On Beverage Alcohol for Withdrawal: “Don’t Use It”

I have rediscovered a paper on the use of beverage alcohol to treat alcohol withdrawal that I found a few years ago and lost. It makes a pretty strong case against using alcohol for the management of withdrawal [1]. I still see it occasionally and I suspect the reason I don’t see it more often is because I and others have attempted to get beverage alcohol completely removed from formulary. If you’re trying to do that at your hospital, good luck. Apparently there are those still around who have more than a modicum of influence on some pharmacy committees.

The authors of this paper conducted a survey of 32 hospitals by contacting the pharmacies by telephone. Of the hospitals surveyed, half still used alcohol. Eleven hospitals used it to manage alcohol withdrawal. The physicians who ordered this were surgeons–all of them.

The authors note that a well-known textbook of Psychiatry as early as 1927 argued that alcohol should be avoided in the management or prevention of delirium tremens. By contrast, in 1907 a surgery textbook recommended its use “in large doses”.

The authors go on to say that “..the use of alcohol is not recommended for either the prevention or treatment of DTs.”

One internist is quoted who made no bones about it, “Don’t use it. To my recurrent consternation, surgical textbooks (and even a paper in a substance abuse journal as recently as last year) have advocated giving alcohol iv for alcohol withdrawal. It is more toxic than the benzodiazepines, harder to administer and requires monitoring of blood levels not to mention the fact that it condones the use of alcohol.” That quote is from way back in 1999.

The authors also speculate that the reason surgeons persist in trying to use alcohol in this way might do it as a carryover from the days before ether, using beer and whiskey to induce muscle relaxation and “senselessness”. I could use the word “senselessness” in another sense here but some would call it insensitive.

1. Rosenbaum, M. and T. McCarty “Alcohol prescription by surgeons in the prevention and treatment of delirium tremens: historic and current practice.” General Hospital Psychiatry 24(4): 257-259.
Beer, other alcohol beverages, and IV alcohol are still used to prevent or treat alcohol withdrawal delirium on surgical services. The history of the use of alcohol by surgeons may play a role in its continued use for withdrawal. In this policy survey 32 inpatient hospital pharmacies were called and asked if alcohol was available, if it was used to treat alcohol withdrawal, and the medical specialties that requested it. Recommendations about the use of alcohol were examined in recent textbooks and from those published early in the twentieth century. One half of the 32 hospitals surveyed had alcoholic beverages available for patient use and eleven hospitals used either package alcohol or IV alcohol in the treatment of alcohol withdrawal. Surgeons used alcohol before anesthesia to help patients tolerate procedures, and the use of alcohol for treatment of alcohol withdrawal still appears in the surgical literature. This preliminary survey indicates that some hospitals still provide beverage alcohol for the treatment of alcohol withdrawal and that surgeons are the specialty ordering alcohol for their patients.