The relationship between alcohol tolerance level and severity of alcohol withdrawal syndrome

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.