Pharmacotherapy of alcohol-withdrawal syndrome in hospitalised patients. Clinical and methodological aspects.

Abstract

Because of the unreliability of the alcoholic, these suggestions are only intended for inpatients. Effective agents are presented first, and then the often very different pharmacological concepts are critically reviewed. Physicians use target symptoms as checkpoints for the effective pharmacological treatment of the alcohol-withdrawal syndrome. Clomethiazole and benzodiazepines are regarded as proven monotherapeutics against delirium. However, their somatic side effects and above all the problems of drug dependence make it necessary to look for a lower-risk medication. In every case, physicians must look more closely into the possibility of treating the individual alcohol-withdrawal syndrome with an agent less liable to cause addiction. Attractive, adequately tested alternatives are now becoming available for the large number of withdrawal syndromes which are below the level of delirium in terms of severity. This paper discusses the significance of substances without dependence potential, e.g. carbamazepine. This aspect is of special interest for the psychiatrist, whose task it is to guarantee the patient's abstinence after detoxification. We also look at other possible advantages of these substances when given in combination with drugs of the alcohol-barbiturate group against severe alcohol-withdrawal syndromes. Following a discussion of priority questions for further research, we draw attention to methodological deficiencies in earlier evaluation studies, and make suggestions for improved designs of drug trials.