JACOB, MOIRE S. MD, FRCP(C); ZILM, DUANE H. PHD; MACLEOD, STUART M. MD, PHD, FRCP(C); SELLERS, EDWARD M. MD, PHD, FRCP(C) Author Information

FRECKER, RICHARD C. MD, PHD; SHAW, JOANNE M. BN; ZILM, DUANE H. BSc, MPHIL, PHD; JACOB, MOIRE S. MD; SELLERS, EDWARD M. MD, PHD; DEGANI, NAEMA MD, PHD Author Information

The pattern of cardiac arrhythmias and their treatment, by propranolol and chlordiazepoxide, during the first 48 hr of alcohol withdrawal has been studied. Prior to treatment, the incidence of serious and life-threatening arrhythmias was found to be very low and uncorrelated with most biochemical parameters. Propranolol treatment, while efficacious in controlling arrhythmias, was limited due to its association with hallucinations. Chlordiazepoxide was associated with poor early control of arrhythmias. The combination of propranolol and chlordiazepoxide was found to perform best overall with substantial reductions in arrhythmias and the fewest treatment failures.

The term addictive as used by the popular press frequently confuses the more precise concepts of acute and chronic tolerance, physical dependence and withdrawal, and psychologic dependence. Serious physical dependence on psychoactive drugs is rare and is easily managed. In contrast, psychologic dependence, the most important reason for persistent drug use, is much more common and is difficult to treat. Some tactics are available - for example, confrontation and discussion with the patient about how a drug is not going to be effective over long periods. Treating the symptom of a complex problem should, of course, not be expected to solve the problem. The most important tactic is to prescribe dependence-associated drugs only when clearly indicated, when the problem is responsive to drug therapy and for the shortest period necessary, without the option for renewing the prescription. Many problems related to drug use long after the period of expected benefit is past can be avoided by far more restrictive drug prescribing. Barbiturates and nonbarbiturate sedative hypnotics (e.g., ethchlorvynol, glutethimide, meprobamate, methaqualone and methyprylon) should not be prescribed for insomnia, acute reactive anxiety, chronic anxiety neurosis or depressive illnesses, since the safer and equally effective benzodiazepines, which are less associated with dependence, are available.