Treatment for Alcohol Withdrawal Is Poor Despite Proven Therapies

Evidence-based practice guidelines are clear that patients at risk for alcohol withdrawal should be monitored and treated with benzodiazepines if the risk is high enough or symptoms are substantial. In a retrospective record review, researchers studied the implementation of such an approach—symptom-triggered therapy—at 2 large general hospitals on 124 inpatients from over 40 different specialty services. The protocol required that patients be able to communicate.

• More than half of patients (52%) were treated inappropriately.

• Thirty-five had no recent heavy alcohol use and therefore were not at risk for withdrawal, 9 could not communicate well, and 20 had neither recent heavy drinking nor were able to communicate.

• Eleven patients had adverse outcomes (i.e., seizure, delirium, death), 7 of whom had received inappropriate treatment.

Comments:

People who have not been drinking heavily recently cannot have and should not be treated for alcohol withdrawal. People who cannot communicate can and sometimes should receive withdrawal treatment but not using a symptom scale that requires verbal communication. Known effective treatments exist for alcohol withdrawal, and they are quite straightforward. If this report is in any way representative of other hospitals in the US, we have a large challenge to appropriately implementing care for this common condition.

Richard Saitz, MD, MPH

Reference:

Hecksel KA, Bostwick JM, Jaeger TM, et al. Inappropriate use of symptom-triggered therapy for alcohol withdrawal in the general hospital. Mayo Clin Proc. 2008;83(3):
274–279.