Managing alcohol withdrawal in hospitalized patients
ABSTRACT
According to one estimate, one in five patients admitted to a hospital suffers from an alcohol use disorder such as alcohol abuse or dependence.1 Other data indicate that one in four medical-surgical patients admitted to a hospital has an alcohol use disorder.2 Consequently, hospital nurses care for many complex patients who experience alcohol withdrawal in the ED or a nursing unit. Yet patients at risk for alcohol withdrawal aren't always obvious, and signs of alcohol abuse can be obscure.3 Patients who drink heavily may not recognize that they have a problem, or be embarrassed and minimize their drinking pattern, not realizing that alcohol withdrawal can be life-threatening. A focused nursing assessment is critical in identifying the potential for alcohol withdrawal symptoms in all hospitalized patients. This article discusses how to assess patients at risk and how to use these assessment findings as a basis for nursing interventions. Terminology describing alcohol use and misuse is variable and confusing, but these broad categories help guide assessment: at-risk drinking, abuse, and dependence. Patients at risk consume quantities of alcohol that put them at risk of dependence but don't meet the criteria for abuse or dependence, such as experiencing withdrawal symptoms after cessation of drinking.4 Alcohol abuse can be described as a pattern of drinking resulting in "significant and recurrent adverse consequences."5 The World Health Organization (WHO) describes harmful drinking as "a pattern of alcohol consumption carrying with it a risk of harmful consequences to the drinker."6Alcohol dependence (also called alcoholism) is defined by the National Institute on Alcohol Abuse and Alcoholism (NIAAA) as a disease with four symptoms:7 * craving: a strong need or urge to drink alcohol * loss of control: inability to stop drinking once drinking has begun * physical dependence: appearance of withdrawal signs and symptoms after stopping drinking * tolerance: the need to drink.
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