Acute alcohol withdrawal and the period immediately after alcohol withdrawal are of clinical importance because this is the time that patients may be most at risk for relapse to drinking.
The current study was a randomized double-blind, placebo-controlled trial comparing valproic acid and gabapentin as (1) treatment for the acute symptoms of alcohol withdrawal (5 d) and (2) the prevention of relapse and amelioration of psychiatric symptoms associated with protracted alcohol withdrawal (4 wk). Fifty-seven male veterans presenting for alcohol detoxification were randomized to receive valproic acid, gabapentin, or placebo for a total of 4 weeks. All subjects received benzodiazepine medication if needed based on symptoms of acute withdrawal from alcohol for the first 5 days of treatment.
Phase 1: symptoms of physiologic withdrawal during the first 5 days of treatment and doses of benzodiazepine required; phase 2: alcohol use and craving, symptoms of psychiatric distress, and sleep disturbances. Subjects entering the study were in mild to moderate withdrawal and the medications were well tolerated.
The results of this randomized trial suggest that the anticonvulsants were not significantly better than placebo in treating mild withdrawal symptoms, did not influence relapse to alcohol and did not treat the symptoms of depression and sleep disturbance that occur in the postwithdrawal period.
There was some evidence that these medications were superior to placebo in alleviating anxiety. Because subjects as a group improved in all domains significantly, it suggests that supportive treatment is effective in mild to moderate withdrawal.
Department of Psychiatry, Yale University School of Medicine, New Haven, CT
Support was provided by the Veterans Affairs MERIT grant (PI=Petrakis), the VA Alcohol Research Center (Dr John Krystal) and the VISN I Mental Illness Research and Clinical Center (MIRECC) (Dr Bruce Rounsaville).
Reprints: Louis A. Trevisan, MD, VA Connecticut, West Haven campus no. 116-A, 950 Campbell Avenue, West Haven, CT 06516 (e-mail: email@example.com).