Second-line and 'alternative' treatments for alcohol withdrawal: alpha-agonists, beta-blockers, anticonvulsants, acupuncture and neuro-electric therapy.

ABSTRACT

Drugs which reduce autonomic overactivity but have no sedative effects can be useful in alcohol withdrawal, either as the sole pharmacological intervention or in conjunction with sedative drugs. They may reduce sedative requirements, but their lack of anticonvulsant and anti-delirium effect can be a disadvantage. Beta-blockers are more effective than alpha-2 agonists. Non-sedative anticonvulsants are of questionable value. Acupuncture and neuro-electric therapy, though often popular with patients and therapists, appear to be no more than impressive placebos in this context. Non-specific treatment effects can be very prominent in withdrawal. Support, information, reassurance and good nursing can reduce the need for specific pharmacological or psychological interventions.