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Diagnosis and treatment of acute alcohol intoxication and alcohol withdrawal syndrome: position paper of the Italian Society on Alcohol

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Abstract

The chronic use of alcohol can lead to the onset of an alcohol use disorder (AUD). About 50% of subjects with an AUD may develop alcohol withdrawal syndrome (AWS) when they reduce or discontinue their alcohol consumption and, in 3–5% of them, convulsions and delirium tremens (DTs), representing life-threatening complications, may occur. Unfortunately, few physicians are adequately trained in identifying and treating AWS. The Italian Society on Alcohol has, therefore, implemented a task force of specialists to draw up recommendations for the treatment of AWS with the following main results: (1) while mild AWS may not require treatment, moderate and severe AWS need to be pharmacologically treated; (2) out-patient treatment is appropriate in patients with mild or moderate AWS, while patients with severe AWS need to be treated as in-patients; (3) benzodiazepines, BDZs are the “gold standard” for the treatment of AWS and DTs; (4) alpha-2-agonists, beta-blockers, and neuroleptics may be used in association when BDZs do not completely resolve specific persisting symptoms of AWS; (5) in the case of a refractory form of DTs, the use of anaesthetic drugs (propofol and phenobarbital) in an intensive care unit is appropriate; (6) alternatively to BDZs, sodium oxybate, clomethiazole, and tiapride approved in some European Countries for the treatment of AWS may be employed for the treatment of moderate AWS; (7) anti-convulsants are not sufficient to suppress AWS, and they may be used only in association with BDZs for the treatment of refractory forms of convulsions in the course of AWS.

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Authors and Affiliations

  1. Unit of Internal Medicine, Department of Internal Medicine, SS Annunziata Hospital, Via Vicini 2, 44042, Cento, Ferrara, Italy

    Fabio Caputo

  2. “G. Fontana” Centre for the Study and Multidisciplinary Treatment of Alcohol Addiction, Department of Medical and Surgical Sciences, University of Bologna, Bologna, Italy

    Fabio Caputo

  3. Section of Neuroscience and Clinical Pharmacology, Department of Biomedical Sciences, University of Cagliari, Cagliari, Italy

    Roberta Agabio

  4. Unit of Addiction Treatment, Lugo, Ravenna, Italy

    Teo Vignoli

  5. Regional Centre on Alcohol, Careggi Hospital, Florence, Italy

    Valentino Patussi & Tiziana Fanucchi

  6. Alcohol Unit, Pordenone, Italy

    Paolo Cimarosti & Cristina Meneguzzi

  7. Alcohol Unit, Ravenna, Italy

    Giovanni Greco

  8. Alcohol Unit, Milan, Italy

    Raffaella Rossin

  9. Alcohol Unit, Nicosia, Enna, Italy

    Michele Parisi

  10. Nursing Home Parco dei Tigli, Teolo, Padova, Italy

    Davide Mioni

  11. Gastroenterology Unit, Mauriziano Hospital, Turin, Italy

    Sarino Arico’

  12. “Murri” Clinic of Internal Medicine, Department of Biomedical Science and Human Oncology, University of Bari, Bari, Italy

    Vincenzo Ostilio Palmieri

  13. Alcohol Unit, Alessandria, Italy

    Valeria Zavan

  14. Alcohol Unit, Turin, Italy

    Pierluigi Allosio

  15. Regional Centre on Alcohol, Genoa, Italy

    Patrizia Balbinot & Gianni Testino

  16. Alcohol Unit, Cosenza, Italy

    Maria Francesca Amendola

  17. Alcohol Unit, Savona, Italy

    Livia Macciò

  18. Department of Internal Medicine, Mater Dei Hospital, Bari, Italy

    Doda Renzetti

  19. National Observatory on Alcohol, National Institute of Health, Rome, Italy

    Emanuele Scafato

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  1. Fabio Caputo
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Correspondence to Fabio Caputo.

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Caputo, F., Agabio, R., Vignoli, T. et al. Diagnosis and treatment of acute alcohol intoxication and alcohol withdrawal syndrome: position paper of the Italian Society on Alcohol. Intern Emerg Med 14, 143–160 (2019). https://doi.org/10.1007/s11739-018-1933-8

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