Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
. 2023;21(2):409-416.
doi: 10.2174/1570159X20666220706105253.

Symptoms of Protracted Alcohol Withdrawal in Patients with Alcohol Use Disorder: A Comprehensive Systematic Review

Silvano Gallus  1 , Alessandra Lugo  1 , Elisa Borroni  1 , Teo Vignoli  2 , Lisa Lungaro  3 , Giacomo Caio  3 , Roberto De Giorgio  3 , Giorgio Zoli  4   5 , Fabio Caputo  3   5
Affiliations

Symptoms of Protracted Alcohol Withdrawal in Patients with Alcohol Use Disorder: A Comprehensive Systematic Review

Silvano Gallus et al. Curr Neuropharmacol. 2023.

Abstract

Background: Alcohol withdrawal syndrome (AWS) is characterized by different phases (acute, early and protracted). Protracted alcohol withdrawal (PAW) presents some symptoms, which may persist for several weeks, months or even years after drinking cessation.

Methods: We conducted a systematic review of the literature in major scientific databases on selected AWS symptoms (craving, sleep disorders, and anhedonia) in patients with alcohol use disorder.

Results: Of the 102 eligible publications (70 RCTs and 32 cohort studies), 88 provided data on craving, 21 on sleep disorders, and 1 on anhedonia. Overall, 37 studies assessed craving using the Obsessive Compulsive Drinking Scale (OCDS). Pooled OCDS decreased from 24.2 at baseline to 18.8 at 1 week, 10.3 at 1 month and 9.7 at 3 months. The corresponding estimates for treated individuals were 23.9, 18.8, 8.7, and 8.8, and for non-treated subjects, they were 25.3, 13.9, 13.2, and 11.4, respectively. In 4 studies assessing sleep disorders using the Epworth Sleeping Scale (ESS), the scale remained stable in time, i.e., 7.3 at baseline, 7.3 at 1 week, 7.2 at 1 month, and 7.1 at 3 months.

Conclusion: This study confirms the presence of PAW after the resolution of the acute phase of AWS. The pharmacological approach to managing PAW may ensure a more rapid reduction of symptoms in three weeks. We highlight the importance of studying PAW and the ability of pharmacological treatment to reduce its symptoms. This review protocol is registered in Prospero (registration number: CRD42020211265).

Summary: This systematic review summarizes literature on major symptoms of protracted alcohol withdrawal in patients with alcohol use disorder. The pharmacological approach to manage protracted alcohol withdrawal ensures a more rapid reduction of symptoms (craving in particular), achieving in three weeks similar results obtained only after almost 6 months without treatment.

Keywords: Alcohol withdrawal syndrome; anhedonia; craving; early alcohol withdrawal; protracted alcohol withdrawal; sleep disorder.

PubMed Disclaimer

Conflict of interest statement

For the present systematic review, Silvano Gallus, Alessandra Lugo and Elisa Borroni acted as statistical and epidemiological consultants for the Laboratorio Farmaceutico CT S.r.l.

Figures

Fig. (1)
Fig. (1)
Flowchart of the systematic review on the symptoms of protracted alcohol withdrawal in patients with alcohol use disorder.
Fig. (2)
Fig. (2)
Linear spline for craving measured by Obsessive Compulsive Drinking Scale (OCDS) over time until one year of follow-up. The knot is the time point where the optimal linear spline model changes slope. Knot observed 18 days after withdrawal; β1 (x<18): -0.76 (p-value<0·001); β1+β2 (x≥18): -0·01 (p-value=0·163), where β1 represents the slope of the line obtained from the linear spline before the knot and β2 after the knot.
Fig. (3)
Fig. (3)
Linear spline for craving measured by Obsessive Compulsive Drinking Scale (OCDS) over time, until six months of follow-up, in strata of pharmacological treatment (the black line: treated with a pharmacological drug, the gray line: untreated or treated with placebo). Treated (black): Knot observed 21 days after withdrawal; β1 (x<21): -0·75 (p-value<0·001); β1+β2 (x≥21): 0·00 (p-value=0·710) Placebo (grey): Knot observed 4 days after withdrawal; β1 (x<4): -2·83 (p-value<0.001); β1+β2 (x≥4): -0·03 (p-value=0·007) Interaction treatment*time: β=-0·00, p-value=0·837.
See this image and copyright information in PMC

References

    1. American Psychiatric Association. Diagnostic and Statistical Manual of Mental Disorders: DSM-5. 5th ed. Arlington American Psychiatric Publishing; 2013. - DOI
    1. Bayard M., McIntyre J., Hill K.R., Woodside J., Jr Alcohol withdrawal syndrome. Am. Fam. Physician. 2004;69(6):1443–1450. - PubMed
    1. Caputo F., Agabio R., Vignoli T., Patussi V., Fanucchi T., Cimarosti P., Meneguzzi C., Greco G., Rossin R., Parisi M., Mioni D., Arico’ S., Palmieri V.O., Zavan V., Allosio P., Balbinot P., Amendola M.F., Macciò L., Renzetti D., Scafato E., Testino G. Diagnosis and treatment of acute alcohol intoxication and alcohol withdrawal syndrome: position paper of the Italian Society on Alcohol. Intern. Emerg. Med. 2019;14(1):143–160. doi: 10.1007/s11739-018-1933-8. - DOI - PubMed
    1. de Timary P., Cordovil de Sousa Uva M., Denoël C., Hebborn L., Derely M., Desseilles M., Luminet O. The associations between self-consciousness, depressive state and craving to drink among alcohol dependent patients undergoing protracted withdrawal. PLoS One. 2013;8(8):e71560. doi: 10.1371/journal.pone.0071560. - DOI - PMC - PubMed
    1. Perney P., Lehert P., Mason B.J. Sleep disturbance in alcoholism: proposal of a simple measurement, and results from a 24-week randomized controlled study of alcohol-dependent patients assessing acamprosate efficacy. Alcohol Alcohol. 2012;47(2):133–139. doi: 10.1093/alcalc/agr160. - DOI - PubMed

Publication types