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ASAM Holds Alcohol Withdrawal Management Guideline Pre-Planning Meeting

by ASAM Staff | December 7, 2017

On October 16, 2017, ASAM and Institute for Research, Education, and Training in the Addictions (IRETA) staff, alongside clinical champions Dr. Richard Saitz, MD, MPH, FACP, DFASAM, and Dr. Darius Rastegar, MD, FASAM, and Quality Improvement Council representatives Dr. Margaret Jarvis, MD, DFASAM and Dr. Barbara Herbert, MD, DFASAM met at the IRETA offices in Pittsburgh, PA to begin planning the development of the alcohol withdrawal management guideline. 

The purpose of this meeting was to define the scope of ASAM’s newly launching guideline on alcohol withdrawal management. To clarify what to include, ASAM employed the PICOTS framework: population (the characteristics of the target population), intervention (treatments and other interventions used), comparison (intervention or control used for comparison), outcomes (outcomes of interested to be answered by evidence), timing (duration of time that is of interest), and setting (setting or context of interest). The PICOTS framework helps to identify key variables or clinical indicators involved in alcohol withdrawal management decisions, which will be used to draft clinical questions and search strategies during the literature review. Examples of some of the conclusions of this discussion are as follows: 

  • Population- No age parameters, pregnant and nursing women, adolescents 
  • Intervention- Benzodiazepines, antipsychotic/neuroleptic agents, nutrition/electrolytes/vitamins 
  • Comparison- Treatment-to-treatment, no treatment, late treatment initiation 
  • Outcomes- Mortality, delirium/confusion, seizures 
  • Timing- No particular timing considerations were discussed. 
  • Setting- Emergency/intensive care unit, general medical hospital, restricted settings (i.e. criminal justice) 

The group also discussed inappropriate practices and concerns, specific elements that would be included in the guideline, and ways to make the guideline useful for end users. Regarding the target audience, the final consensus was that the alcohol withdrawal management guideline will primarily be intended for clinicians who manage alcohol withdrawal in specialty and non-specialty settings, but it will also have utility for administrators, insurers, and legislators. 

The GRADE method will be used to extract data and evaluate the quality of the materials found in the literature review. The next meeting will take place on February 26, 2018 to develop a comprehensive list of potential guideline statements which will later be rated for appropriateness using the RAND/UCLA Appropriateness Method (RAM) by the expert panel. The list of statements will identify different combinations of clinical indicators in various clinical situations seen in alcohol withdrawal management. 

The alcohol withdrawal management guideline is anticipated to be finalized by the first quarter of 2019. For more information or questions, please contact ASAMGuideline@ASAM.org