Benzodiazepine-Sparing Alcohol Withdrawal Protocol Pilot in Postsurgical Head and Neck Cancer Patients

Alcohol use disorder is associated with high rates of morbidity and mortality in hospitalized patients. Patients with head and neck cancer have rates of comorbid alcohol use as high as 30% to 60%. Traditionally, withdrawal is managed by assessing symptoms with the Clinical Institute Withdrawal Assessment (CIWA) and treating with benzodiazepines. Benzodiazepines perpetuate neurotransmitter dysregulation in alcohol withdrawal, but valproic acid can correct dysregulations of glutamic and GABAergic systems.

We conducted an IRB-approved retrospective chart review of patients admitted from January 2019 to February 2020 who were admitted for head or neck cancer surgery and had concurrent diagnoses of alcohol use disorder. We reviewed cases of patients who received nonbenzodiazepine withdrawal treatments (gabapentin, valproic acid) and compared them to patients who received benzodiazepine tapers.

In the benzodiazepine population, 60% of patients underwent active alcohol withdrawal. Of these, 66.7% were given as-needed benzodiazepines based on CIWA scores. In the benzodiazepine-sparing group, 50% received valproic acid and 50% received gabapentin. Only 1 had an elevated CIWA score above 8, and only 1 patient had a dose of lorazepam (for agitation).

This preliminary data demonstrates improvement in outcomes, increased control over withdrawal symptoms, and minimization of episodes of agitation and rates of delirium.

In patients with significant medical comorbidities, the utilization of a benzodiazepine-sparing protocol is protective against withdrawal. We have found benefit from proactive utilization of a benzodiazepine-sparing protocol versus a traditional CIWA-based reactive treatment model for alcohol withdrawal.