These can include: 199 ● Panic attacks ● Irritability ● Tremor ● Restlessness ● Agitation ● Sleep disturbances ● Sweating ● Difficulty concentrating ● Weight loss ● Nausea or vomiting ● Headache ● Tachycardia ● Loss of appetite ● Muscle tension, spasms, or pain Severe cases of withdrawal can cause psychosis or seizures, which can be fatal. Seizures are more likely in patients with a history of alcohol addiction, brain damage, or abnormalities on an electroencephalogram. Other factors that can lead to more severe cases of benzodiazepine withdrawal include longer durations of benzodiazepine use before discontinuation, abrupt discontinuation after regular use, use of benzodiazepines with a shorter half-life, and use of higher benzodiazepine doses. 199 Treatment of Benzodiazepine Use Disorder Treatment of benzodiazepine use disorder involves tapering off benzodiazepines in a safe manner, and preventing patients from returning to benzodiazepine use after completing their taper. Many patients can successfully taper benzodiazepine use on an outpatient basis. However, inpatient treatment may be warranted for patients who have failed several tapering attempts, those taking very high doses of benzodiazepines, or those who have significant medical comorbidities that must be monitored during the taper, such as seizures. 199 When establishing a plan for tapering benzodiazepines, providers have a choice of tapering the agent that the patient is already taking, or Alcohol Alcohol is one of the most widely used intoxicants in the world. In 2020, the National Survey on Drug Use and Health found that 50% of adults have used alcohol in the past month, and 22.2% reported drinking five or more drinks on one occasion in the past month. 178 The use of alcohol occurs on a spectrum, ranging from occasional drinking to regular, heavy use. Alcohol use disorder is a medical condition characterized by an inability to control alcohol use despite adverse consequences. 202 Alcohol use disorder is a serious national health problem in the United States. It is estimated that more than 14 million American adults had an alcohol use disorder in 2019, as well as 414,000 adolescents aged 12 to 17. 202 There are over 95,000 deaths every year that are directly attributed to alcohol use, and the economic cost of alcohol use is astounding: excessive alcohol use in the United States is said to cost nearly $250 billion annually. The majority of these costs (77%) are associated with binge drinking, or drinking
switching to a long-acting agent to complete the taper. Short-acting benzodiazepines are associated with more severe withdrawal symptoms, worse rebound anxiety after stopping the benzodiazepine, and higher dropout rates from discontinuation studies. Agents such as diazepam or chlordiazepoxide are commonly chosen to complete benzodiazepine tapers due to their longer duration of action. 199 Taper rates of 25 to 50 percent every 1 to 2 weeks over a course of 6 to 10 weeks are generally recommended. Tapering schedules should be individualized based on the starting benzodiazepine dose and duration of use, as well as patient’s ability to tolerate withdrawal symptoms. Patients who have used benzodiazepines for longer periods of time experience a higher likelihood of experiencing withdrawal symptoms while tapering. Patients are often recommended to follow up weekly with their providers for monitoring. If physical withdrawal symptoms are intolerable, it is recommended to return to the dose prior to the most recent reduction and slowing down the taper rate. This can help reduce withdrawal symptoms and increase the likelihood of success with the benzodiazepine taper. 199 Adjunctive therapies to aid in tapering benzodiazepines have been evaluated, such as antidepressants and mood stabilizers. In the absence of specific comorbidities, these agents are associated with a low quality of evidence supporting their use. However, patients with comorbidities such as depression, anxiety, insomnia, or opioid use disorder should receive proper treatment of these comorbidities to aid in the success of treatment of benzodiazepine use disorder. Psychosocial interventions such as cognitive behavioral therapy (CBT) are also recommended for patients undergoing benzodiazepine tapering; studies have shown higher rates of benzodiazepine discontinuation in patients undergoing CBT when compared with tapering alone. 199 more than three alcoholic beverages per occasion for women, or more than four drinks for men. 203\ In the United States, alcohol use disorder has a lifetime prevalence of approximately 29%. Despite the high prevalence and common complications, alcohol use disorder is undertreated. Less than 10% of patients with a diagnosis of alcohol use disorder in the past 12 months receive any treatment, and only around 6% of patients with alcohol use disorder receive evidence- based care. 204 There is a clear need for improvement in the treatment of this common condition; this course serves to review the recognition, diagnosis, and treatment of alcohol use disorder. Short- and Long-Term Effects of Alcohol Inebriation Alcohol is a central nervous system (CNS) depressant, causing decreased reaction time, motor coordination, and mental performance. After ingestion, it is swiftly absorbed into the bloodstream through the stomach and small intestine.
Book Code: CA23CME
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