Drug and Alcohol Services A brief guide to the management of alcohol and other drug withdrawal September 2018 Suggested citation: Duong, T., Vytialingam, R., & O’Regan, R. (2018). A brief guide to the management of alcohol and other drug withdrawal. Perth, Western Australia: Mental Health Commission. ISBN: 978-0-9944434-3-4 © Mental Health Commission 2018 Acknowledgements: Christmass, M., Connolly, C., Stone, J., Helfgott, S., Palmer, B., & The Next Step Inpatient Withdrawal Planning committee This booklet is produced by Next Step Drug and Alcohol Services, Mental Health Commission. It may be reproduced in whole or in part for study or training purposes subject to an inclusion of an acknowledgement of the source and no commercial usage or sale. Contents Introduction ...................................................................................................................................................................................................... 4 General principles of withdrawal ...................................................................................................................................................................... 5 Assessment .................................................................................................................................................................................................. 5 Treatment .................................................................................................................................................................................................... 5 Post Withdrawal .......................................................................................................................................................................................... 6 Alcohol .............................................................................................................................................................................................................. 7 1. Introduction ...................................................................................................................................................................................... 7 2. Withdrawal ....................................................................................................................................................................................... 7 2.1 Withdrawal seizures ......................................................................................................................................................................... 8 2.2 Delirium Tremens (DTs) .................................................................................................................................................................... 8 3. Treatment ......................................................................................................................................................................................... 8 3.1 Monitoring ............................................................................................................................................................................. 9 3.2 Benzodiazepines ..................................................................................................................................................................... 9 3.3 Thiamine for prophylaxis and treatment of Wernicke-Korsakoff Syndrome (WKS).............................................................. 11 3.4 Other medications for symptomatic relief ........................................................................................................................... 11 3.5 Pharmacotherapies for relapse prevention .......................................................................................................................... 12 3.5 Psychosocial intervention ............................................................................................................................................................... 12 4. Pregnancy and breastfeeding ......................................................................................................................................................... 12 5. Post Withdrawal ............................................................................................................................................................................. 13 Opioids ............................................................................................................................................................................................................ 14 1. Introduction .................................................................................................................................................................................... 14 2. Withdrawal ..................................................................................................................................................................................... 14 3. Treatment ....................................................................................................................................................................................... 15 3.1 Monitoring ........................................................................................................................................................................... 15 3.2 Buprenorphine ..................................................................................................................................................................... 16 3.3 Clonidine .............................................................................................................................................................................. 16 3.4 Other medications for symptomatic relief for opioid withdrawal ........................................................................................ 17 4. Pregnancy ....................................................................................................................................................................................... 18 5. Naltrexone ...................................................................................................................................................................................... 18 6. Naloxone ......................................................................................................................................................................................... 18 Cannabis .......................................................................................................................................................................................................... 19 1. Introduction .................................................................................................................................................................................... 19 2. Withdrawal ..................................................................................................................................................................................... 19 3. Treatment ....................................................................................................................................................................................... 20 3.1 Monitoring ........................................................................................................................................................................... 20 3.2 Medications for symptomatic relief for cannabis withdrawal .............................................................................................. 21 3.3 Psychological and social support .......................................................................................................................................... 21 4. Pregnancy ....................................................................................................................................................................................... 21 Benzodiazepines .............................................................................................................................................................................................. 22 1. Introduction .................................................................................................................................................................................... 22 2. Withdrawal ..................................................................................................................................................................................... 23 3. Treatment ....................................................................................................................................................................................... 24 3.1 Monitoring ........................................................................................................................................................................... 25 3.2 Medications for symptomatic relief ..................................................................................................................................... 25 3.3 Psychological and social support .......................................................................................................................................... 25 4. Pregnancy ......................................................................................................................................................................................