Research review: Effective practices for treating withdrawal


Wooden figurine in the chalk drawn labyrinth

In 2019 the Ministry of Health commissioned a rapid review of the evidence relating to the management of withdrawal from alcohol and other drugs. The aim of the review was to identify "the most effective practices for treatment of withdrawal from specific substances."

Reviews such as this one are used by the NSW Ministry of Health to inform the Clinical Guidelines that maintain and improve the quality of patient care.

The review examined existing evidence on psychosocial (the psychological and social factors influencing mental health), physical and pharmacological (therapeutic medicine) interventions for substance withdrawal. There was a focus on approaches to treating withdrawal from the following drugs:

  • Alcohol
  • Benzodiazepines
  • Amphetamines and methamphetamine
  • Cocaine
  • Methylenedioxy methamphetamine (MDMA)
  • Opioids
  • Cannabis
  • Pregabalin/gabapentin (prescription drugs for neuropathic pain)
  • Gamma hydroxybutyrate (GHB), and gamma-butyrolactone (GBL) and 1,4-butanediol (1,4BD)
  • High dose transfers from methadone to buprenorphine

Key findings

The authors of the review, led by addiction medicine specialist Professor Nick Lintzeris, found that approaches integrating psychosocial, physical and pharmacological interventions were optimal for patients.

Withdrawal services need to be seen as a short-term intervention in a longer continuum of care provided by a range of health and welfare services ­– Management of Withdrawal from Alcohol and Other Drugs 2019, Sax Institute

However effective, the review found that stand-alone withdrawal interventions had limited long term impact without a post-withdrawal 'package of care' or integrated health care approach. That is with a treatment plan that involves different services or therapeutic methods, both clinical and those offered by community services.

"Effective withdrawal services involve: timely access to treatment, a comprehensive clinical assessment, and a treatment care plan that addresses the patient's substance use, health, psycho-social conditions and clinical risk factors (e.g. child protection, violence, homelessness, overdose); regular monitoring throughout the withdrawal period, and effective transfer of care procedures."

While some patients respond well to treatment in a residential or hospital setting away from family or social networks, the review showed that patients and their carers also benefited from having withdrawal treatment options and pathways available to them in a variety of settings (e.g. community or home based).

It was also found that the role of physical interventions - such as exercise or relaxation, while still an emerging area, show increasing evidence they can help with withdrawal symptoms such as sleep, anxiety and cravings for some substances.

For a detailed look at what treatment and support options are available in NSW, including a summary of what to expect, read In focus: Alcohol and other drug treatment and support and visit Getting help.

For free and confidential advice 24/7 call the Alcohol and Drug Information Service (ADIS) on 1800 250 015. Counsellors are available to provide information, referrals, crisis counselling and support. Or start a Web Chat with an ADIS counsellor online Monday to Friday, 8.30am – 5pm. ADIS can also provide up-to-date information about service availability in your area during the COVID-19 pandemic.

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