Benzodiazepine requirements during alcohol withdrawal syndrome: clinical implications of using a standardized withdrawal scale.

An accurate characterization of the severity of the alcohol withdrawal syndrome is likely to provide clear guidelines for drug therapy in this disorder. We studied (retrospectively) the usefulness of a standardized withdrawal scale on benzodiazepine drug requirements for patients undergoing alcohol detoxification in a general hospital. One hundred thirty-three patients received the revised Clinical Institute withdrawal Assessment Scale for Alcohol and were medicated only if the score was greater than 10. A comparison group of 117 patients was treated without reference to the scale. The groups were evenly matched with respect to age, sex, concurrent drug use, and laboratory abnormalities. Subjects treated according to the scale required less benzodiazepine (median dose, 50 mg diazepam equivalent compared with 75 mg) (p = 0.04). Rates of complications, discharge against medical advice, and length of stay did not differ between the groups. Rank correlation coefficients revealed a closer relationship between the degree of alcohol exposure (as determined by admitting blood alcohol levels, creatine phosphokinase, and SGOT) and benzodiazepine requirements during withdrawal for the group treated with the scale. Findings suggest that when the scale is used, patients with a greater degree of physical dependence receive (appropriately) a higher dose of benzodiazepine and those with a lesser degree of dependence receive (appropriately) a lower dose of benzodiazepine. Use of the scale appears to minimize both under- and overdosing with benzodiazepine for alcohol withdrawal syndrome.