Clinical management of alcohol withdrawal: A systematic review
Open accessAbstract
Alcohol withdrawal is commonly encountered in general hospital settings. It forms a major part of referrals received by a consultation-liaison psychiatrist. This article aims to review the evidence base for appropriate clinical management of the alcohol withdrawal syndrome. We searched Pubmed for articles published in English on pharmacological management of alcohol withdrawal in humans with no limit on the date of publication. Articles not relevant to clinical management were excluded based on the titles and abstract available. Full-text articles were obtained from this list and the cross-references. There were four meta-analyses, 9 systematic reviews, 26 review articles and other type of publications like textbooks. Alcohol withdrawal syndrome is a clinical diagnosis. It may vary in severity. Complicated alcohol withdrawal presents with hallucinations, seizures or delirium tremens. Benzodiazepines have the best evidence base in the treatment of alcohol withdrawal, followed by anticonvulsants. Clinical institutes withdrawal assessment-alcohol revised is useful with pitfalls in patients with medical comorbidities. Evidence favors an approach of symptom-monitored loading for severe withdrawals where an initial dose is guided by risk factors for complicated withdrawals and further dosing may be guided by withdrawal severity. Supportive care and use of vitamins is also discussed.
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Most patients still have a strong craving for alcohol during abstinence, even after receiving standardized in-patient treatment.
“However, most patients still have a strong craving for alcohol during abstinence, even after receiving standardized in-patient treatment.”
From Research protocol of the efficacy of probiotics for the treatment of alcohol use disorder among adult males: A comparison with placebo and acceptance and commitment therapy in a randomized controlled trial (2023) · cites this paper as [5]
The Abstract discusses symptoms after stopping alcohol, and the Detoxification section describes treatment to reduce withdrawal symptoms and support abstinence. Searches for craving and for persistent desire to drink after inpatient treatment found no passage saying that most patients have strong cravings despite treatment. (LLM, conf=0.76)
Experimental — accuracy not yet measuredPsychological dependence on alcohol is hard to resist, so it is extremely difficult to maintain long-term abstinence, and alcohol use disorder is prone to relapse.
“This psychological dependence on alcohol is hard to resist, so it is extremely difficult to maintain long-term abstinence, and AUD is prone to relapse [5, 6].”
From Research protocol of the efficacy of probiotics for the treatment of alcohol use disorder among adult males: A comparison with placebo and acceptance and commitment therapy in a randomized controlled trial (2023) · cites this paper as [5]
The Abstract and the Detoxification section discuss physical withdrawal symptoms and short-term management of abstinence. Searches for psychological dependence, difficulty maintaining long-term abstinence, and relapse found no passage in our copy addressing those claims. (LLM, conf=0.72)
Experimental — accuracy not yet measured
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- Authors
- Bharadwaj, B., & Kattimani, S.
- Affiliations
- Jawaharlal Institute of Post Graduate Medical Education and Research (IN)
- Corresponding author
- Bharadwaj, Balaji
- Venue
- Industrial Psychiatry Journal
- Published
- 2013
- Volume
- 22
- Issue
- 2
- Pages
- 100
- ISSN
- 0972-6748 (ISSN-L)
- PMC
- PMC4085800
- OpenAlex
- W2059915772
- Cited by
- 154
- References
- 49
- Citations by year
- 2026: 10 · 2025: 15 · 2024: 16 · 2023: 24 · 2022: 16 · 2021: 12 · 2020: 17 · 2019: 10 · 2018: 6 · 2017: 12 · 2016: 7 · 2015: 8 · 2014: 1
- FWCI
- 0.70
- Type
- journal article
- Language
- en
- Open access
- gold
- doi.org
- Licence
- cc-by-nc-sa
- Locations
- Industrial Psychiatry Journal (publishedVersion, cc-by-nc-sa)
- PubMed Central (publishedVersion, cc-by-nc-sa)
- PubMed (publishedVersion)
- DOAJ (DOAJ: Directory of Open Access Journals) (submittedVersion, cc-by-sa)
- Topics
- Health Sciences › Medicine › Neurology › Alcoholism and Thiamine Deficiency
- Health Sciences › Medicine › Epidemiology › Substance Abuse Treatment and Outcomes
- Health Sciences › Medicine › Pathology and Forensic Medicine › Alcohol Consumption and Health Effects
- Keywords
- alcohol withdrawal, benzodiazepines, antiepileptic drugs, delirium tremens, hallucinations, CAGE questionnaire, supportive care, vitamins, psychosomatic medicine
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