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Hospital Management

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Addressing Unhealthy Alcohol Use in Primary Care

Abstract

Unhealthy alcohol use is common among hospitalized patients, and those with dependence need to be assessed for withdrawal risk. Thiamine should always be given to these patients; they should be monitored with a structured withdrawal rating scale (e.g., CIWA) and treated with benzodiazepines as the drug-of-choice for monotherapy of alcohol withdrawal. Referral to alcohol counseling rehabilitation services should be part of discharge planning when appropriate.

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References

  1. Roson B, Monte R, Gamallo R, et al. Prevalence and routine assessment of unhealthy alcohol use in hospitalized patients. Eur J Intern Med. 2010;21:458–464.

    Article  PubMed  Google Scholar 

  2. SBIRT outcomes in Houston: final report on InSight, a hospital district-based program for patients at risk for alcohol or drug use problems. Alcohol Clin Exp Res. 2009;33:1374–1381.

    Google Scholar 

  3. Smothers BA, Yahr HT, Sinclair MD. Prevalence of current DSM-IV alcohol use disorders in short-stay, general hospital admissions, United States, 1994. Arch Intern Med. 2003;163:713–719.

    Article  PubMed  Google Scholar 

  4. Vitale SG, Van De Mheen D, Van De Wiel A, Garretsen HF. Alcohol and illicit drug use among emergency room patients in the Netherlands. Alcohol Alcohol. 2006;41:553–559.

    PubMed  Google Scholar 

  5. Sri EV, Raguram R, Srivastava M. Alcohol problems in a general hospital—a prevalence study. J Indian Med Assoc. 1997;95:505–506.

    PubMed  CAS  Google Scholar 

  6. Blake RB, Brinker MR, Ursic CM, Clark JM, Cox DD. Alcohol and drug use in adult patients with musculoskeletal injuries. Am J Orthop (Belle Mead NJ). 1997;26:704–709; discussion 709–710.

    CAS  Google Scholar 

  7. Arolt V, Driessen M. Alcoholism and psychiatric comorbidity in general hospital inpatients. Gen Hosp Psychiatry. 1996;18:271–277.

    Article  PubMed  CAS  Google Scholar 

  8. Bray JW, Cowell AJ, Hinde JM. A systematic review and meta-analysis of health care utilization outcomes in alcohol screening and brief intervention trials. Med Care. 2011;49:287–294.

    Article  PubMed  Google Scholar 

  9. Ewing JA. Detecting alcoholism. The CAGE questionnaire. JAMA. 1984;252:1905–1907.

    Article  PubMed  CAS  Google Scholar 

  10. Bohn MJ, Babor TF, Kranzler HR. The Alcohol Use Disorders Identification Test (AUDIT): validation of a screening instrument for use in medical settings. J Stud Alcohol. 1995;56:423–432.

    PubMed  CAS  Google Scholar 

  11. Cherpitel CJ. Screening for alcohol problems in the emergency department. Ann Emerg Med. 1995;26:158–166.

    Article  PubMed  CAS  Google Scholar 

  12. Cherpitel CJ. Screening for alcohol problems in the U.S. general population: a comparison of the CAGE and TWEAK by gender, ethnicity, and services utilization. J Stud Alcohol. 1999;60:705–711.

    PubMed  CAS  Google Scholar 

  13. National Institute on Alcohol Abuse and Alcoholism. Helping patients who drink too much: a clinician’s guide. NIH Publication No. 07-3769; 2007.

    Google Scholar 

  14. Conigrave KM, Saunders JB, Whitfield JB. Diagnostic tests for alcohol consumption. Alcohol Alcohol. 1995;30:13–26.

    PubMed  CAS  Google Scholar 

  15. Spies CD, Emadi A, Neumann T, et al. Relevance of carbohydrate-deficient transferrin as a predictor of alcoholism in intensive care patients following trauma. J Trauma. 1995;39:742–748.

    Article  PubMed  CAS  Google Scholar 

  16. Nilssen O, Ries R, Rivara FP, Gurney JG, Jurkovich GJ. The WAM score: sensitivity and specificity of a user friendly biological screening test for alcohol problems in trauma patients. Addiction. 1996;91:255–262.

    Article  PubMed  CAS  Google Scholar 

  17. Hoeksema HL, de Bock GH. The value of laboratory tests for the screening and recognition of alcohol abuse in primary care patients. J Fam Pract. 1993;37:268–276.

    PubMed  CAS  Google Scholar 

  18. Hietala J, Koivisto H, Anttila P, Niemela O. Comparison of the combined marker GGT-CDT and the conventional laboratory markers of alcohol abuse in heavy drinkers, moderate drinkers and abstainers. Alcohol Alcohol. 2006;41:528–533.

    PubMed  CAS  Google Scholar 

  19. Parran TV Jr, Weber E, Tasse J, Anderson B, Adelman C. Mandatory toxicology testing and chemical dependence consultation follow-up in a level-one trauma center. J Trauma. 1995;38:278–280.

    Article  PubMed  Google Scholar 

  20. Glickman L, Herbsman H. Delirium tremens in surgical patients. Surgery. 1968;64:882–890.

    PubMed  CAS  Google Scholar 

  21. Ferguson JA, Suelzer CJ, Eckert GJ, Zhou XH, Dittus RS. Risk factors for delirium tremens development. J Gen Intern Med. 1996;11:410–414.

    Article  PubMed  CAS  Google Scholar 

  22. Wojnar M, Bizon Z, Wasilewski D. The role of somatic disorders and physical injury in the development and course of alcohol withdrawal delirium. Alcohol Clin Exp Res. 1999;23:209–213.

    Article  PubMed  CAS  Google Scholar 

  23. Blondell RD, Looney SW, Hottman LM, Boaz PW. Characteristics of intoxicated trauma patients. J Addict Dis. 2002;21:1–12.

    Article  PubMed  Google Scholar 

  24. Lukan JK, Reed DN Jr, Looney SW, Spain DA, Blondell RD. Risk factors for delirium tremens in trauma patients. J Trauma. 2002;53:901–906.

    Article  PubMed  Google Scholar 

  25. Mayo-Smith MF. Pharmacological management of alcohol withdrawal. A meta-analysis and evidence-based practice guideline. American Society of Addiction Medicine Working Group on Pharmacological Management of Alcohol Withdrawal. JAMA. 1997;278:144–151.

    Google Scholar 

  26. Sellers EM, Naranjo CA, Harrison M, Devenyi P, Roach C, Sykora K. Diazepam loading: simplified treatment of alcohol withdrawal. Clin Pharmacol Ther. 1983;34:822–826.

    Article  PubMed  CAS  Google Scholar 

  27. Saitz R, Mayo-Smith MF, Roberts MS, Redmond HA, Bernard DR, Calkins DR. Individualized treatment for alcohol withdrawal. A randomized double-blind controlled trial. JAMA. 1994;272:519–523.

    Article  PubMed  CAS  Google Scholar 

  28. Kouimtsidis C, Reynolds M, Hunt M,et al. Substance use in the general hospital. Addict Behav. 2003;28:483–499.

    Article  PubMed  Google Scholar 

  29. Busto U, Simpkins J, Sellers EM, Sisson B, Segal R. Objective determination of benzodiazepine use and abuse in alcoholics. Br J Addict. 1983;78:429–435.

    Article  PubMed  CAS  Google Scholar 

  30. Busto UE, Sellers EM. Anxiolytics and sedative/hypnotics dependence. Br J Addict. 1991;86:1647–1652.

    Article  PubMed  CAS  Google Scholar 

  31. McKeon A, Frye MA, Delanty N. The alcohol withdrawal syndrome. J Neurol Neurosurg Psychiatry. 2008;79:854–862.

    Article  PubMed  CAS  Google Scholar 

  32. Khan A, Levy P, DeHorn S, Miller W, Compton S. Predictors of mortality in patients with delirium tremens. Acad Emerg Med. 2008;15:788–790.

    Article  PubMed  Google Scholar 

  33. McMicken D, Liss JL. Alcohol-related seizures. Emerg Med Clin North Am. 2011;29:117–124.

    Article  PubMed  Google Scholar 

  34. Campos J, Roca L, Gude F, Gonzalez-Quintela A. Long-term mortality of patients admitted to the hospital with alcohol withdrawal syndrome. Alcohol Clin Exp Res. 2011;35:1180–1186.

    Article  PubMed  Google Scholar 

  35. Naranjo CA, Sellers EM, Chater K, Iversen P, Roach C, Sykora K. Nonpharmacologic intervention in acute alcohol withdrawal. Clin Pharmacol Ther. 1983;34:214–219.

    Article  PubMed  CAS  Google Scholar 

  36. Blondell RD. Ambulatory detoxification of patients with alcohol dependence. Am Fam Physician. 2005;71:495–502.

    PubMed  Google Scholar 

  37. Sullivan JT, Sykora K, Schneiderman J, Naranjo CA, Sellers EM. Assessment of alcohol withdrawal: the revised clinical institute withdrawal assessment for alcohol scale (CIWA-Ar). Br J Addict. 1989;84:1353–1357.

    Article  PubMed  CAS  Google Scholar 

  38. Ploner M, Schnitzler A. Wernicke’s encephalopathy. Lancet. 2003;361:1000.

    Article  PubMed  Google Scholar 

  39. Meier S, Daeppen JB. Prevalence, prophylaxis and treatment of Wernicke encephalopathy. Thiamine, how much and how do we give it?. Rev Med Suisse. 2005;1:1740–1744.

    PubMed  CAS  Google Scholar 

  40. Paparrigopoulos T, Tzavellas E, Karaiskos D, Kouzoupis A, Liappas I. Complete recovery from undertreated Wernicke-Korsakoff syndrome following aggressive thiamine treatment. In Vivo. 2010;24:231–233.

    PubMed  Google Scholar 

  41. Thorarinsson BL, Olafsson E, Kjartansson O, Blondal H. Wernicke’s encephalopathy in chronic alcoholics. Laeknabladid. 2011;97:21–29.

    PubMed  Google Scholar 

  42. Holbrook AM, Crowther R, Lotter A, Cheng C, King D. Meta-analysis of benzodiazepine use in the treatment of acute alcohol withdrawal. CMAJ. 1999;160:649–655.

    Google Scholar 

  43. Amato L, Minozzi S, Vecchi S, Davoli M. Benzodiazepines for alcohol withdrawal. Cochrane Database Syst Rev. 2010. doi:10.1002/14651858.CD005063.pub3.

    Google Scholar 

  44. Prater CD, Miller KE, Zylstra RG. Outpatient detoxification of the addicted or alcoholic patient. Am Fam Physician. 1999;60:1175-1183.

    PubMed  CAS  Google Scholar 

  45. Solomon J, Rouck LA, Koepke HH. Double-blind comparison of lorazepam and chlordiazepoxide in the treatment of the acute alcohol abstinence syndrome. Clin Ther. 1983;6:52–58.

    PubMed  CAS  Google Scholar 

  46. Hayashida M, Alterman AI, McLellan AT, et al. Comparative effectiveness and costs of inpatient and outpatient detoxification of patients with mild-to-moderate alcohol withdrawal syndrome. N Engl J Med. 1989;320:358–365.

    Article  PubMed  CAS  Google Scholar 

  47. Wartenberg AA, Nirenberg TD, Liepman MR, Silvia LY, Begin AM, Monti PM. Detoxification of alcoholics: improving care by symptom-triggered sedation. Alcohol Clin Exp Res. 1990;14:71–75.

    Article  PubMed  CAS  Google Scholar 

  48. D’Onofrio G, Rathlev NK, Ulrich AS, Fish SS, Freedland ES. Lorazepam for the prevention of recurrent seizures related to alcohol. N Engl J Med. 1999;340:915–919.

    Article  PubMed  Google Scholar 

  49. DeCarolis DD, Rice KL, Ho L, Willenbring ML, Cassaro S. Symptom-driven lorazepam protocol for treatment of severe alcohol withdrawal delirium in the intensive care unit. Pharmacotherapy. 2007;27:510–518.

    Article  PubMed  CAS  Google Scholar 

  50. Saitz R, Palfai TP, Cheng DM, et al. Brief intervention for medical inpatients with unhealthy alcohol use: a randomized, controlled trial. Ann Intern Med. 2007;146:167–176.

    Google Scholar 

  51. Freyer-Adam J, Coder B, Baumeister SE,et al. Brief alcohol intervention for general hospital inpatients: a randomized controlled trial. Drug Alcohol Depend. 2008;93:233–243.

    Article  PubMed  Google Scholar 

  52. Gentilello LM, Rivara FP, Donovan DM, et al. Alcohol interventions in a trauma center as a means of reducing the risk of injury recurrence. Ann Surg. 1999;230:473–480; discussion 480–473.

    Article  PubMed  CAS  Google Scholar 

  53. Chick J, Lloyd G, Crombie E. Counselling problem drinkers in medical wards: a controlled study. Br Med J (Clin Res Ed). 1985;290:965–967.

    Article  CAS  Google Scholar 

  54. Bien TH, Miller WR, Tonigan JS. Brief interventions for alcohol problems: a review. Addiction. 1993;88:315–335.

    Article  PubMed  CAS  Google Scholar 

  55. Anderson P, Scott E. The effect of general practitioners’ advice to heavy drinking men. Br J Addict. 1992;87:891–900.

    Article  PubMed  CAS  Google Scholar 

  56. Cowell AJ, Bray JW, Mills MJ, Hinde JM. Conducting economic evaluations of screening and brief intervention for hazardous drinking: methods and evidence to date for informing policy. Drug Alcohol Rev. 2010;29:623–630.

    Article  PubMed  Google Scholar 

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Correspondence to Richard D. Blondell .

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Blondell, R., Azadfard, M. (2013). Hospital Management. In: Saitz, R. (eds) Addressing Unhealthy Alcohol Use in Primary Care. Springer, New York, NY. https://doi.org/10.1007/978-1-4614-4779-5_18

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  • DOI: https://doi.org/10.1007/978-1-4614-4779-5_18

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