Clinical Characteristics and Treatment Outcomes of Alcohol Withdrawal Syndrome in Adolescents and Young Adults

Objective

Despite the high prevalence of underage drinking, little is known about alcohol withdrawal syndrome (AWS) in adolescents and young adults. The aim of this study is to characterize AWS in this population.

Method

We conducted a retrospective chart review of all hospital admissions with the Clinical Institute Withdrawal Assessment of Alcohol Scale, Revised (CIWA-Ar) protocol at Mayo Clinic between June 2019 and June 2022.

Results

We identified a total of 10,220 patients with 16,338 hospital admissions where CIWA-Ar protocol was implemented. Within this cohort, 130 patients (70 male and 60 female; 1.3% of all patients) with 148 admissions (0.9% of all admissions) were under 21 years of age. A total of 44% of patients (n = 65) presented with suicidal ideations, and 26% (n = 40) had suicide attempts. In all, 22 (n = 33) required admission to the intensive care unit. The median length of stay in the intensive care unit was 32.8 hours. The median peak CIWA-Ar score was 9 (minimum-maximum = 4-39, interquartile range = 7), and the median time from hospital admission to peak CIWA-Ar score was 9.4 hours (minimum-maximum = 0.1-126, interquartile range = 20.2). A total of 40% of patients (n = 59) received benzodiazepines, whereas 20% (n = 31) required antipsychotics. Three patients (2%) developed delirium tremens, and 5 episodes of alcohol withdrawal seizures (3.4%) were observed. No deaths were reported during hospitalization. However, over the subsequent follow-up period from 2019 to 2023, the all-cause post-hospitalization mortality rate was 3% (n = 4) within 1.6 (±0.6) years.

Conclusion

These data suggest that adolescents and young adults presenting for treatment of AWS are at risk for morbidity and mortality due to suicidality and withdrawal complications such as withdrawal seizures and delirium tremens. Further studies should evaluate the underlying social and neurobiological predictors of vulnerability and resilience in this age group.

Plain language summary

A study of adolescents and young adults experiencing alcohol withdrawal (AW) at Mayo Clinic identified 130 patients under 21 years old among 10,220 patients with AW (1.3% of the total) and 148 admissions among 16,338 admissions (0.9% of all AW admissions). Results revealed concerning trends in these minors: 44% presented with suicidal thoughts, 26% attempted suicide, and 22% required treatment in the intensive care unit. Although no in-hospital deaths were recorded, 4 patients (3%) experienced all-cause mortality within 1.6 years after discharge, but the causes of death remained unknown. These findings highlight the health risks of underage drinking and emphasize the need for further research.