It has 3 essential functions: information, support, and comfort, promoting the prevention and control of symptoms and weaning accidents. The interest in relaxation techniques and body reappropriation (physiotherapy) is to be evaluated. The establishment or strengthening of a psychotherapeutic relationship, which must continue beyond weaning, a work of self-image enhancement and narcissistic restoration of the person are essential. Depending on the subject, this approach includes individual psychotherapy, group psychotherapy, family or couples therapy for alcoholism recovery, behavioral therapies. The participation of aid movements is to be considered as soon as the weaning period is over. Social support supplements the medical care and the
Care giving in a calm and quiet atmosphere with frequent reassurance visits is an important part of non-pharmacological treatment.
Medication treatment
Benzodiazepines (BZD) are now the first-line drug treatment for alcohol withdrawal syndrome. They reduce the incidence and severity of withdrawal syndrome, seizures and delirium tremens. The preventive treatment of these complications by BZD should be systematic in case of outpatient withdrawal. Long-half-life BZDs such as diazepam are better at preventing seizures but have an increased risk of accumulation in hepatocellular insufficiency. Oxazepam is then of potential interest because of an unmodified metabolism. Short half-life BZDs have a higher potential for abuse. The oral route should be preferentially used.
prescribing doses over 24 hours: 1 PC diazepam 10 mg every 6 hours for 1 to 3 days and then reduce to a stop in 4 to 7 days or 6 cps diazepam 10 mg on the 1 st day of decline ‘1 cp each day until stop. This strategy is recommended as outpatient,
Personalized prescription possibly guided by a scale of evaluation of the severity of the symptoms
Use of an oral loading dose of a long half-life BZD.
Other BZDs than diazepam can be used with similar efficacy: it is estimated that 10 mg of diazepam is equivalent to 30 mg of oxazepam, 2 mg of lorazepam, 1 mg of alprazolam and 15 mg of clorazepate.
The prescription of BZD beyond one week is justified only in case of dependence on BZD associated with alcohol dependence.
Other psychotropic drugs for alcoholism recovery is (meprobamate, barbiturates, neuroleptics) have a lower benefit-risk ratio than BZDs. Tetrabramate has been withdrawn from the market since the 1999 Consensus Conference due to hepatotoxicity issues.
Associated treatments
hydration: the water intake must be sufficient but without hyperhydration. Infusions should be avoided in conscious patients (this is a current practice in France). The oral route should be preferred.
The prescription of magnesium is to be considered only in case of hypokalemia. Withdrawal may promote the development of serious neurological or cardiac disorders due to thiamine deficiency, especially in the case of glucose-associated intake. It is necessary to administer thiamine, 500 mg daily to any patient starting weaning. Parenteral administration preferably by intravenous infusion should be recommended during the 1 st week in case of lack of clinical signs [ 20 ] [ 21 ] .
Beta-blockers or clonidine reduce the signs of adrenergic hyperactivity of withdrawal but do not provide protection against seizures. Beta-blockers disrupt the interpretation of Cushman’s score. The interest of a corticosteroid treatment remains to be confirmed. The prescription of folic acid is to be discussed in pregnant women to reduce the risk of fetal malformations.
