Prescribing in alcohol use disorders

Last month's research roundup provided you with an overview of articles looking at the many and varied uses of botulinum toxin. The articles reviewed looked at the prescribing in glabellar lines, the use in overactive bladder conditions and in the management of hyperhidrosis (Robertson, 2022). This month, we will review three articles all with a relationship to prescribing in alcohol dependence. The first article looks at prescribing for alcohol detoxification while the second focuses on withdrawal syndromes. The final article looks at medication factors and patient characteristics in people admitted to hospital with an alcohol-related condition.

This first article, published in the Irish Medical Journal in January 2022 (Doody et all, 2022), presents the findings of a clinical audit on alcohol detoxification within the National Institute of Health and Care Excellence (NICE) guidelines (NICE, 2010). It comprised a retrospective patient chart review for patients admitted during a pre-defined six-month period in 2016-2017 for prescription of an alcohol detoxification schedule and who met the study inclusion criteria within a single mental health service. This service comprised two hospitals with 293 beds and specialist units including the addiction services centre. Three cycles of the audit were completed with the first cycle being part of a larger international audit, Prescribing Observatory for Mental Health, UK (POMH-UK). The audit was to determine adherence to the guidelines around diagnosis and management of physical complications in alcohol-use disorders. The rationale for this was to improve and maintain rates of successful detoxification with minimal complications as an alcohol-use disorder is associated with increased morbidity and mortality. Outcome measures used were derived from the gold standard guidelines and included a thorough alcohol history, documentation of physical examination, monitoring of vital signs and investigation of liver function. Further recommendations included screening for Wernicke's encephalopathy and monitoring of breath alcohol levels as well as documentation of chlordiazepoxide and thiamine prescription regimes.