Development of optimal treatment tactics for alcohol withdrawal. I. Assessment and effectiveness of supportive care

The relative roles of supportive care and pharmacotherapy in the treatment of alcohol withdrawal are not established. A reliable and validated withdrawal severity assessment scale (Clinical Institute Withdrawal Assessment for Alcohol, CIWA-A) was developed to assess initially and then follow the clinical course of 38 hospitalized chronic alcoholics requiring hospitalization for withdrawal but without serious concurrent medical or surgical problems. Supportive care, consisting of standardized half-hourly patient assessment (CIWA-A) and nursing care, was used as the initial treatment for all patients. Twenty-eight (74%) patients with clinical supportive care successes within 8 hours, 75% within 4 hours. Two responding patients subsequently developed evidence of withdrawal at 48 hours (hallucinations) and 72 hours (seizure). Ten patients (26%) did not respond to supportive care and required drug therapy in addition. Responders to supportive care drink more by history and have less severe liver disease than nonresponders. There are no other apparent predictors of the patients who require drug therapy. Three quarters of hospitalized patients, without serious medical complications, in alcohol withdrawal respond to intensive supportive care. However, pharmacotherapy is essential for nonresponders and patients with hallucinations.