BOSTON — An extensive study of VA patients concluded that the best way to manage alcohol withdrawal in hospitalized settings is the use of long-acting benzodiazepines with symptom-triggered therapy, as recommended in American Society of Addiction Medicine (ASAM) guidelines.
The research led by the VA Boston Healthcare System in West Roxbury, MA, and Harvard Medical School in Boston pointed out that few studies describe contemporary alcohol withdrawal management in hospitalized settings or review current practices considering the guidelines by the ASAM. Numerous VAMCs also participated in the study.
The study team conducted a retrospective cohort study of patients hospitalized with alcohol withdrawal on medical or surgical wards in 19 VHA hospitals between Oct. 1, 2018, and Sept. 30, 2019. The researchers obtained demographic and comorbidity data from the VHA’s Corporate Data Warehouse. Chart review was used to obtain inpatient management and hospital outcomes, and factors associated with treatment duration and complicated withdrawal were examined.
Of the 594 patients included in this study, reported in the Journal of Addiction Medicine, 51% were managed with symptom-triggered therapy alone, 26% with fixed dose plus symptom-triggered therapy, 10% with front-loading regimens plus symptom-triggered therapy, and 3% with fixed dose alone.1
Most of the patients were prescribed lorazepam (87%) followed by chlordiazepoxide (33%), diazepam (14%) and phenobarbital (6%).
The results indicated that symptom-triggered therapy alone (relative risk [RR], 0.68; 95% confidence interval [CI], 0.57-0.80) and front-loading with symptom-triggered therapy (RR, 0.75; 95% CI, 0.62-0.92) were associated with reduced treatment duration. “Lorazepam (RR, 1.20; 95% CI, 1.02-1.41) and phenobarbital (RR, 1.28; 95% CI, 1.06-1.54) were associated with increased treatment duration,” the authors advised. “Lorazepam (adjusted odds’ ratio, 4.30; 95% CI, 1.05-17.63) and phenobarbital (adjusted odds’ ratio, 6.51; 95% CI, 2.08-20.40) were also associated with complicated withdrawal.”
The researchers noted that, overall, their results support guidelines by the ASAM to manage patients with long-acting benzodiazepines using symptom-triggered therapy. “Healthcare systems that are using shorter acting benzodiazepines and fixed-dose regimens should consider updating alcohol withdrawal management pathways to follow ASAM recommendations,” they suggested.
- Ronan MV, Gordon KS, Skanderson M, Krug M, et. Al. Contemporary Management and Outcomes of Veterans Hospitalized With Alcohol Withdrawal: A Multicenter Retrospective Cohort Study. J Addict Med. 2024 Mar 7. doi: 10.1097/ADM.0000000000001297. Epub ahead of print. PMID: 38452185.
