Multimodal integrative approach combining Ayurveda with conventional therapy for alcohol withdrawal syndrome

Alcohol Withdrawal Syndrome (AWS) can be defined as a condition when a person addicted to alcohol abruptly ceases or decreases the amount of alcohol intake. The common signs and symptoms of alcohol withdrawal are tremors, ataxia, gait disturbances, irritability, seizures, tachycardia, hypertension, insomnia, hallucinations, disorientation, and delirium tremens. A 41-year-old man presented with tremor, sweating, hallucinations, insomnia, and disorganized speech after an abrupt withdrawal of chronic alcohol consumption for one week. The patient had a history of hypertension but no psychological or substance-related illness. The diagnosis of AWS was made based on clinical history, presenting symptoms, and laboratory results, which included increased liver enzymes but normal metabolic and hematological functions. The Clinical Institute Withdrawal Assessment for Alcohol Scale, Revised (CIWA-Ar) score of the patient was 36. To manage the condition, an integrative management approach was adopted, combining Ayurveda modalities including Shirodhara (~therapeutic oil-streaming over the head) with Brahmi taila ; internal medications such as Shrikhandasava , Mrudwikadi kashaya , and Brahmi ghrita ; Yoga therapy; and conventional treatment including lorazepam and intravenous fluids with multivitamins, to control the severe autonomic hyperactivity during the acute phase. The CIWA-Ar score decreased to 15 after one week and further reduced to 7 by day 37. Furthermore, compared to the previously reported case with resolution of AWS over two months with conventional treatment alone, the reduction in CIWA-Ar score in lesser time frame in this case suggests potential benefit of the integrative approach. However, further clinical studies with the required sample size are needed to confirm the findings and outcomes.