Alcohol withdrawal syndromes - prediction from detailed medical and drinking histories

The predictability of the withdrawal syndrome on the basis of the drinking history immediately prior to detoxification was investigated in 43 patients admitted to an inpatient Alcoholism Service; a pilot study consisted of 17 patients and a subsequent definitive study of 26. After obtaining informed consent, blood alcohol concentrations were measured. Each subject was extensively interviewed to obtain a medical and dietary history and to determine alcohol and drug intake in the past week and months. The levels of intoxication and withdrawal signs/symptoms were assessed on admission and daily for at least 3 days. Urine and blood toxicology screens were also performed for 19 subjects. Contrary to widespread impressions, most of the patients were able to give a detailed account of their drinking and drinking-related behavior in the 3 days prior to admission and 73% could do this for the previous 7 days. Subjects were consistent in their reporting; 85% gave drinking histories consistent among interviews conducted independently by the medical, research and counseling staff. A significant correlation (r = 0.55; P less than 0.01) was found between the severity of withdrawal and the total alcohol intake in the days immediately prior to admission. No significant correlation was evident between withdrawal severity and the number of years of heavy drinking. Amounts of benzodiazepines (diazepam and flurazepam) administered by the medical staff during the first 3 days of withdrawal and for the total hospital stay were also found to be significantly correlated with withdrawal severity (r = 0.58; P less than 0.01 for both). Regression analyses of these data also confirmed the statistically significant relationships between alcohol intake and withdrawal severity and between withdrawal severity and amounts of benzodiazepines used for detoxication. Of special interest was the finding that 50% of the subjects reported no hangovers within he past year or more and 23% reported that they had never experienced a hangover, despite very heavy drinking. In addition, only 50% of the patients had regularly consumed coffee or any caffeine-containing substance; this low incidence of caffeine intake was statistically significantly less than that found in extensive surveys of the general population in which only 3-10% eschew caffeine-containing beverages. It is concluded that the severity of alcohol withdrawal can be related to a cluster of variables among which is recent alcohol intake. The present results are, at the same time, consistent with previous observations of the appreciable differences among individuals in the consequences of abrupt cessation of chronic alcohol consumption.