J Korean Neuropsychiatr Assoc.  2013 Mar;52(2):67-75.

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

• Kim HY
• Lee HK
• Lee KS
• Joe KH
• Choi SW
• Seo JS

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.

Keyword

Addiction; Guidelines; Alcohol withdrawal; Benzodiazepine; Symptom triggered therapy; Thiamine

MeSH Terms

Benzodiazepines
Consensus
Dibenzothiazepines
Haloperidol
Humans
Korea
Lorazepam
Surveys and Questionnaires
Risperidone
Thiamine
Quetiapine Fumarate
Benzodiazepines
Dibenzothiazepines
Haloperidol
Lorazepam
Risperidone
Thiamine

Figure

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  Fig. 1 RAND Corporation's 9-point scale for rating appropriateness of medical decisions.

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