Lejoyeux M, Solomon J, Adès J
Department of Psychiatry, Hôpital Bichat, Claude Bernard, Paris, France.
Alcohol Alcohol. 1998 Nov-Dec;33(6):563-75. doi: 10.1093/alcalc/33.6.563.
Benzodiazepines (BZDs) are the preferred pharmacological agents for treatment of acute alcohol withdrawal. Treatment with BZDs can be administered on an out-patient basis for subjects experiencing mild to moderate withdrawal and on an in-patient basis for the most severe forms of withdrawal. The efficacy of BZDs for long-term treatment of alcoholism has been more controversial. Controlled studies indicate that BZD treatment does not improve abstinence rate. Most reviews of drug treatment of alcoholism conclude that routine use of BZDs is not indicated on a long-term basis. However, the clinical reality is that many alcoholics are treated by BZDs during detoxification and then continue to receive them for the treatment of anxiety disorders or insomnia, often secondary to alcohol dependence. After a review of the biological properties of BZDs related to their therapeutic issues, this review discusses the major indications for BZD treatment of alcoholism. BZDs are first prescribed to prevent and treat symptoms of alcohol withdrawal. Indication of BZD administration during alcohol withdrawal and criteria of choice of an agent according to its half-life or its route of administration are discussed. The different protocols of BZD treatment during withdrawal are considered (e.g. loading techniques, symptom-triggered therapy). The use of BZDs in the treatment of anxiety associated with alcohol dependence is examined. Among unwanted effects, risk of abuse, memory impairment, confusion, and delirium are described. Finally, practical guidelines for the use of BZDs in the treatment of alcoholism are proposed.
苯二氮䓬类药物（BZDs）是治疗急性酒精戒断的首选药物。对于轻度至中度戒断的患者，BZDs治疗可在门诊进行；对于最严重的戒断形式，则需住院治疗。BZDs用于酒精中毒长期治疗的疗效更具争议性。对照研究表明，BZD治疗并不能提高戒酒率。大多数关于酒精中毒药物治疗的综述得出结论，长期常规使用BZDs并无必要。然而，临床实际情况是，许多酗酒者在戒毒期间接受BZDs治疗，之后继续服用以治疗焦虑症或失眠症，这些症状往往继发于酒精依赖。在回顾了与BZDs治疗问题相关的生物学特性后，本综述讨论了BZDs治疗酒精中毒的主要适应证。BZDs首先用于预防和治疗酒精戒断症状。文中讨论了酒精戒断期间BZD给药的适应证以及根据药物半衰期或给药途径选择药物的标准。考虑了戒断期间BZD治疗的不同方案（如负荷技术、症状触发疗法）。研究了BZDs在治疗与酒精依赖相关的焦虑症中的应用。还描述了不良反应，包括滥用风险、记忆损害、意识模糊和谵妄。最后，提出了BZDs用于治疗酒精中毒的实用指南。
