Hospital Rx for Alcoholics: Hair of the Dog

Teaching facilities serve liquor to prevent or treat DTs

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By
HealthDay Reporter

TUESDAY, Feb. 4, 2003 (HealthDayNews) -- Severe alcoholics who are treated at American hospitals are getting a surprising message from their doctors: Drink up!

In a study released today, researchers found that an astounding 38 percent of teaching hospitals surveyed keep patients supplied with beer, wine and liquor to prevent or treat alcohol withdrawal syndrome, a condition that afflicts people who drink steadily all day. Some hospitals even allow doctors to boost the blood-alcohol level of patients through intravenous drips. A few others allowed the patient or a visitor bring the booze into the hospital.

"It's a cynical approach: Give them some beer and ship them out the door," said the study's co-author, Dr. Richard D. Blondell, a professor of family medicine at the University of Louisville. According to Blondell, who also practises in the department of family and community medicine at the University of Louisville Hospital, it's not uncommon for hospitals to serve booze on a breakfast tray.

Blondell became interested in the treatment when the parents of a young alcoholic patient complained when a doctor prescribed two beers to their son. In another case, he heard from an recovering alcoholic who fell off the wagon, got in a car accident and couldn't understand why doctors gave him beer for lunch.

"Those incidents caused our hospital to get rid of beer, wine and liquor that was kept in the pharmacy," Blondell said. "We took beer off the formulary."

Before the switch in policy, Blondell's hospital had been following a longstanding tradition of giving patients the "hair of the dog that bit them." Doctors first began treating alcoholics with alcohol back in the 1920s and 1930s, and the practice never went away, according to Blondell.

Doctors want to keep a steady blood-alcohol level in the patients so they could safely be treated for other conditions, such as an injury due to drunkenness, he said.

Alcoholics who drink steadily all day are most prone to developing nasty symptoms when they stop. The brain becomes used to being bathed in alcohol and malfunctions when it is taken away, said William Fals-Stewart, senior research scientist at the Research Institute on Addictions at the State University of New York at Buffalo.

"You get shaking and a lot of what looks like the symptoms of anxiety, like tension and paranoia," he said. The most severe symptoms are delirium tremens (DTs), which come in an estimated 5 percent of alcohol withdrawal cases. Patients with the DTs suffer from hallucinations or seizures, or both.

Blondell and colleagues surveyed 122 teaching hospitals and received 116 responses. The findings appear in the Feb. 5 issue of the Journal of the American Medical Association.

Nearly 75 percent of the hospitals -- 83 -- acknowledged dispensing alcohol to patients within the past year. Of those, 62 hospitals said they used alcohol to treat or prevent alcohol withdrawal syndrome in patients. Hospitals listed a variety of other reasons for dispensing alcohol, including use as a sedation, as an appetite stimulant, and as a "patient courtesy."

Beer was most common, dispensed at 53 hospitals, followed by distilled spirits (31), wine (25), brandy (10), and grain alcohol (7). Twenty hospitals dispensed only through intravenous tubes.

Studies have shown that sedatives -- like Valium -- are the best treatment for alcohol withdrawal syndrome, Fals-Stewart said. While the medications may make patients sleepy, they don't have the main side effect of alcohol -- drunkenness. Nor do they cause damage to the liver and body tissues like alcohol does, he said.

Hospitals don't need to look very far to understand the risks of giving booze to patients, he said. "Alcohol reduces the symptoms, but it carries a lot of baggage. The alcoholics who have gone through this could have told them that."

A spokeswoman for the American Hospital Association declined comment, saying that the group didn't have enough information to address the survey findings.

More information

For information on alcohol, try the National Institute on Alcohol Abuse and Alcoholism . Learn more about delirium tremens from emedicine.com.

SOURCES: Richard D. Blondell, professor of family medicine, M.D., University of Louisville, Ky.; William Fals-Stewart, Ph.D., senior research scientist, Research Institute on Addictions, State University of New York at Buffalo; Feb. 5, 2003, Journal of the American Medical Association

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