Trends in pharmacotherapy selection for the treatment of alcohol withdrawal in the Free State Province, South Africa

Abstract

BACKGROUND. The selection of pharmacotherapy for the treatment of alcohol withdrawal remains a clinical challenge. Research continues into the underlying pathophysiology of dependence and withdrawal. A spectrum of clinical presentations of alcohol dependence is emerging, yet recommendations and guidelines have remained unchanged for some time. OBJECTIVES. To engage with the problem of translating research into practice, as reflected by the selection of pharmacotherapy for alcohol withdrawal by medical practitioners in the Free State Province, South Africa. METHODS. A questionnaire-based survey and interviews were conducted among 121 professionals in both the private and public sectors across the province. A subgroup was formed comprising the 58 doctors who indicated that they prescribe for alcohol withdrawal. Participants worked in private general practice, specialist psychiatry practice, in a state hospital or in a treatment centre. RESULTS. Prescribing practices varied based on practitioners’ geographical distribution and professional capacity. Deviation from standard recommendations included the routine use of clothiapine and antidepressants in withdrawal regimens. Prescribing clothiapine appears to be a local custom. While prescription of antidepressants may indicate unrealistic expectations of therapeutic benefit, there are clear indications that this is maintained to mask the diagnosis of an alcohol-related condition. Prescribing for alcohol withdrawal is therefore not necessarily determined by pathophysiology or efficacy of medication. CONCLUSION. Withdrawal regimens need to be reassessed by researchers, policy makers and funders, balancing new developments with the real-life experiences and challenges of prescribers and their patients.