In rare and severe cases of alcohol withdrawal, one NHS trust is prescribing alcohol to treat patients. A specialised team at Sandwell and West Birmingham Hospitals NHS Trust prescribes carefully controlled doses of alcohol in a medical setting to a select group of patients. The goal? To prevent life-threatening complications.
This unconventional approach has sparked discussions surrounding its safety and effectiveness. But a review by my colleagues and I found that alcohol prescribing was as effective as standard treatments in most cases.
Alcohol withdrawal happens when someone with a significant dependency on alcohol stops drinking. If left inadequately treated, it can lead to seizures, severe cases of delirium (often referred to as “delirium tremens” or “DTs”) and death.
Benzodiazepines are medications used to manage such withdrawal symptoms. But for some patients, they aren’t always effective, leaving them at risk of severe withdrawal complications.
Alcohol prescribing may be used in patients at risk of developing these severe withdrawal symptoms due to their significant alcohol consumption history or lack of responsiveness to benzodiazepines. Small, controlled doses can help stabilise withdrawal symptoms.
But the use of alcohol in this context is not without risks. Administering alcohol, even under medical supervision, can lead to complications if the person has certain medical conditions. There are also ethical concerns around giving alcohol to people who are trying to stop drinking. For some, this could send mixed messages about their treatment and recovery.
Many patients with an established dependence on alcohol no longer drink it because of the rewarding or pleasurable effects it has on them. They drink because of ingrained habits, conditioned responses to cues and to avoid the negative symptoms of not drinking.
The use of alcohol in medical treatments stretches back decades. Historically, alcohol was sometimes used to control DTs. Some early 20th-century medical literature documents cases where alcohol was prescribed in hospitals to alleviate symptoms in patients who were dependent on alcohol. For example, some doctors recommended small doses of alcohol to prevent or manage the hallucinations and seizures associated with DTs.
At Sandwell and West Birmingham Hospitals NHS Trust, alcohol is handled as a controlled drug. Stringent protocols are in place to ensure patient safety. Only consultants with expertise in alcohol management are authorised to prescribe it. And each case is closely monitored by the alcohol care team.
Research on alcohol prescribing remains limited. But there are case studies and small-scale investigations that offer insights into its potential benefits. Our review of the limited studies available found that alcohol prescribing was at least as effective as standard treatments in 70% of cases, with no significant negative outcomes. But the evidence is far from conclusive. More rigorous research is needed to establish clear guidelines.
Our research has also involved reviewing patient outcomes following the implementation of alcohol prescribing by the alcohol care team at Sandwell and West Birmingham Hospitals NHS Trust.
We compared the outcomes of patients who received alcohol with those treated using benzodiazepines. Alcohol was prescribed to people with signs of severe alcohol withdrawal, those at high risk of developing DTs, or patients with a history of very harmful alcohol consumption (typically 30 or more units per day). We also included patients known to the alcohol care team for having previously experienced severe alcohol withdrawal, alcohol-related seizures, or DTs.
On average, we found that patients received a total of 16 units of alcohol during their treatment. This was significantly less than the amount they typically consumed outside of hospital. Research my colleagues and I conducted revealed that patients prescribed alcohol were less likely to require unplanned hospital admissions for alcohol withdrawal. And they had fewer seizures after starting therapy compared with those treated with benzodiazepines.
We have also explored how alcohol prescribing could complement standard care for patients with alcohol withdrawal. Recently, we presented a case where both oral and intravenous alcohol were used to manage a particularly challenging situation.
The patient in question had symptoms of severe alcohol withdrawal and an ankle fracture that needed surgery. They were treated with intravenous ethanol during their stay in hospital. This approach successfully controlled their symptoms and allowed the surgery to proceed. It also avoided the need for admission to an intensive care unit.
Our findings show that using alcohol prescribing as a way of managing withdrawal is both practical and achievable. This approach has the potential to improve the way healthcare is delivered while reducing the strain on hospital resources.
Our research also highlights the need for further work to better understand the effects of alcohol prescribing on patients and to explore how this innovative approach could be implemented elsewhere. Based on our findings, some experts have suggested that it may be time to re-evaluate the broader use of alcohol in managing alcohol withdrawal for certain patients.
We are now gathering feedback from patients who have received alcohol as part of their treatment for alcohol withdrawal. This feedback helps us understand the effect of alcohol on their symptoms and how the intervention was managed and communicated to them during their care.
We are also analysing data from a survey and conducting interviews with healthcare professionals. This work aims to explore staff experiences and perspectives on using alcohol prescribing. By addressing challenges and building on emerging evidence, we aim to refine this approach and expand its application to benefit more patients.
Darren Quelch wishes to acknowledge Sally Bradberry (Sandwell and West Birmingham NHS Trust Alcohol Lead), Arlene Copland (Sandwell and West Birmingham NHS Trust Alcohol Nurse Consultant) and Carol Appleyard (Sandwell and West Birmingham NHS Trust Alcohol Care Team Lead). All have played a vital role in leading the initiative for alcohol prescribing and innovating care for patients presenting to acute services with alcohol dependence at Sandwell and West Birmingham NHS Trust. Darren Quelch receives funding from Sandwell and West-Birmingham NHS Trust research fellowship scheme. Darren Quelch is also a senior research fellow at the Sandwell and West-Birmingham NHS Trust Alcohol Care and Clinical Toxicology Team.
