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Kim, Lee, Lee, Joe, Choi, and Seo: Korean Addiction Treatment Guidelines Series (II): Pharmacological Treatment of Alcohol Withdrawal
Original Article
Journal of Korean Neuropsychiatric Association

Journal of Korean Neuropsychiatric Association 2013; 52(2): 67-75.

Published online: 31 March 2013

DOI: https://doi.org/10.4306/jknpa.2013.52.2.67

Korean Addiction Treatment Guidelines Series (II): Pharmacological Treatment of Alcohol Withdrawal

Hui-Yeon Kim, MD1, Hae-Kook Lee, MD, PhD2, Kye-Seong Lee, MD3, Keun-Ho Joe, MD4, Sam-Wook Choi, MD5, Jeong-Seok Seo, MD, PhD1

1Department of Psychiatry, Konkuk University Chungju Hospital, School of Medicine, Konkuk University, Chungju, Korea.

2Department of Psychiatry, Uijeongbu St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Uijeongbu, Korea.

3Department of Psychiatry, Addiction Center, Seoul National Hospital, Seoul, Korea.

4Dasarang Central Hospital, Uiwang, Korea.

5Department of Addiction Rehabilitation and Social Welfare, Eulji University, Seoul, Korea.

Address for correspondence Jeong-Seok Seo, MD, PhD. Department of Psychiatry, Konkuk University Chungju Hospital, School of Medicine, Konkuk University, 82 Gugwon-daero, Chungju 380-704, Korea. Tel +82-43-840-8470, Fax +82-43-845-8470, sjs52632@daum.net

Received 15 February 2013       Revised 1 March 2013       Accepted 4 March 2013

Copyright © 2013 Korean Neuropsychiatric Association

Abstract

Objectives

In development of Korean addiction treatment guidelines, the aim of this study was to investigate the experts' consensus regarding current pharmacological practice in treatment of alcohol withdrawal.

Methods

Using recommendations from foreign clinical guidelines, which were either lacking in evidence or could not be directly applied to Korea, the executive committee developed a questionnaire consisting of 17 questions. Using a nine-point scale, members of the Korean Addiction Psychiatry, who were experts (n=150) with sufficient experience in treatment of alcohol use disorder, were asked to evaluate the appropriateness of each item on the questionnaire. We classified the experts' opinion according to three categories, based on the lowest scores of 6.5 or greater as a first-line/preferred treatment, 3.5-6.5 as a second-line/reasonable treatment, and lower than 3.5 as a third-line/inappropriate treatment. The consensus was determined by chi-square test (p<0.05). Response rate was 70.4% (81/115).

Results

The results of the survey from the experts were as follows: 1) Symptom triggered therapy (STT) was the most appropriate strategy in treatment of alcohol withdrawal (95% CI 7.41-8.04). 2) Prophylactic benzodiazepine was recommended for management of expecting alcohol withdrawal in out-patient-department patients. 3) Among benzodiazepines, lorazepam was the most preferred. 4) For patients with severe withdrawal, lorazepam 7.4 mg/day (95% CI 6.48-8.25, maximum dose=20 mg) was recommended. 5) Risperidone, quetiapine, and haloperidol were the first-line drugs for patients with alcohol withdrawal and combined psychotic symptoms. 6) 127.5 mg (95% CI 111-145) for 2.8 months of prophylactic thiamine and 213.5 mg (95% CI 190-240) for 6.2 months of thiamine for Wernicke-Korsakoff's syndrome were recommended.

Conclusion

We hope that these Korean addiction treatment guidelines, added by the Korean experts' consensus, will be helpful in promoting the efficacy of treatment for alcohol withdrawal.

Keywords: Addiction, Guidelines, Alcohol withdrawal, Benzodiazepine, Symptom triggered therapy, Thiamine

Figures and Tables

Fig. 1
RAND Corporation's 9-point scale for rating appropriateness of medical decisions.
jkna-52-67-g001
Table 1
The type of affiliations and response rate
jkna-52-67-i001
Table 2
Three strategies using benzodiazepine for alcohol withdrawal
jkna-52-67-i002

STT : Symptom triggered therapy, LDT : Loading dose therapy, FST : Fixed-schedule therapy, SD : Standard deviation, 95% CI : 95% confidence interval

Table 3
Preference of benzodiazepine in alcohol withdrawal
jkna-52-67-i003

*: No consensus. SD : Standard deviation, 95% CI : 95% confidence interval

Table 4
Daily dosage of benzodiazepine according to severity of alcohol withdrawal symptoms
jkna-52-67-i004

CIWA-Ar : Clinical Institute Withdrawal Assessment for Alcohol, Min : Minimum doses, Max : Maximum dose, SD : Standard deviation

Table 5
Preference of antipsychotics for alcohol withdrawal with psychotic symptoms
jkna-52-67-i005

SD : Standard deviation, 95% CI : 95% confidence interval

Table 6
Dosage and duration of thiamine for Wernicke-Korsakoff's syndrome prevention and treatment
jkna-52-67-i006

Min : Minimum dose, Max : Maximum dose, SD : Standard deviation, 95% CI : 95% confidence interval

Notes

The authors have no financial conflicts of interest.

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