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KMID : 0368820130520020067
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Journal of the Korean Neuropsychiatr Association
2013 Volume.52 No. 2 p.67 ~ p.75
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Korean Addiction Treatment Guidelines Series (II): Pharmacological Treatment of Alcohol Withdrawal
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Kim Hee-Yeon
Lee Hae-Kook
Lee Kye-Seong
Joe Keun-Ho
Choi Sam-Wook
Seo Jeong-Seok
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Abstract
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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.
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KEYWORD
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Addiction, Guidelines, Alcohol withdrawal, Benzodiazepine, Symptom triggered therapy, Thiamine
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