Managing withdrawal from drugs and alcohol: what works best?

With almost one in six Australians drinking at risky levels and 3.4 million of us reporting use of an illicit substance in 2019, it’s clear that dependence on alcohol and other drugs is a societal problem of huge dimensions.

Governments typically provide services to manage withdrawal from drugs and alcohol, and as we learn more about what works best, it’s crucial that these services are designed to reflect the latest and best evidence available.

An Evidence Check from the Sax Institute, commissioned by NSW Health, takes a closer look at what researchers have found to be the most effective practices for treating withdrawal from alcohol and other drugs. The authors, led by addiction medicine specialist Professor Nick Lintzeris, found that while the evidence was patchy in many places, it was in general robust enough to be encompassed in evidence-based clinical guidelines.

Withdrawal services, they say, should be seen as a short-term intervention in a longer continuum of care. Stand-alone services may not have long-term impact, they warn. Services need to be conceived as a package of care, integrating psychosocial, physical and pharmacological interventions.

The role of physical interventions – such as exercise or relaxation – is still an emerging area but there is increasing evidence that exercise can help with withdrawal symptoms such as sleep, anxiety and cravings.

On the other hand, the evidence is much weaker for peer engagement during withdrawal, such as the 12-step help program made famous by Alcoholics Anonymous.

Many of the drugs used in withdrawal have been mainstays for years, such as benzodiazepines for alcohol and buprenorphine for opioids. But the evidence for cannabis withdrawal is undergoing transformation: while historically there have been no medication options, there is increasing optimism around cannabinoid-agonist drugs such as nabiximols.

One challenge for withdrawal services is to ensure their availability to those who need them. While services in NSW have tended to be either residential or hospital-based, the Evidence Check authors emphasise the need for a range of access options, determined by patient preference, severity of withdrawal, patient-preference and cultural factors. For example, for Aboriginal people, residential units and hospitals may not be the most effective options as these do not allow them to remain close to family and country.

The Evidence Check will be used to inform the revised Clinical Guidelines that are currently under review by NSW Health.

Access this Evidence Check here.

Find out more about the Sax Institute’s Evidence Checks here.