Animal Models Natalie M. Zahr, Ph.D. and Adolf Pfefferbaum, M.D. PMCID: PMC5513685

NHS Website. 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(5):617–621.

Sachdeva A, Chandra M, Deshpande SN. A comparative study of fixed tapering dose regimen versus symptom-triggered regimen of lorazepam for alcohol detoxification. Alcohol. 2014;49 (3):287–291.

DOI:10.1093/alcalc/agt181 of Addiction

Kasser C, Geller A, Howell E, Wartenberg A. Detoxification: Principles and protocols. American Society and Medicine. Available:http://www.asam.org/pub1/detoxification.htm. [cited 2010 Sept 7].

Whitfield CL, Thompson G, Lamb A et al. Detoxification of 1,024 alcoholic patients without psychoactive drugs. JAMA 1978;239:1409-10

Flannery A, Adkins D, Cook A. Unpeeling the evidence for the banana bag: Evidence-based recommendations for the management of alcohol-associated vitamin and electrolyte deficiencies in the ICU. Crit Care Med. 2016;44(8):1545–1552 DOI:10.1097/CCM.000000000000 1659

Sharp C, Wilson M, Nordstrom K. Psychiatric emergencies for clinicians: Emergency department management of Wernicke-Korsakoff syndrome. J Emerg Med. 2016;51(4):401– 404. DOI:10.1016/j. jemermed.2016.05.044

Day E, Bentham P, Callaghan R, Kuruvilla T, George S. Thiamine for prevention and treatment of Wernicke-Korsakoff Syndrome in people who abuse alcohol. Cochrane Database System Rev. 2013;7. 45. Botswick J. Medication Table 6: Benzodiazepines. In: Chavez B, editor. CPNP Psychiatric Pharmacotherapy Review Course. 2018–2019 ed. Lincoln, NE: College of Psychiatric and Neurologic Pharmacists; 2018.

Koob GF. Alcoholism: Allostasis and beyond. Alcohol Clin Exp Res. 2003;27(2):232–43.

Tzschentke TM, Schmidt WJ. Glutamatergic mechanisms in addiction. Mol Psychiatry. 2003;8(4):373– 82.

Barrons R, Roberts N. The role of carbamazepine and oxcarbazepine in alcohol withdrawal syndrome. J Clin Pharm Ther. 2010;35:153– 167.

EPUB 2010/05/12.

Bonnet U, Hamzavi-Abedi R, Specka M, Wiltfang J, Lieb B, Scherbaum N. An open trial of gabapentin in acute alcohol withdrawal using an oral loading protocol. Alcohol Alcohol. 2010;45:143– 145.

EPUB 2009/12/19.

Krebs M, Leopold K, Richter C et al. Levetiracetam for the treatment of alcohol withdrawal syndrome: An open-label pilot trial. J Clin Psychopharmacol. 2006;26:347–349.

EPUB 2006/05/17.

Muller CA, Schafer M, Schneider S et al. Efficacy and safety of levetiracetam for outpatient alcohol detoxification. Pharmacopsychiatry. 2010;43:184–189.

EPUB 2010/05/27

Hoiseth G, Bernard JP, Stephanson N et al. Comparison between the urinary alcohol markers EtG, EtS, and GTOL/5-HIAA in a controlled drinking experiment. Alcohol Alcohol. 2008;43:187 191.

EPUB 2008/01/31

Bleich S, Bayerlein K, Hillemacher T, Degner D, Kornhuber J, Frieling H. An assessment of the potential value of elevated homocysteine in predicting alcohol-withdrawal seizures. Epilepsia. 2006;47:934–938.

EPUB 2006/05/12.

Burns E, Gray R, Smith LA. Brief screening questionnaires to identify problem drinking during pregnancy: A systematic review. Addiction. 2010;105:601–614.

EPUB 2010/04/21

Maldonado JR, Sher Y, Das S et al. Prospective Validation Study of the Prediction of Alcohol Withdrawal Severity Scale (PAWSS) in Medically Ill Inpatients: A New Scale for the Prediction of Complicated Alcohol Withdrawal Syndrome. Alcohol Alcohol. 2015;50:509–518.

EPUB 2015/05/23.

Hillemacher T, Frieling H, Wilhelm J et al. Indicators for elevated risk factors for alcoholwithdrawal seizures: An analysis using a random forest algorithm. J Neural Transm. 2012;119:1449–1453.

EPUB 2012/05/25

Maldonado JR, Sher Y, Ashouri JF et al. The “Prediction of Alcohol Withdrawal Severity Scale” (PAWSS): Systematic literature review and pilot study of a new scale for the prediction of complicated alcohol withdrawal syndrome. Alcohol. 2014;48:375–390.

EPUB 2014/03/25

Pieninkeroinen IP, Telakivi TM, Hillbom ME. Outcome in subjects with alcohol-provoked seizures. Alcohol Clin Exp Res. 1992;16:955– 959.

EPUB 1992/10/01

Nair PP, Kalita J, Misra UK. Status epilepticus: Why, what, and how. J Postgrad Med. 2011;57:242–252.

EPUB 2011/09/24.

G, Liang Y, Zhou J. A wide spectrum of variably periictal MRI abnormalities induced by a single or a cluster of seizures. J Neurol Sci. 2014;343:167–172.

EPUB 2014/06/22.

Ojutkangas R, Gillman MA. Psychotropic analgesic nitrous oxide for treating alcohol withdrawal in an outpatient setting. Int J Neurosci 1994;76: 35-9.

Gillman MA, Lichtigfeld FJ. Analgesic nitrous oxide for alcohol withdrawal: A critical appraisal after 10 years’ use. Postgrad Med J. 1990;66:5.

Gillman MA, Lichtigfeld FJ. The drug management of severe alcohol withdrawal syndrome. PostgradMed J. 1990;66:1005-9.

Gorski TT, Miller M. Counselling for Relapse Prevention. Inneoendence, MO:Herald House/Independence Press;1982.

A systemic review of modified electroconvulsive therapy to treat delirium Katie Lupke, Nicola Warren, Andrew Tedorczuk, Saraah Steele, Uday Kalour, Annie Wand, Gali Robinson, Stephen Parker Available:https://doi.org.10.1111.acps.13492

A systemic review of modified electroconvulsive therapy to treat delirium Katie Lupke, Nicola Warren, Andrew Tedorczuk, Saraah Steele, Uday Kalour, Annie Wand, Gali Robinson, Stephen Parker Available:https://doi.org.10.1111.acps.13493

Alcohol Reha biltation.

Available: https://priorygroup/addiction treatment/alcohol rehab..https://www.addiction centre.co /treatment/cognitive-behavioural-therap.