A Study of Factors Influencing the Severity of Alcohol Withdrawal State in Patients of Alcohol Dependence Syndrome.
Journal Title: International Journal of Medical Science and Innovative Research (IJMSIR) - Year 2019, Vol 4, Issue 3
Abstract
Introduction: Beverage alcohol which is a product of fermenting fruit or grape was probably found around before humans walked the earth. It is among the most widely used psychoactive substances in the world. Alcohol Use Disorders is a global problem and is the third leading cause of death throughout the world. Withdrawal symptoms can manifest in an uncomplicated manner like coarse tremors, insomnia, anxiety, increased heart rate while a small but significant number of individuals present in a complicated manner as in delirium tremens which can occur in 5% of the cases. Past history of complicated withdrawal, older age, poor nutritional status and history of high tolerance to alcohol are predictors of increased severity of withdrawal while few more predictors are yet to be established in order to improve the line of management of these individuals. Materials And Methods: A cross-sectional study was done on 165 individuals who fulfilled the criteria of alcohol dependence syndrome aged between 18-65 years who attended out/ in-patient departments of SSMC and who gave informed consent They were assessed using a semi-structured proforma, Alcohol Use Disorder Identification Test (AUDIT), Clinical Institute of Withdrawal Assessment for alcohol (CIWA-Ar) and individuals who qualified for delirium were assessed using Delirium Rating School (DRS-R98). Results: Majority of the participants were between 31-50 years (63.6%) with mean age being 41.70 (SD ± 9.97), males (94.5%) who were mostly educated upto high school (30.9%) and were involved in clerical work or were shop owners or farmers (55.8%). Most of them were married (77.0%). Majority of the study subjects initiated alcohol consumption between 20-30 years of age (81.2%) with mean age being 26.84 (SD ± 5.36). 60.0% of them consumed alcohol daily with 39.4% of them consuming 180-270 ml. Majority of them had a family history of alcohol use (66.1%). Most of them did not have a fixed pattern of alcohol use (38.2%). There was no period of abstinence in most of the subjects (53.9%). About 58.8% of them were involved in concomitant use of other substances out of which 57.6% of them used tobacco. CIWA scores of the study subjects done on day 1 had 44.8% of moderate severity, 26.7% being severe, 26.1% being mild while 2.4% had very mild severity. The withdrawal assessment done on day 7 in the same individuals showed 58.2% having mild severity, 32.1% having very mild withdrawal, 7.3% having moderate withdrawal while 2.4% having severe withdrawal. Conclusion: This study suggests that the severity of alcohol withdrawal decreases where in on day 1 if the severity was moderate became mild or very mild when assessed on days 7. There are various factors which influence the severity of alcohol withdrawal state in patients of alcohol dependence syndrome. While some sociodemographic factors like occupation, income of the individuals, religion play significant role in determining the severity of withdrawal state, others like age, gender, educational status and marital status do not influence withdrawal severity. Few other factors like quantity and frequency of consumption, amount spent, family history and concomitant use of other substances make a major impact in withdrawal. By assessing the severity, we can reduce the morbidity and mortality associated with alcohol and hence also prevent untoward consequences because of them.
Authors and Affiliations
Dr. Vachana Kamila
Keywords
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