The Relationship Between Alcohol Tolerance Level and Severity of Alcohol Withdrawal Syndrome
- Authors: Achuvakov R.S.1, Alehin V.Е.2, Bakirov L.R.2, Valeeva T.S.2, Selina L.А.3, Efremova U.S.2, Gashkarimov V.R.4, Efremov I.S.5, Asadullin A.R.2,6
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Affiliations:
- Republican Clinical Psychotherapeutic Center Bashkir State Medical University
- Bashkir State Medical University
- Ufa University of Science and Technology
- Republican Clinical Psychiatric Hospital
- Independent Researcher
- Saratov State Medical University named after V.I. Razumovsky
- Issue: Vol LVII, No 2 (2025)
- Pages: 132-139
- Section: Original study arcticles
- Submitted: 14.12.2024
- Accepted: 26.12.2024
- Published: 14.06.2025
- URL: https://journals.eco-vector.com/1027-4898/article/view/642825
- DOI: https://doi.org/10.17816/nb642825
- EDN: https://elibrary.ru/HMFKCY
- ID: 642825
Cite item
Abstract
BACKGROUND: Alcohol withdrawal syndrome (AWS) is a condition that develops as a result of an abrupt reduction or cessation of ethanol intake. The severity of AWS depends on numerous factors, one of which is the extent of ethanol consumption and alcohol tolerance. Alcohol tolerance, especially when it is increased, is one of the key diagnostic criteria of alcohol dependence.
AIM: The work aimed to analyze the relationship between severity of AWS and maximum daily alcohol tolerance.
METHODS: A continuous screening of patients with alcohol dependence syndrome who were undergoing inpatient treatment at a specialized addiction facility was conducted on days 7–14 of their hospital stay (post-withdrawal period). Inclusion, non-inclusion, and exclusion criteria were established for the selection of participants. All patients were diagnosed with middle stage alcohol dependence syndrome. At the time of inclusion in the study, none of the participants had AWS. To assess the severity of AWS, the CIWA-Ar scale was used.
RESULTS: The study included 399 participants diagnosed with F10.2 (alcohol dependence), of whom 83 (21%) were females and 316 (79%) were males. The mean age of the patients was 41.52 ± 8.42 years. During hospital stay, 108 (27%) patients had an AWS-associated convulsive seizure, while 291 (73%) had no convulsive seizures. Statistical analysis revealed a significant relationship between daily alcohol tolerance and the severity of individual alcohol withdrawal symptoms. It was also found that patients with convulsive seizures after alcohol withdrawal had higher daily alcohol tolerance. A threshold value of daily alcohol tolerance of 3.59 g/kg of body weight predictive of the development of AWS-associated convulsive seizures was calculated.
CONCLUSION: The study found that the severity of AWS was positively correlated with the maximum daily alcohol tolerance. When daily alcohol tolerance is more than 3.5 g/kg of body weight, patients should be considered at risk for developing AWS-associated convulsive seizures.
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About the authors
Rustem S. Achuvakov
Republican Clinical Psychotherapeutic CenterBashkir State Medical University
Email: achuvakov.rustem@mail.ru
Candidate of the Department of Psychiatry, Narcology and Psychotherapy
Russian Federation, 15 Prudnaya st, unit 1, Ufa, 450069; Ufa, 450008Vyacheslav Е. Alehin
Bashkir State Medical University
Email: a.v.e888@yandex.ru
ORCID iD: 0009-0005-0623-4718
SPIN-code: 2685-8629
MD, Cand. Sci. (Medicine), Assistant Professor
Russian Federation, Ufa, 450008Linar R. Bakirov
Bashkir State Medical University
Email: Blr.ufa@yandex.ru
ORCID iD: 0000-0002-7519-436X
SPIN-code: 9495-1117
MD, Cand. Sci. (Medicine), Assistant Professor
Russian Federation, Ufa, 450008Tatyana S. Valeeva
Bashkir State Medical University
Email: jakekline@yandex.ru
ORCID iD: 0009-0002-1178-5715
SPIN-code: 4622-5007
Assistant Lecturer
Russian Federation, Ufa, 450008Lada А. Selina
Ufa University of Science and Technology
Email: Lada.selina@mail.ru
ORCID iD: 0000-0003-1859-8541
SPIN-code: 2292-6883
Assistant Lecturer
Russian Federation, UfaUl′yana S. Efremova
Bashkir State Medical University
Email: uliana.efremova2024@gmail.com
ORCID iD: 0000-0002-5513-2946
SPIN-code: 6224-2270
6th year student
Russian Federation, Ufa, 450008Vadim R. Gashkarimov
Republican Clinical Psychiatric Hospital
Author for correspondence.
Email: gashkarimov@yandex.ru
ORCID iD: 0000-0001-9944-141X
SPIN-code: 3828-4634
Psychiatrist
Russian Federation, UfaIlya S. Efremov
Independent Researcher
Email: efremovilya102@gmail.com
ORCID iD: 0000-0002-9994-8656
SPIN-code: 9983-8464
MD, Cand. Sci. (Medicine), Independent Researcher
Russian Federation, UfaAzat R. Asadullin
Bashkir State Medical University; Saratov State Medical University named after V.I. Razumovsky
Email: droar@yandex.ru
ORCID iD: 0000-0001-7148-4485
SPIN-code: 3740-7843
Russian Federation, Ufa; Saratov
References
- Day E, Daly C. Clinical management of the alcohol withdrawal syndrome. Addiction. 2022;117(3):804–814. doi: 10.1111/add.15647
- Livne O, Feinn R, Knox J, et al. Alcohol withdrawal in past-year drinkers with unhealthy alcohol use: Prevalence, characteristics, and correlates in a national epidemiologic survey. Alcohol Clin Exp Res. 2022;46(3):422–433. doi: 10.1111/acer.14781
- Choi HY, Seo JS, Lee SK. Assessment and treatment of alcohol withdrawal syndrome. Korean J Gastroenterol. 2020;76(2):71–77. doi: 10.4166/kjg.2020.76.2.71
- Vigouroux A, Garret C, Lascarrou JB, et al. Alcohol withdrawal syndrome in ICU patients: Clinical features, management, and outcome predictors. PLoS One. 2021;16(12):e0261443. doi: 10.1371/journal.pone.0261443
- Woo KN, Kim K, Ko DS, et al. Alcohol consumption on unprovoked seizure and epilepsy: An updated meta-analysis. Drug Alcohol Depend. 2022;232:109305. doi: 10.1016/j.drugalcdep.2022.109305
- Sansone G, Megevand P, Vulliémoz S, et al. Long-term outcome of alcohol withdrawal seizures. Eur J Neurol. 2024;31(1):e16075. doi: 10.1111/ene.16075
- Wood E, Albarqouni L, Tkachuk S, et al. Will this hospitalized patient develop severe alcohol withdrawal syndrome? The rational clinical examination systematic review. JAMA. 2018;320(8):825–833. doi: 10.1001/jama.2018.10574
- Elvig SK, McGinn MA, Smith C, et al. Tolerance to alcohol: A critical yet understudied factor in alcohol addiction. Pharmacol Biochem Behav. 2021;204:173155. doi: 10.1016/j.pbb.2021.173155
- Sullivan JT, Sykora K, Schneiderman J, et al. Assessment of alcohol withdrawal: the revised clinical institute withdrawal assessment for alcohol scale (CIWA-Ar). Br J Addict. 1989;84(11):1353–1357. doi: 10.1111/j.1360-0443.1989.tb00737.x
- Efremov IS, Sultanova RI, Akhmetova EA, et al. Clinical aspects of alcohol dependence associated with a history of withdrawal syndrome complicated by convulsive syndrome. Narcology. 2022;21(2):52–57. doi: 10.25557/1682-8313.2022.02.52-57 EDN: IURVRR
- O'Dean SM, Mewton L, Chung T, et al. Definition matters: assessment of tolerance to the effects of alcohol in a prospective cohort study of emerging adults. Addiction. 2022;117(11):2955–2964. doi: 10.1111/add.15991
- Patrick ME, Azar B. High-intensity drinking. Alcohol Research. 2018;39(1):49–55.
- McBride O, Teesson M, Baillie A, Slade T. Assessing the dimensionality of lifetime DSM-IV alcohol use disorders and a quantity-frequency alcohol use criterion in the Australian population: A factor mixture modelling approach. Alcohol Alcohol. 2011;46(3):333–341. doi: 10.1093/alcalc/agr008
- Hasin DS, Beseler CL. Dimensionality of lifetime alcohol abuse, dependence and binge drinking. Drug Alcohol Depend. 2009;101(1-2):53–61. doi: 10.1016/j.drugalcdep.2008.10.025
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