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Alcohol withdrawal management is an important part of the continuum of care for alcohol use disorder. While some individuals at low risk of complications can safely undergo alcohol withdrawal at home, others may require inpatient withdrawal management services to prevent life-threatening complications.
In this episode of Addiction Practice Pod, Dr. Marcus Greatheart and David Ball talk with clinical nurse specialist Avee Khela about alcohol withdrawal management pathways, and we hear from Sandra Stewart on the importance of compassionate, non-judgemental care.
- Discuss withdrawal management strategies and considerations for alcohol use disorder (AUD) care based on patient risk and preferences.
- Summarize common alcohol withdrawal assessment tools, including their limitations.
- Discuss the importance of continued care for AUD after withdrawal management, including pharmacotherapy and psychosocial interventions.
- Identify strategies to support patients living in rural communities and/or with limited access to dedicated withdrawal management services.
In this episode, you’ll hear:
- 3:05 – Avee Khela – Clinical Nurse Specialist, Provincial Mental Health and Substance Use Network
- 15:45 – Sandra Stewart – Former Member of Eastside Illicit Drinker’s Group for Education, Member of Vancouver Area Network of Drug Users
Here’s what listeners can take away from this episode:
- The purpose of withdrawal management is to alleviate symptoms of withdrawal, make the patient as comfortable as possible during this process, transition to continuing care if appropriate, and to support the patient’s goals around alcohol consumption or cessation. While not all people with AUD require medically supervised withdrawal management, for some, it can prevent life-threatening complications such as seizures and delirium tremens*.
- Clinical tools for choosing the appropriate withdrawal management pathway (such as the PAWSS tool) are useful; however, they should be used in conjunction with best clinical judgement. This involves considering factors such as availability of health care resources—like a bed at an inpatient withdrawal management facility—as well as patient preferences and availability of social supports.
- Continuing AUD care after withdrawal management is an essential part of comprehensive treatment and can involve pharmacotherapy as well as psychosocial and community supports. It is important for health care providers to be aware of available supports and ensure that information and relevant referrals are offered following withdrawal management.
- Individuals living in rural and remote communities may face greater barriers to receiving care for alcohol withdrawal, such as a lack of inpatient services and significant distances to travel. Outpatient management may be possible through community care and enhanced monitoring.
- Health care providers should provide compassionate, non-judgmental care to their patients and actively work to reduce internal biases. The language and tone you use with a patient can have lasting impacts on their willingness to access health care.
*Delirium tremens is a severe complication of alcohol withdrawal. It is characterized by severe confusion, disorientation and/or hallucinations with clouding of global sensorium (inability to think clearly/concentrate), accompanied by severe autonomic hyperactivity (tachycardia, hypertension, hyperthermia, agitation, and sweating). (ACTOC Module 3)
- Canadian Centre on Substance Use and Addiction (CCSA). Canada’s Guidance on Alcohol and Health: Final Report. 2023. Ottawa, O.N.: CCSA.
- British Columbia Centre on Substance Use (BCCSU), B.C. Ministry of Health and B.C. Ministry of Mental Health and Addictions. Provincial Guideline for the Clinical Management of High-Risk Drinking and Alcohol Use Disorder. 2019. Vancouver, B.C.: BCCSU.
- BCCSU. Withdrawal Management Pathway for Adult Patients with AUD. 2020.
- BCCSU. A Guideline for the Clinical Management of High-Risk Drinking and Alcohol Use Disorder [Summary of Recommendations]. 2021.
- Evans L, Lewis ZB, Seupaul RA. Can we predict severe alcohol withdrawal syndrome? Ann Emerg Med. 2020;76(3):328-329.
- Ganatra RB, Breu AC, Ronan MV. Clinical guideline highlights for the hospitalist: 2020 American Society of Addiction Medicine clinical practice guideline on alcohol withdrawal management. J Hosp Med. 2022;17(1):47-49.
- Hillbom M, Pieninkeroinen I, Leone M. Seizures in alcohol-dependent patients: epidemiology, pathophysiology and management. CNS Drugs. 2003;17(14):1013-1030.
- Lenardson, JD, Race, MM, Gale JA. Availability, characteristics, and role of detoxification services in rural areas [Working Paper]. Cutler Institute for Health and Social Policy, Muskie School of Public Service, University of Southern Maine; 2009.
- Maldonado JR, Sher Y, Ashouri JF, et al. The “Prediction of Alcohol Withdrawal Severity Scale” (PAWSS): systematic literature review and pilot study of a new scale for the prediction of complicated alcohol withdrawal syndrome. Alcohol. 2014;48(4):375-390.
- Myers CR. Using Telehealth to remediate rural mental health and healthcare disparities. Issues Ment Health Nurs. 2019;40(3):233-239.
- Pullen E, Oser C. Barriers to substance use treatment in rural and urban communities: Counselor perspectives. Subst Use Misuse. 2014;49(7):891-901.
- Purcell-Khodr GC, Lee KSK, Conigrave JH, Webster E, Conigrave KM. What can primary care services do to help First Nations people with unhealthy alcohol use? A systematic review: Australia, New Zealand, USA and Canada. Addict Sci Clin Pract. 2020;15(1):31.
- British Columbia Centre on Substance Use (BCCSU). Alcohol Withdrawal Management in Rural and Remote Communities (AUD ECHO) [Video]. YouTube. Published November 22, 2022.
- BCCSU. Alcohol Withdrawal Management (AUD ECHO) [Video]. YouTube. Published June 1, 2021.
- BCCSU. Harm Reduction Approaches to High-Risk Drinking and Alcohol Use Disorder (AUD ECHO) [Video]. YouTube. Published February 2, 2021.
- Prediction of alcohol withdrawal severity scale. MDCalc. https://www.mdcalc.com/calc/10102/prediction-alcohol-withdrawal-severity-scale. Accessed April 14, 2023.
- Statistics Canada. Health fact sheets: Heavy drinking, 2018. Ottawa: Statistics Canada;2019.
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