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Improve severe alcohol withdrawal treatment by training doctors: B.C. study

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August 29, 2018 - 7:00 AM

VANCOUVER - There's an urgent need to improve the treatment of severe alcohol withdrawal because too many patients are being admitted to hospital when they could be managed through outpatient services or by family doctors, says the lead author of a new study.

Dr. Evan Wood, executive director of the B.C. Centre on Substance Use, said family doctors and emergency departments could use a simple screening questionnaire to assess and diagnose patients before treatment is recommended.

The study published Tuesday in the Journal of the American Medical Association reviewed 530 studies involving more than 71,000 patients.

Wood said St. Paul's Hospital in Vancouver is the only hospital in Canada that uses the questionnaire, called the Prediction of Alcohol Withdrawal Severity Scale, resulting in improved patient care and cost savings to the health-care system.

The assessment tool involves a measurement of patients' blood alcohol level and about 10 questions including whether they have previously experienced episodes of alcohol withdrawal; whether they have had seizures or blackouts and whether they have combined alcohol with any other substance of abuse in the last 90 days.

Wood said it's time doctors were trained to use the simple questionnaire, which could allow patients to be prescribed one of several drugs that work to reduce cravings and binge drinking, an increasing problem around the world.

Cognitive behavioural therapy could also be used and is a proven intervention in alcohol addiction, he said.

"It should be a source of embarrassment that the system of care is not functioning at a modern level," he said, adding evidence-based treatment is needed for patients who could otherwise experience life-threatening issues.

"That's the motivation here, to seize the opportunity and finally bring addiction care into the list of things that family doctors know how to diagnose and treat and health authority programs adequately fund. Ultimately that will save a lot of costs and reduce a lot of suffering."

Heavy drinkers who abruptly stop or seriously cut back on how much they consume could, in severe cases, experience symptoms such as delirium tremens, or the DTs, which may include hallucinations and delusions.

Three medications are currently approved in Canada to manage withdrawal, said Wood, adding the B.C. Centre on Substance Use is planning to release guidelines later this year for the treatment of alcohol use disorder, with an aim for all divisions of family practice, emergency rooms and health authorities in the province to implement them.

"There's a host of reasons, including the fact that until the opioid crisis, addiction care was an afterthought. We just have not put an emphasis on evidence-based addiction care."

R-Jay Melnichuk, 28, twice sought help for severe alcohol withdrawal, the first time at age 21, when he lived in Calgary.

"I'd been drinking for a year straight, almost 26 ounces a day, and the only thing a doctor could tell me was to not stop drinking or 'I could give you Valium,' " he said about his second attempt at getting help, at a walk-in clinic.

He ended up detoxing on his own after that experience, but the withdrawal symptoms were harsh.

"I was hallucinating, I got the shakes, I couldn't eat anything or drink anything for four days. It was quite terrifying," he said of envisioning bats flying at him like darts after his mother drove through the night from Winnipeg to support him.

Melnichuk, who moved to Surrey, B.C., in 2014, has advised emergency room doctors at Peace Arch Hospital and Surrey Memorial Hospital on how to recognize signs of alcoholism and severe alcohol withdrawal as part of the outreach he does with his Alcoholics Anonymous group.

The effects of alcoholism can go on for years and be so severe that doctors need to be trained to diagnose and treat patients with ongoing care, he said.

"It can be a lifelong burden on tons of families," said Melnichuk, who now runs a transition home for men who have completed a substance use program he also attended on Vancouver Island.

Research by the Canadian Institute for Substance Use Research and the Canadian Centre on Substance Use and Addiction says alcohol use costs Canadians an annual $14.6 billion in health care, lost production, criminal justice and other direct costs.

The Canadian Centre for Substance Use Research at the University of Victoria released a study last year that said British Columbia has the highest rate of hospitalizations in the country caused by alcohol.

— Follow @CamilleBains1 on Twitter.

News from © The Canadian Press, 2018
The Canadian Press

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