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 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 males and 60 females: 1.3% of all patients] with 148 admissions (0.9% of all admissions) were under 21 years of age. Forty-four percent (n=65) of patients presented with suicidal ideations, while 26% (n=40) had suicide attempts. Twenty-two percent (n=33) required admission to the intensive care unit (ICU). The median ICU LOS was 32.8 hours. The median peak CIWA-Ar score was 9 (Min-Max=4-39, IQR=7), while the median time from hospital admission to peak CIWA-Ar score, was 9.4 hours (Min-Max=0.1-126, IQR=20.2). Forty percent (n=59) received benzodiazepines while 20% (n=31) required antipsychotics. Three patients (2%) developed delirium tremens (DT) and we observed 5 episodes of alcohol withdrawal seizures (3.4%). 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 of morbidity and mortality due to suicidality and withdrawal complications such as withdrawal seizures, and DT. Further studies should evaluate the underlying social and neurobiological predictors of vulnerability and resilience in this age group.