Exploring alcohol withdrawal syndrome and predicting alcohol consumption change in patients admitted to a genenral hospitals in Vietnam

Abstract

Risky alcohol drinking is common in hospitalized patients. Early detecting risky alcohol drinkers in hospital is important to provide appropriate management of Alcohol withdrawal syndrome (AWS). This first aim of this study was to identify the extent to which patients admitted to a general hospital in Vietnam meet the criteria for risky alcohol drinker (RAD), alcohol use disorder (AUD), and alcohol withdrawal syndrome (AWS). The second aim was to identify predictors of intension to change and changing alcohol consumption using the Integrated Behavior Model as a conceptual framework. Design: A prospective survey was conducted in Kien An - a general hospital in the north of Vietnam during March-June 2018. To achieve the first objective, 1340 patients admitted to a general hospital was screened for risky alcohol drinkers, AUD and AWS. There were 314 from 2,168 patients admitted to the hospital were identified as risky alcohol drinkers for collecting data of the second objective. Patients who drank greater than the set limit for safe were classified as RADs. RADs who had the Alcohol Use Disorder Identification Test (AUDIT) score of 8 or more were identified as AUDs. Diagnostic and Statistical Manual of Mental Disorders version 5 was used as a criteria to diagnose AWS. The AWS scale was used to quantitate AWS severity level. Upon admission, there were 250 male and 1 female risky alcohol drinkers were interviewed using a designed questionnaire on their experiential and instrumental attitude toward changing alcohol consumption, descriptive and injunctive norm, perceived behavior control, alcohol dependent severity, intention to change alcohol consumption and alcohol consumption. A total of 176 and 115 RADs were follow-up for alcohol consumption using the first 3 question of AUDIT at 1 and 3 months after hospital discharge, respectively. The results found that prevalence of risky alcohol drinkers, AUD patients, AWS patients of hospitalized patients were 15.5%, 13.1%, and 7.3%, respectively. All the AUD and AWS patients were male. The majority of risky alcohol drinkers, AUD, AWS were found in the group of 40-60-year-old male. Multivariate multinomial logistic regression showed that instrumental attitude toward changing alcohol consumption had significant relationship with intention in both some and strong intention group comparing to no intention group (OR = 2.8 and 4.9, respectively). Only perceived behavior control had significant relationship with intention in strong intention group comparing to no intention group (OR = 2.1). Intention to act was the only influencing factor that significantly related to changing alcohol consumption (OR = 1.3 and 1.4 in some change and significant change group respectively comparing to no change group at 1 month; and OR = 1.2 and 1.5 in some change and significant change group respectively comparing to no change group at 3 months after discharging from the hospital). In conclusion, AUD and AWS were common in hospitalized patients. Setting up the protocol to identify AWS is urgent. Stronger beliefs about a positive outcome from changing alcohol consumption and more confidence over obstacles or environmental temptation correlated with higher patient intention to change. Intention to act is the strongest predictor of reduced alcohol consumption behavior. Patients were able to change their alcohol consumption after discharge from the hospital. A hospital stay and education of alcohol’s impact on health may motivate patients to change their alcohol consumption.