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The purpose of this paper is to identify published literature from a general hospital setting that may highlight variables implicated in the development of severe alcohol withdrawal syndrome (SAWS) in patients who have alcohol dependence syndrome (ADS).

A systematic literature review was carried out using the electronic databases: MEDLINE, Medline in Process, Cinahl, Embase and PsycINFO from 1989 to 2017. The focus of this search was on English language studies of individuals over 16 years admitted to general hospital with ADS, delirium tremens (DTs), alcohol-related seizure (ARS) or alcohol withdrawal syndrome (AWS).

Of the 205 studies screened, eight met the criteria for inclusion. Six studies were quantitative retrospective cohort and two were retrospective case-control. Six studies investigated risk factors associated with DTs, one examined SAWS and one alcohol kindling. Descriptive analysis was performed to summarise the empirical evidence from studies were 22 statistically significant risk factors were found; including the reason for admission to hospital, daily alcohol consumption, previous DTs and prior ARS. The last two factors mentioned appeared in two studies.

Further research should consider the quality and completeness of the alcohol history data and competence of staff generating the data in retrospective studies.

The paper suggests that the factors linked to SAWS development from the literature may not fully explain why some individuals who have ADS develop SAWS, and others do not.

The purpose of this paper is to develop an alcohol withdrawal syndrome risk stratification tool that could support the safe discharge of low risk patients from the emergency department.

A retrospective cohort study that included all patients referred to the acute addiction liaison nursing service over one calendar month (n=400, 1–30 April 2016) was undertaken. Bivariate and multivariate modelling identified the significant variables that supported the prediction of severe alcohol withdrawal syndrome (SAWS) in the cohort population.

The Glasgow Modified Alcohol Withdrawal Scale (GMAWS), hours since last drink, fast alcohol screening test (FAST) and systolic blood pressure correctly identified 89 per cent of patients who developed SAWS and 84 per cent of patients that did not. Increasing each component by a score of one is associated with an increase in the odds of SAWS by a factor of 2.76 (95% CI 2.21, 3.45), 1.31 (95% CI 1.24, 1.37), 1.30 (95% CI 1.08, 1.57) and 1.22 (95% CI 1.10, 1.34), respectively.

The research was conducted in a single healthcare system that had a high prevalence of alcohol dependence syndrome (ADS). Second, the developed risk stratification tool was unable to guarantee no risk and lastly, the FAST score previously aligned to severe ADS may have influenced the patients highest GMAWS score.

The tool could help redesign the care pathway for patients who attend the emergency department at risk of SAWS and link low risk patients with community alcohol services better equipped to deal with their physical and psychological needs short and long term supporting engagement, abstinence and prolongation of life.

The tool could help redesign the care pathway for emergency department patients at low risk of SAWS and link them with community alcohol services better equipped to deal with their physical and psychological needs, short and long term, supporting engagement, abstinence and prolongation of life.

Alcohol withdrawal syndrome (AWS) is a serious condition that can result in death if it is not recognized and treated appropriately. A high fidelity simulation scenario on AWS was created for psychiatric nurses in an educational setting that focused on the recognition of alcohol withdrawal, implementation of the Clinical Institute Withdrawal Assessment (CIWA) and initiation of appropriate treatment and management of AWS.

A formative assessment teaching strategy was used to evaluate the development and implementation of a high fidelity simulation (HFS) on alcohol withdrawal syndrome. The HFS was part of a baccalaureate undergraduate psychiatric nursing education designed to reinforce classroom theory and clinical application. Results were measured using a self‐report survey completed by students that focused on the details of content and performance.

Feedback from the 38 nursing students who evaluated the HFS was overall positive. Survey results showed that the HFS scenario reinforced the classroom theory on addiction and mental disorders while translating and supporting student's learning to clinical practice. The HFS provided opportunity for students to practice skills when they had not had this experience during the clinical rotation. Only four students felt uncomfortable with decision making and initiating the CIWA scale after the HFS.

There is a gap in the development and use of standardized simulations for mental health and substance abuse scenarios as a teaching strategy in nursing programs. The results of this study supported using HFS as an educational strategy and set the stage for future complex simulations such as dual diagnosis and clients with comorbidities.

The purpose of this paper is to illustrate delirium as a possible consequence of the application of symptom-triggered therapy for alcohol withdrawal and to explore alternative treatment modalities. In the management of alcohol withdrawal syndrome, symptom-triggered therapy directs nursing staff to regularly assess patients using standardized instruments, such as the Clinical Institute for Withdrawal Assessment of Alcohol, Revised (CIWA-Ar), and administer benzodiazepines at symptom severity thresholds. Symptom-triggered therapy has been shown to lower total benzodiazepine dosage and treatment duration relative to fixed dosage tapers (Daeppen et al., 2002). However, CIWA-Ar has important limitations. Because of its reliance on patient reporting, it is inappropriate for nonverbal patients, non-English speakers (in the absence of readily available translators) and patients in confusional states including delirium and psychosis. Importantly, it also relies on the appropriate selection of patients and considering alternate etiologies for signs and symptoms also associated with alcohol withdrawal.

The authors report a case of a 47-year-old male admitted for cardiac arrest because of benzodiazepine and alcohol overdose who developed worsening delirium on CIWA-Ar protocol.

While symptom-triggered therapy through instruments such as the CIWA-Ar protocol has shown to lower total benzodiazepine dosage and treatment duration in patients in alcohol withdrawal, over-reliance on such tools may also lead providers to overlook other causes of delirium.

This case illustrates the necessity for providers to consider using other available assessment and treatment options including objective alcohol withdrawal scales, fixed benzodiazepine dosage tapers and even antiepileptic medications in select patients.

Alcohol‐related brain damage (ARBD) is an increasing challenge for service providers working with older people and adults. It has a complex aetiology and does not progress in the same way as other causes of dementia. The devastating effects of ARBD undermine a person's ability to lead an independent life, yet it is thought that with the right interventions, a degree of recovery can be seen in 75% of sufferers. People with ARBD do not neatly fit into an existing category of care; they ‘fall through the net’ at multiple points in the care pathway. Using a patient synopsis drawn from clinical practice the author illustrates the impact of an advanced practice role in relation to the nursing care of patients with ARBD, as well as making suggestions for the provision of education and support for mainstream services.

In 1992, a Scottish Office grant was awarded to develop a nurse‐led alcohol liaison service for patients within a busy general hospital (Leslie & Learmonth, 1994).This project was based on previous research conducted in the same hospital that concluded that early detection of alcohol problems and minimal intervention could considerably reduce long‐term alcohol‐related damage (Chick et al., 1985). A first article describing the service was published in 1994 (Leslie & Learmonth). This follow‐up article aims to describe how the service has developed and expanded since then. This includes the many issues we have encountered on our path to a greater understanding and delivery of specialist alcohol service.

The assessment of cognitive impairment in community services for older people remains under-explored. The paper aims to discuss this issue.

Cognitive impairment was examined in 25 people aged 65 and over with alcohol use disorders, on the caseload of community mental health services over a six-month period. All subjects assessed using Addenbrooke’s Cognitive Assessment (ACE-III).

In total, 76 per cent of the group scored below the cut-off point for likely dementia but only 45 per cent of people scored below the cut-off point for tests of language, compared with 68-84 per cent people in other domains.

This finding has implications for the detection of alcohol-related brain cognitive impairment in clinical settings.

Standardised cognitive testing is common within mental health services for older people, but may also have utility within addiction services.

The early detection of alcohol-related cognitive impairment can improve social outcomes in both drinking behaviour and the social consequences of alcohol-related dementia.

This may be the first published study of cognitive impairment in patients under a mental team for older people with alcohol use disorders and offers some unique findings within this sampling frame.

Alcohol misuse leads to a massive drain upon an already stretched NHS budget. High numbers of individuals with alcohol related physical and health needs are being admitted into the secondary health care setting at great financial cost. This paper examines a profile of this population presenting to the secondary care setting over a 12‐month period. It is suggested that the misuse of alcohol does not take place in isolation. It is often accompanied by other problematic behaviours such as domestic violence, inappropriate, neglectful parenting, or child abuse, offending behaviour, and psychological problems. Evidence for the nature and extent of these associated behaviours is reported and discussed. Comparisons are made particularly with data related to tobacco smoking, and the positive aspects of smoking cessation programmes are outlined. Almost all of the population reported on over the 12‐month period were tobacco smokers. The re‐emergence of the incidence of smoking with the reduction of smoking cessation programmes is noted. The challenge for substance misuse services is how best to respond to the needs of this growing population who often present withalcohol misuse together with smoking behaviours. A collaborative model of response is outlined and suggested as the best way forward. This involves substance misuse services working together with professional colleagues within the acute hospital environment and community to ensure sustainable positive clinical outcomes following hospital discharge.

This paper describes the development of a novel integrative self-directed treatment tool which uses cognitive behavioural therapy techniques to reduce anxiety symptoms in patients presenting to treatment for alcohol-related problems. More specifically, the purpose of this paper is to explore patient and health practitioner perceptions of the booklet, in order to determine its suitability and utility in the context of existing alcohol treatment services. The extent of cross-informant agreement between patient and health practitioner responses is also examined.

This research utilises a cross-sectional qualitative research design using semi-structured interview methods with patients presenting to hospital for alcohol-related diseases/illnesses/accidents/injuries (n=15) and practitioners (n=10) working at inpatient, outpatient and residential substance treatment facilities.

The present study found that the majority of patients (80 per cent) and practitioners (90 per cent) expressed a motivation to utilise the proposed booklet, agreeing that the booklet was a practical, achievable and educational resource for patients suffering from co-occurring anxiety symptoms in substance abuse facilities. Participants outlined limitations of the resource, suggesting that the booklet would be most suitable for patients with moderate to high cognitive ability, who also exhibit a motivation to change alcohol consumption and have access to additional support.

Findings from the present study suggest that the booklet may be most effective in improving treatment accessibility and patient treatment seeking behaviours; rather than reducing practitioner-patient contact.

This paper focuses on the development and utility of a novel resource suitable for substance abuse treatment facilities. The findings and feedback produced from the present study can assist with modifications of the intervention and in improving the effectiveness of future trials.

The purpose of this paper is to test the effectiveness of a self-directed cognitive behavioural therapy (CBT) booklet allowing immediate access to treatment for anxiety during alcohol use disorder (AUD) interventions.

Parallel pilot randomised controlled trial: 69 individuals in AUD treatment, continued to receive treatment alone (control: n=29) or in addition, a self-directed, four week CBT booklet to manage anxiety (intervention: n=40). Primary outcome measures were changes in state (SAnx) and trait anxiety (TAnx) at four weeks. Secondary outcome measures were changes in adaptive (ACop), maladaptive (MCop) coping and quality of life (QoL, physical (PHQoL), psychological (PSQoL), social (SQoL), environment (EQoL)) at four weeks.

Participants had significantly higher SAnx (p < 0.01) and TAnx (p < 0.01) baseline scores compared to the general population. There were no statistically significant group changes in SAnx or TAnx (p > 0.05). Control group allocation predicted improvement in ACop (p < 0.01), MCop (p < 0.05), PHQoL (p < 0.01), PSQoL (p < 0.05) and SQoL (p < 0.01); CBT group allocation predicted improvement in EQoL (p=0.05). All effect sizes were small to moderate (Cohen’s d < 0.50). Percentage of book completion did not determine changes in anxiety, coping or quality of life.

A four week self-directed CBT booklet did not significantly reduce anxiety during AUD treatment. Larger sample sizes will determine the most suitable treatment delivery mode for this type of CBT.