Alcohol Withdrawal Syndrome: Benzodiazepines and Beyond
Open accessAbstract
Alcohol dependence is an increasing and pervasive problem. Alcohol withdrawal symptoms are a part of alcohol dependence syndrome and are commonly encountered in general hospital settings, in most of the departments. Alcohol withdrawal syndrome ranges from mild to severe. The severe complicated alcohol withdrawal may present with hallucinations, seizures or delirium tremens. Benzodiazepines have the largest and the best evidence base in the treatment of alcohol withdrawal, and are considered the gold standard. Others, such as anticonvulsants, barbiturates, adrenergic drugs, and GABA agonists have been tried and have evidence. Supportive care and use of vitamins is essential in the management. Symptom triggered regime is favoured over fixed tapering dose regime, although monitoring through scales is cumbersome. 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 'Alcohol withdrawal syndrome' in humans during the last 10 years. A total of 1182 articles came up. Articles not relevant to clinical utility and management were excluded based on the titles and abstract available. Full text articles, meta-analyses, systematic reviews and randomized controlled trials were obtained from this list and were considered for review.
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Monitoring and treatment of alcohol craving is an important link to improve the therapeutic effect of alcohol use disorder.
“the monitoring and treatment of alcohol craving is an important link to improve the therapeutic effect of AUD [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 [6]
The “6. Baclofen” section reports that baclofen reduced craving in alcohol-dependent patients. The paper discusses monitoring withdrawal symptoms, not monitoring craving, and does not say that monitoring and treating craving improves overall AUD treatment outcomes. (LLM, conf=0.82)
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 [6]
The paper describes impaired control over drinking (section labeled ABStRAct; page unavailable), and its Conclusion mentions patients with multiple failed attempts at abstinence (page unavailable). These support difficulty stopping or remaining abstinent, but the paper does not say that psychological dependence causes this difficulty or establish that AUD is generally prone to relapse. (LLM, conf=0.82)
Experimental — accuracy not yet measuredMost 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 [6]
The ‘Setting For detoxification’ section discusses when inpatient care is appropriate and notes that separating patients from alcohol-related stimuli may reduce relapse risk. It does not report that most patients have strong cravings during abstinence after standardized inpatient treatment. Searches for ‘craving’ and post-treatment abstinence found no passage addressing that claim; page numbers were unavailable in our copy. (LLM, conf=0.77)
Experimental — accuracy not yet measuredPsychological dependence is the key factor leading people to start drinking again after abstinence.
“Therefore, psychological dependence is the key factor leading to people start drinking again after abstinence”
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 [6]
The paper’s discussion of alcohol dependence describes withdrawal and impaired control over drinking, and its Alcohol Withdrawal Syndrome section describes symptoms after cessation. Neither addresses whether psychological dependence is the key reason people resume drinking after abstinence (searched: psychological dependence, relapse after abstinence). (LLM, conf=0.72)
Experimental — accuracy not yet measured
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- E-mail: mona.rmlh@gmail.com FinAnciAL or oTher coMPeTinG inTereSTS: None. Date of Submission: Feb 08, 2015 Date of Peer Review: Jun 08, 2015 Date of Acceptance: Jul 03, 2015 Date of Publishing: Sep 01, 2015
- Authors
- Sachdeva, A.
- Corresponding author
- Sachdeva, Ankur
- ORCID
- Sachdeva, Ankur
- Venue
- JOURNAL OF CLINICAL AND DIAGNOSTIC RESEARCH
- Publisher
- JCDR Research and Publications
- Published
- 2015
- Volume
- 9
- Issue
- 9
- Pages
- VE01-VE07
- ISSN
- 0973-709X (ISSN-L)
- 2249-782X
- PMC
- PMC4606320
- OpenAlex
- W2403049698
- Cited by
- 141
- References
- 83
- Citations by year
- 2026: 5 · 2025: 15 · 2024: 16 · 2023: 15 · 2022: 15 · 2021: 15 · 2020: 18 · 2019: 10 · 2018: 19 · 2017: 7 · 2016: 6
- FWCI
- 1.40
- Type
- journal article
- Language
- en
- Open access
- gold
- doi.org
- Licence
- cc-by-nc-nd
- Locations
- JOURNAL OF CLINICAL AND DIAGNOSTIC RESEARCH (publishedVersion, cc-by-nc-nd)
- PubMed Central (publishedVersion)
- 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, alcoholism, benzodiazepines, delirium tremens, hallucinations, seizures, antiepileptic drugs, barbiturates, adrenergic drugs, GABA agonists, supportive care, vitamin supplementation, withdrawal management
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