Alcohol Dependence Syndrome

Occurs when an individual is physically or psychologically dependent upon alcohol

Clinical presentation of alcohol withdrawal

• First symptoms occur within hours and peak at 24-48 hours

• Restlessness, tremor, sweating, anxiety, nausea and vomiting, loss of appetite and insomnia

• Tachycardia and systolic hypertension evident

• Generalised seizures usually in first 24 hours

• Can progress to the medical emergency Delirium Tremens
• 5% of cases
• Peak onset within 2 days of abstinence
• Often presents insidiously with night time confusion
• Confusion, disorientation, agitation, hypertension, fever, visual and auditory hallucinations, paranoid ideation
• Mortality 2-5% (with medical support - higher without)

• In most cases symptoms resolve in 5-7 days

Investigations

• 3 or more present have been present together at some time during the use of previous year:
• Strong desire or sense of compulsion to take drug
• Difficulty in controlling use of substance in terms of onset, termination, or level of use
• Physiological withdrawal state
• Evidence of tolerance
• Progressive neglect of other pleasures/interests because of use/effects of substance
• Persistence with use despite clear evidence of harmful consequences

Management

• General support - reassurance, advice etc.

• Benzodiazepines - long acting agents, titrate against severity of symptoms, reduce gradually over 7 days

• Vitamin supplementation including thiamine as prophylaxis against Wenicke's encephalopathy
• Must be parenteral
• Increase dose if Wernicke's suspected

• Relapse prevention