management of alcohol dependence

Last reviewed 10/2020

Management involves:

• pharmacological treatment
• psychological and social support
• pharmacological prevention of relapse

Drug regimens for assisted withdrawal (1)

When conducting community-based assisted withdrawal programmes, use fixed-dose medication regimens

Fixed-dose or symptom-triggered medication regimens can be used in assisted withdrawal programmes in inpatient or residential settings. If a symptom-triggered regimen is used, all staff should be competent in monitoring symptoms effectively and the unit should have sufficient resources to allow them to do so frequently and safely.

Prescribe and administer medication for assisted withdrawal within a standard clinical protocol. The preferred medication for assisted withdrawal is a benzodiazepine (chlordiazepoxide or diazepam)

In a fixed-dose regimen, titrate the initial dose of medication to the severity of alcohol dependence and/or regular daily level of alcohol consumption

• in severe alcohol dependence higher doses will be required to adequately control withdrawal and should be prescribed according to the SPC. Make sure there is adequate supervision if high doses are administered. Gradually reduce the dose of the benzodiazepine over 7-10 days to avoid alcohol withdrawal recurring.

Notes:

• fixed-dose or symptom-triggered medication regimens can be used in assisted withdrawal programmes in inpatient or residential settings. If a symptom-triggered regimen is used, all staff should be competent in monitoring symptoms effectively and the unit should have sufficient resources to allow them to do so frequently and safely
• a symptom-triggered approach involves tailoring the drug regimen according to the severity of withdrawal and any complications
  • the service user is monitored on a regular basis and pharmacotherapy only continues as long as the service user is showing withdrawal symptoms
• when managing alcohol withdrawal in the community, avoid giving people who misuse alcohol large quantities of medication to take home to prevent overdose or diversion . Prescribe for installment dispensing, with no more than 2 days' medication supplied at any time
• in a community-based assisted withdrawal programme, monitor the service user every other day during assisted withdrawal. A family member or carer should preferably oversee the administration of medication. Adjust the dose if severe withdrawal symptoms or over-sedation occur
• do not offer clomethiazole for community-based assisted withdrawal because of the risk of overdose and misuse

Reference:

• 1) NICE (February 2011). Alcohol-use disorders - Diagnosis, assessment and management of harmful drinking and alcohol dependence