Diagnosis and treatment of acute alcohol intoxication and alcohol withdrawal syndrome: position paper of the Italian Society on Alcohol
- 1.1k Downloads
The chronic use of alcohol can lead to the onset of an alcohol use disorder (AUD). About 50% of subjects with an AUD may develop alcohol withdrawal syndrome (AWS) when they reduce or discontinue their alcohol consumption and, in 3–5% of them, convulsions and delirium tremens (DTs), representing life-threatening complications, may occur. Unfortunately, few physicians are adequately trained in identifying and treating AWS. The Italian Society on Alcohol has, therefore, implemented a task force of specialists to draw up recommendations for the treatment of AWS with the following main results: (1) while mild AWS may not require treatment, moderate and severe AWS need to be pharmacologically treated; (2) out-patient treatment is appropriate in patients with mild or moderate AWS, while patients with severe AWS need to be treated as in-patients; (3) benzodiazepines, BDZs are the “gold standard” for the treatment of AWS and DTs; (4) alpha-2-agonists, beta-blockers, and neuroleptics may be used in association when BDZs do not completely resolve specific persisting symptoms of AWS; (5) in the case of a refractory form of DTs, the use of anaesthetic drugs (propofol and phenobarbital) in an intensive care unit is appropriate; (6) alternatively to BDZs, sodium oxybate, clomethiazole, and tiapride approved in some European Countries for the treatment of AWS may be employed for the treatment of moderate AWS; (7) anti-convulsants are not sufficient to suppress AWS, and they may be used only in association with BDZs for the treatment of refractory forms of convulsions in the course of AWS.
KeywordsAcute alcohol intoxication Alcohol withdrawal syndrome Pharmacological treatment
Compliance with ethical standards
Conflict of interest
The author(s) declare that they have no conflict of interest.
Statement of human and animal rights
The Italian Society on Alcohol has followed the Ethical Statements required for a review paper.
For this type of study formal consent is not required.
- 1.World Health Organization (WHO) (2014) Global status report on alcohol and health. World Health Organization, GenevaGoogle Scholar
- 3.Grant BF, Goldstein RB, Saha TD, Chou SP, Jung J, Zhang H, Pickering RP, Ruan WJ, Smith SM, Huang B, Hasin DS (2015) Epidemiology of DSM-5 alcohol use disorder: results from the national epidemiologic survey on alcohol and related conditions III. JAMA Psychiatry 72:757–766CrossRefPubMedPubMedCentralGoogle Scholar
- 7.Istituto Superiore di Sanità (2002) National programme of guidelines. Istituto Superiore di Sanità, RomeGoogle Scholar
- 13.Rolland B, Paille F, Gillet C, Rigaud A, Moirand R, Dano C, Dematteis M, Mann K, Aubin HJ (2016) Pharmacotherapy for alcohol dependence: the 2015 recommendations of the French alcohol society, issued in partnership with the european federation of addiction societies. CNS Neurosci Ther 22:25–37CrossRefPubMedGoogle Scholar
- 14.Soyka M, Kranzler HR, Hesselbrock V, Kasper S, Mutschler J, Möller HJ, WFSBP Task Force on Treatment Guidelines for Substance Use Disorders (2017) Guidelines for biological treatment of substance use and related disorders, part 1: alcoholism, first revision. World J Biol Psychiatry 18:86–119CrossRefPubMedGoogle Scholar
- 15.Schuckit MA (2006) Drug and alcohol abuse. A clinical guide to diagnosis and treatment, 6th edn. Springer, New YorkGoogle Scholar
- 22.Ministry of Health (2017) Annual Report of the Ministry of Health to the Parliament about the interventions on alcohol related problemsGoogle Scholar
- 24.Arnaud N, Diestelkamp S, Wartberg L, Sack PM, Daubmann A, Thomasius R (2017) Short to midterm effectiveness of brief motivational intervention to reduce alcohol use and related problems for alcohol intoxicated children and adolescents in pediatric emergency department: a randomized controlled trial. Acad Emerg Med 24:186–200CrossRefPubMedGoogle Scholar
- 30.Amato L, Minozzi S, Davoli M (2011) Efficacy and safety of pharmacological interventions for the treatment of the Alcohol Withdrawal Syndrome. Cochrane Database Syst Rev 6:CD008537Google Scholar
- 35.Attilia F, Perciballi R, Rotondo C, Capriglione I, Iannuzzi S, Attilia ML, Coriale G, Vitali M, Cereatti F, Fiore M, Ceccanti M, interdisciplinary study group CRARL, SITAC, SIPAD, SITD, SIPD (2018) Alcohol withdrawal syndrome: diagnostic and therapeutic methods. Sindrome astinenziale da alcol: processi diagnostici e terapeutici. Riv Psichiatr 53:118–122PubMedGoogle Scholar
- 38.Sarai M, Tejani AM, Chan AH, Kuo IF, Li J (2013) Magnesium for alcohol withdrawal. Cochrane Database Syst Rev 6:CD008358Google Scholar
- 42.Muncie HL Jr, Yasinian Y, Oge’ L (2013) Outpatient management of alcohol withdrawal syndrome. Am Fam Phys 88:589–595Google Scholar
- 52.Agence nationale de sècuritè du mèdicament (ANSM) (2017) Recommandation temporaire d'utilisation (RTU) du balcofene dans la prise en charge des patients alcoolo-dependantsGoogle Scholar
- 55.Leone MA, Vigna-Taglianti F, Avanzi G et al (2010) Gamma-hydroxybutyrate (GHB) for treatment of alcohol withdrawal and prevention of relapses. Cochrane Database Syst Rev 2:CD006266Google Scholar
- 63.Agabio R, Leite-Morris K, Addolorato G, Colombo G (2016) Targeting the GABAB receptor for the treatment of alcohol use disorder. In: Colombo G (ed) GABAB receptor. Springer, ChamGoogle Scholar
- 65.Liu J, Wang LN (2017) Baclofen for alcohol withdrawal. Cochrane Datatabase Syst Rev 8:008502Google Scholar
- 71.Murphy DJ, Shaw GK, Clarke I (1983) Tiapride and chlormethiazole in alcohol withdrawal: a double-blind trial. Alcohol Alcohol 18:227–237Google Scholar
- 74.Martinotti G, di Nicola M, Frustaci A, Romanelli R, Tedeschi D, Guglielmo R, Guerriero L, Bruschi A, De Filippis R, Pozzi G, Di Giannantonio M, Bria P, Janiri L (2010) Pregabalin, tiapride and lorazepam in alcohol withdrawal syndrome: a multi-centre, randomized, single-blind comparison trial. Addiction 105:288–299CrossRefPubMedGoogle Scholar
- 75.Minozzi S, Amato L, Vecchi S, Davoli M (2010) Anticonvulsants for alcohol withdrawal. Cochrane Database Syst Rev 3:CD005064Google Scholar
- 84.Caputo F, Francini S, Stoppo M, Lorenzini F, Vignoli T, Del Re A, Comaschi C, Leggio L, Addolorato G, Zoli G, Bernardi M (2009) Incidence of craving for and abuse of gamma-hydroxybutyric acid (GHB) in different populations of treated alcoholics: an open comparative study. J Psychopharmacol 23:883–890CrossRefPubMedGoogle Scholar