Abstract
Introduction
Alcohol withdrawal (AWS) is a life-threatening condition that can rapidly escalate to seizures and delirium tremens. Management of AWS typically involves benzodiazepine administration. However, some patients may not respond effectively to these medications. In April 2020 the Alcohol Care Team (ACT) at Sandwell and West-Birmingham NHS Trust (SWB) implemented an oral ethanol prescribing protocol to be used with patients at risk of severe AWS.
Aims
We sought to investigate the effects of oral ethanol on both subjective (patient experiences) and objective (CIWAR-Ar scores) measures of AWS.
Methods
Two cohorts of patients’ data were reviewed: 29 for CIWA score, 49 for patient survey. Data were collected as part of routine clinical care. The following variables were collected: alcohol use history, demographics (age, sex, ethnicity), AUDIT scores and CIWA-Ar scores (including dates and times), and patient outcomes from a perspectives questionnaire (including perceived impact of AWS symptoms and future drinking goals). Data were analyzed using SPSS; content analysis was used to explore qualitative responses to gain a deeper understanding of patients’ experiences.
Results
Objective measures: 20 patients’ data were included (75% between 25 and 49 years, 25% between 50 and 64 years, 90% were male). The median number of units consumed per day were 30-40. CIWA-Ar scores decreased or remained the same in 90% of patients with 83.3% recording a decrease between the first and last doses of ethanol administration (figure 1). All those who received between 8 and 10 doses of ethanol showed a decrease in CIWA-Ar score (table 1).
Subjective measures: 93.9% of patients reported symptom relief, and 91.8% would be willing to be treated with ethanol again. Of those who had been treated in the past with benzodiazepines, 69.5% of patients preferred ethanol. 56.8% reported an ongoing aim of abstinence and 34.1% reported intentions reduce alcohol use. Among those who disliked receiving ethanol 32% felt they were not given enough and 24% felt they had to wait too long before receiving ethanol. 78.7% felt confident or very confident with the team administering the ethanol and 95.5% felt the intervention was well explained to them.
Discussion and future directions
Oral ethanol led to effective objective and subjective reductions in AWS. Whilst limited in sample size this data suggests that oral ethanol could be an effective AWS management strategy, with high patient satisfaction, in certain individuals. Further research is needed in a greater number of patients improve our understanding of the impact of oral ethanol prescribing practice on AWS.
Alcohol withdrawal (AWS) is a life-threatening condition that can rapidly escalate to seizures and delirium tremens. Management of AWS typically involves benzodiazepine administration. However, some patients may not respond effectively to these medications. In April 2020 the Alcohol Care Team (ACT) at Sandwell and West-Birmingham NHS Trust (SWB) implemented an oral ethanol prescribing protocol to be used with patients at risk of severe AWS.
Aims
We sought to investigate the effects of oral ethanol on both subjective (patient experiences) and objective (CIWAR-Ar scores) measures of AWS.
Methods
Two cohorts of patients’ data were reviewed: 29 for CIWA score, 49 for patient survey. Data were collected as part of routine clinical care. The following variables were collected: alcohol use history, demographics (age, sex, ethnicity), AUDIT scores and CIWA-Ar scores (including dates and times), and patient outcomes from a perspectives questionnaire (including perceived impact of AWS symptoms and future drinking goals). Data were analyzed using SPSS; content analysis was used to explore qualitative responses to gain a deeper understanding of patients’ experiences.
Results
Objective measures: 20 patients’ data were included (75% between 25 and 49 years, 25% between 50 and 64 years, 90% were male). The median number of units consumed per day were 30-40. CIWA-Ar scores decreased or remained the same in 90% of patients with 83.3% recording a decrease between the first and last doses of ethanol administration (figure 1). All those who received between 8 and 10 doses of ethanol showed a decrease in CIWA-Ar score (table 1).
Subjective measures: 93.9% of patients reported symptom relief, and 91.8% would be willing to be treated with ethanol again. Of those who had been treated in the past with benzodiazepines, 69.5% of patients preferred ethanol. 56.8% reported an ongoing aim of abstinence and 34.1% reported intentions reduce alcohol use. Among those who disliked receiving ethanol 32% felt they were not given enough and 24% felt they had to wait too long before receiving ethanol. 78.7% felt confident or very confident with the team administering the ethanol and 95.5% felt the intervention was well explained to them.
Discussion and future directions
Oral ethanol led to effective objective and subjective reductions in AWS. Whilst limited in sample size this data suggests that oral ethanol could be an effective AWS management strategy, with high patient satisfaction, in certain individuals. Further research is needed in a greater number of patients improve our understanding of the impact of oral ethanol prescribing practice on AWS.
| Original language | English |
|---|---|
| Publication status | Published - 21 Nov 2024 |
| Event | Royal college of psychiatrists addictions faculty meeting - Cardiff, United Kingdom Duration: 21 Nov 2024 → 21 Nov 2024 |
Conference
| Conference | Royal college of psychiatrists addictions faculty meeting |
|---|---|
| Country/Territory | United Kingdom |
| City | Cardiff |
| Period | 21/11/24 → 21/11/24 |
