Objectives of Alcohol Withdrawal Services
Research suggests that withdrawal treatment alone has little, if any, impact on long-term alcohol use. Withdrawal management should not be seen as a stand-alone treatment that is likely to result in prolonged periods of abstinence, but instead as a transitional step on the long road to abstinence. Unfortunately, many patients, families, friends, and health and welfare professionals hold unrealistic expectations about the outcomes of withdrawal services. Many are disappointed when people in these programs either cannot entirely give up drinking, or recommence regular drinking soon after a withdrawal attempt.
Alcohol withdrawal may be planned (an individual voluntarily presenting for treatment), or unplanned (following unintended discontinuation of alcohol use for example, hospitalisation or incarceration). Unplanned withdrawal tends to be most severe.
A realistic set of objectives for withdrawal services is as follows:
To interrupt a pattern of heavy and regular alcohol use. Some people require the structure and support of withdrawal services in order to stop drinking. While many people have a longer-term goal of achieving abstinence, others may be seeking a temporary break from their alcohol use.
To alleviate withdrawal symptoms. Relief of the discomfort of alcohol withdrawal symptoms is an important reason for patients presenting for treatment, and one of the primary aims of withdrawal services.
To prevent severe withdrawal complications. Management of alcohol withdrawal aims to prevent or manage potentially life-threatening complications such as seizures, delirium and Wernicke’s encephalopathy. Furthermore, alcohol withdrawal can complicate concomitant medical or psychiatric conditions.
To facilitate links to ongoing treatment for alcohol dependence or other alcohol-related disorders. Alcohol dependence is a chronic relapsing condition, and positive long-term outcomes are more often associated with participation in ongoing treatment such as counselling, self-help residential rehabilitation and pharmacological (see Chapter 6, Chapter 9 and Chapter 10). Managed withdrawal provides an opportunity to plan and engage in post-withdrawal treatment services. It may also support treatment of associated medical disorders (see Chapter 22) such as poorly controlled hypertension, abnormal liver function tests (LFTs), poor glycaemic control in diabetic, mental disorders (see Chapter 21), and assist investigation of cognitive decline/early dementia (Chapter 19).
To facilitate treatment of other disorders. Withdrawal may be planned to prepare for elective surgery, or treatment of cancer or other disorders unrelated to alcohol use.
To get help with any other problems. While some people will be unwilling or unable to continue in ongoing drug treatment programs, they may benefit from establishing links with primary or specialist health services or welfare services (for example, accommodation, employment services).
|Grade of recommendation
|Successful completion of alcohol withdrawal does not prevent recurrent alcohol consumption and additional interventions are needed to achieve long-term reduction in alcohol consumption.
|Realistic goals of clinicians, patients and their carers for withdrawal services include: interrupting a pattern of heavy and regular alcohol use, alleviating withdrawal symptoms, preventing severe withdrawal complications, facilitating links to ongoing treatment for alcohol dependence including pharmacotherapy, providing help with any other problems (such as accommodation, employment services).