Benzodiazepines and the treatment of alcohol abuse

Barbiturates for the treatment of alcohol withdrawal syndrome: A systematic review of clinical trials

PURPOSE

To perform a systematic review of the clinical trials concerning the use of barbiturates for the treatment of acute alcohol withdrawal syndrome (AWS).

MATERIALS AND METHODS

A literature search of MEDLINE, EMBASE, and the Cochrane Library, together with a manual citation review was conducted. We selected English-language clinical trials (controlled and observational studies) evaluating the efficacy and safety of barbiturates compared with benzodiazepine (BZD) therapy for the treatment of AWS in the acute care setting. Data extracted from the included trials were duration of delirium, number of seizures, length of intensive care unit and hospital stay, cumulated doses of barbiturates and BZDs, and respiratory or cardiac complications.

RESULTS

Seven studies consisting of 4 prospective controlled and 3 retrospective trials were identified. Results from all the included studies suggest that barbiturates alone or in combination with BZDs are at least as effective as BZDs in the treatment of AWS. Furthermore, barbiturates appear to have acceptable tolerability and safety profiles, which were similar to those of BZDs in patients with AWS.

CONCLUSIONS

Although the evidence is limited, based on our findings, adding phenobarbital to a BZD-based regimen is a reasonable option, particularly in patients with BZD-refractory AWS.

Signs and symptoms assessment: a guide for the treatment of the alcohol withdrawal syndrome

A technique for evaluating signs and symptoms of alcohol withdrawal that provides an accurate guide to benzodiazepine dosage is presented. In addition to achieving homeostasis, the total benzodiazepine dosage is greatly reduced. Adjunctive therapies for seizure prophylaxis and hypertension as well as substitution of other benzodiazepines for diazepam are discussed.

Pharmacological treatment of tobacco dependence

Pharmacologically based approaches for the treatment of tobacco dependence are reviewed. The rational basis for pharmacologic treatment approaches is that tobacco dependence is partially, and critically, mediated by the actions of tobacco-delivered nicotine to the central nervous system. These actions include direct reinforcing properties of nicotine itself, tolerance and physiologic dependence, possible beneficial effects of nicotine in the alleviation of anxiety and control of weight, and neurohormonal regulation which can become important to the maintenance of emotional well-being and performance at work. Insofar as tobacco abstinence leads to negative consequences, via these biobehavioral mechanisms, pharmacologic intervention should be able to assist in initial tobacco detoxification and help tobacco abstinent persons to avoid subsequent relapse. The purpose of this review is to survey some of the efforts to develop such interventions, as well as to elucidate some of the issues relevant to such development. Four distinct approaches are discussed: (1) Nicotine replacement, in which physiologic dependence is transferred to a safer and more therapeutically manageable nicotine delivering formulation; this category includes nicotine polacrilex gum; (2) Blockade therapy, in which a drug is taken that blocks the reinforcing properties of nicotine should relapse occur; (3) Nonspecific pharmacotherapy, in which the biobehaviorally mediated correlates of tobacco abstinence are treated on a symptomatic basis; (4) Deterrent therapy, in which a drug is taken prior to smoking such that any tobacco use would produce reliable aversive effects.

Treatment of mental problems in general practice. A one year prospective study from an island community in northern Norway

The aim of the study was to provide a basis for improving the treatment and prevention of mental problems in a defined local community. The prescribing of psychotropic drugs has been recorded as well as the use of non-drug therapy and the factors which worsened the patients' mental problems. The rate of psychotropic drug-users was 15% for females and 9% for males. The total prescribing during one year amounted to 59 defined daily doses (DDD) per thousand inhabitants per day. Hypnotics/sedatives constituted 30%, anti-histamines 23%, neuroleptics 18%, minor tranquillizers 16%, and antidepressants 13%. About 1/4 of the psychotropic drug-users was prescribed more than 180 DDD per year, representing a risk group for chronic use. The majority of all psychotropic drugs (65%) was prescribed through indirect contacts implying a danger of developing "repeat prescription syndromes". Less than one half of the patients who might have benefited from referral to a psychiatrist had, in fact, been referred during the previous three years. Somatic disease (among the psychotropic drug-users) and illness among other family members were frequently reported as worsening factors. This indicates the importance of holistic therapy and prophylaxis in general practice. Among our advice for prevention of mental problems to the local authorities was the arrangement of weekly social meetings and clubs for disabled pensioners and elderly people.

Psychotropic drug prescribing in general practice. II. A three year retrospective study from an island community in northern Norway

In a rural community in the northern part of Norway, the prescribing of psychotropic drugs has been recorded. The total prescribing during three years amounted to 60 defined daily doses per thousand inhabitants per day. Hypnotics and sedatives comprised together with antihistamines, 50% of the total amount of defined daily doses. Neurosis was the dominating indication for prescribing. The majority of the patients (59%) received less than 50 defined daily doses per year, indicating that most patients have a moderate consumption of psychotropic drugs. One of five users were prescribed more than 180 defined daily doses per year (71% of all DDD), representing a probable risk-group for chronic use.