Becciolini Laurent, Wehrli Fabienne, Kronschnabel Jens, Wiesendanger Carolina, Scherbaum Norbert, Roser Patrik
Center for Addictive Disorders, Department of Adult Psychiatry and Psychotherapy, University Hospital of Psychiatry Zurich, University of Zurich, 8001 Zurich, Switzerland.
Institute of Psychology, Department of Clinical Psychology, University of Zurich, 8006 Zurich, Switzerland.
Brain Sci. 2025 Jul 17;15(7):758. doi: 10.3390/brainsci15070758.
Alcohol withdrawal syndrome is a common clinical challenge that may lead to significant complications if not properly managed. Symptom-triggered therapy (STT) represents a promising alternative to fixed-dose regimens (FDRs) providing benzodiazepine prescriptions based on objectively quantified withdrawal symptoms. This study aimed to evaluate the effectiveness and safety of STT using the Hamburg Alcohol Withdrawal Scale (HAES) compared to FDRs in the management of inpatient alcohol detoxification.
In a retrospective case-control study, alcohol detoxification treatment in STT was compared with FDRs. During a twelve-month observation period, a total of 123 patients in the STT group were recruited and compared with 123 controls in the FDR group (matched according to sex, age, and current amount of alcohol consumption) treated in the same hospital before the implementation of STT. The study outcomes included the total benzodiazepine dosage, duration of acute detoxification phase, length of inpatient stay, and occurrence of complications such as epileptic seizures and delirium tremens.
STT showed a significantly lower total benzodiazepine dosage (22.50 mg vs. 115.00 mg, < 0.001), a shorter duration of the detoxification phase (48.00 h vs. 201.75 h, < 0.001), and a reduced length of inpatient stay (23.00 days vs. 28.00 days, = 0.003) compared to FDRs. There were no significant differences in the rates of complications between the two settings. Linear mixed model analysis revealed that the differences remained highly significant even after adjusting for various explanatory variables (i.e., age, sex, standard units of alcohol, psychiatric comorbidities, treatment discontinuation, and occurrence of any complication).
STT appears to be as effective and safe as traditional fixed-dose regimens of benzodiazepines for the management of inpatient alcohol detoxification. This approach may thereby minimize unnecessary pharmacological exposure, facilitate the earlier integration of patients into psychoeducational and psychosocial interventions, and reduce healthcare costs.
酒精戒断综合征是一个常见的临床挑战，如果管理不当可能导致严重并发症。症状触发疗法（STT）是一种有前景的替代固定剂量方案（FDRs）的方法，它根据客观量化的戒断症状开具苯二氮䓬类药物处方。本研究旨在评估使用汉堡酒精戒断量表（HAES）的症状触发疗法与固定剂量方案在住院酒精脱毒管理中的有效性和安全性。
在一项回顾性病例对照研究中，将症状触发疗法的酒精脱毒治疗与固定剂量方案进行比较。在12个月的观察期内，共招募了123例症状触发疗法组患者，并与123例固定剂量方案组对照（根据性别、年龄和当前饮酒量匹配）进行比较，这些对照是在症状触发疗法实施前在同一家医院接受治疗的。研究结果包括苯二氮䓬类药物总剂量、急性脱毒期持续时间、住院时间以及癫痫发作和震颤谵妄等并发症的发生情况。
与固定剂量方案相比，症状触发疗法显示苯二氮䓬类药物总剂量显著更低（22.50毫克对115.00毫克，<0.001），脱毒期持续时间更短（48.00小时对201.75小时，<0.001），住院时间缩短（23.00天对28.00天，=0.003）。两种治疗方式的并发症发生率无显著差异。线性混合模型分析显示，即使在调整各种解释变量（即年龄、性别、酒精标准单位、精神科合并症、治疗中断和任何并发症的发生情况）后，差异仍然非常显著。
对于住院酒精脱毒的管理，症状触发疗法似乎与传统的苯二氮䓬类固定剂量方案一样有效和安全。这种方法因此可以最大限度地减少不必要的药物暴露，促进患者更早地融入心理教育和心理社会干预，并降低医疗成本。
