Alcohol Withdrawal Treatment in the Medically Hospitalized Patient: A Pilot Study Assessing Predictors for Medical or Psychiatric Complications

Psychosomatics. Sep-Oct 2015;56(5):547-55. doi: 10.1016/j.psym.2014.12.002. Epub 2014 Dec 7.

Abstract

Background: Optimizing alcohol withdrawal treatment is a clinical priority, yet it is difficult to predict on presentation which patients would require benzodiazepines or in which patients withdrawal would be complicated. Detoxification studies typically exclude patients with medical comorbidities, psychiatric comorbidities, or multiple substance use disorders; therefore, it is difficult to generalize their conclusions to all types of patients.

Objective: This retrospective study with no exclusion criteria identifies the risk factors for complicated withdrawal.

Methods: A retrospective medical record review of 47 veterans admitted to a tertiary veteran's medical hospital for alcohol detoxification. Demographics, blood alcohol level, Charlson Comorbidity Index, drinks per drinking day, pre-psychiatry consult benzodiazepine administration, and length of stay were compared for veterans with complications vs those without.

Results: Overall, 21% patients experienced significant complications during their medically-managed detoxification, including behavioral disruptions and delirium tremens. Of the patients, 79% were initially assessed using the Clinical Institute Withdrawal Assessment for Alcohol-Revised scale, and 34% continued to be monitored with the Clinical Institute Withdrawal Assessment for Alcohol-Revised scale during their hospital stay. A Clinical Institute Withdrawal Assessment for Alcohol-Revised scale score ≥15 at presentation was significantly associated with increased odds of complications (p = 0.005). There was a trend toward significance of association of complications with tachycardia, history of delirium tremens, and benzodiazepines being administered before psychiatric consultation. The groups did not significantly differ with respect to age, admission blood alcohol level, Charlson Comorbidity Index, comorbid recent substance abuse, or length of stay.

Conclusion: Clinical Institute Withdrawal Assessment for Alcohol-Revised scale scores ≥15 at presentation was significantly associated with increased odds of complicated alcohol withdrawal (odds ratio = 28, 95% CI: 2.5-317.6, p = 0.005), which supports findings from previous studies.

MeSH terms

  • Alcohol Withdrawal Delirium / drug therapy
  • Alcoholism / complications*
  • Benzodiazepines / therapeutic use
  • Comorbidity
  • Hospitalization
  • Humans
  • Male
  • Middle Aged
  • Pilot Projects
  • Retrospective Studies
  • Risk Factors
  • Substance Withdrawal Syndrome / complications*
  • Substance Withdrawal Syndrome / drug therapy
  • Treatment Outcome
  • Veterans

Substances

  • Benzodiazepines