Early Diagnosis of Alcohol Withdrawal Syndrome is Crucial to Managing and Treating Alcohol Use Disorder and Related Problems, Study Suggests

Newswise — Approximately one-third of US adults experience recent unhealthy alcohol use, and of those, one in seven suffer from alcohol withdrawal syndrome (AWS), according to a new US population-based study with substantial clinical implications. Symptoms of alcohol withdrawal in heavy drinkers are linked to considerable distress and functional impairment, poorer long-term drinking and other health outcomes, greater likelihood of hospitalization, and higher healthcare costs and morbidity and mortality risk. The estimated prevalence of AWS varies widely. Little is known about its manifestations among people in the general population with unhealthy alcohol use, limiting clinicians’ ability to identify patients at risk of AWS. Better information on AWS could enhance its prevention and timely, targeted treatment efforts.

For the study in Alcoholism: Clinical & Experimental Research, researchers used data from a national US population survey involving approximately 36,000 non-institutionalized adults conducted in 2012–13. They assessed the prevalence of AWS among participants whose responses revealed unhealthy alcohol use in the past year. The survey included information on demographic characteristics, substance use disorders and psychiatric conditions, drinking behaviors, alcohol withdrawal symptoms, family history of problem drinking, serious medical conditions, healthcare utilization related to drinking, and quality of life. The investigators also sorted participants experiencing unhealthy alcohol use into categories based on the severity of alcohol use disorder (AUD; none, mild, moderate, severe).

Among the survey participants, 35% (12,634) endorsed unhealthy alcohol use in the past year and formed the study sample. Of these, 39% (4,986) met criteria for AUD and 15% (1,948) for AWS. Those experiencing AWS typically reported two or three symptoms, primarily nausea/vomiting, insomnia, and psychomotor agitation. The most severe AWS symptoms — hallucinations and seizures — were least common. Participants meeting the diagnostic criteria for AWS were mostly male (57%), white (67%), and college educated (61%). They were disproportionately young (aged 18-29), unmarried, with low annual incomes, and residing in urban areas. AWS was associated with binge drinking, family history of problem drinking, and AUD, with the likelihood of AWS increasing with the severity of AUD. In addition, participants experiencing AWS carried a heavy burden of co-occurring mental health diagnoses, including depression and bipolar disorder, personality disorders, and drug use disorders. They had greater alcohol-related healthcare utilization, such as more frequent emergency room visits, than alcohol users without AWS.

This is the first study to report the prevalence and characteristics of AWS in a sample of adults with unhealthy alcohol use drawn from a survey of the general US population. Its findings highlight the importance of early diagnosis and treatment of people with AWS as crucial for its prevention and management among drinkers with unhealthy alcohol use. The investigators advised that clinicians evaluate patients with AWS for co-occurring psychiatric disorders that could affect alcohol treatment. 

Alcohol withdrawal in past-year drinkers with unhealthy alcohol use: Prevalence, characteristics, and correlates in a national epidemiologic survey.  O. Livne, R. Feinn, J. Knox, E. Hartwell, J. Gelernter, D. Hasin, H. Kranzler (pp xxx).

ACER-21-5083.R1