Withdrawal in perspective

Different needs of differing patients

Many patients who have sustained serious problems as a result of their drinking have not contracted the dependence syndrome and will experience no significant physiological disturbance on withdrawal. A further important group of patients will be showing dependence to slight or moderate degree, but will not suffer from withdrawal symptoms which are to any major extent debilitating. However, there are patients who will feel wretched on withdrawal, and a small group for whom withdrawal will precipitate life-threatening disturbance.

Given diversity in possible withdrawal experience, it makes no sense to approach the treatment of withdrawal in terms of a fixed regime for all-comers. A spectrum of likely withdrawal experiences suggests the need for a spectrum of treatment approaches as corollary. Many patients will need no medication at all to help them come off alcohol, and for many others withdrawal can be safely managed on an out-patient basis with minimum drug cover. In only the minority will withdrawal require admission to hospital, but for some of those patients the effective use of medication will be vital. The clinical significance of withdrawal is firstly, therefore, the demand it makes on the clinician to see the different needs of different patients and to manage minor withdrawal states without unnecessary fuss, while at the same time learning to recognize the necessity for very great care in treating the potentially dangerous situation. This chapter discusses treatment in terms of different regimes for different intensities of need.