A weaning approach in case of holy dependence represents intensive and long work often requiring hospitalization in a specialized environment.
Alcohol and tobacco [ 22 ]
Eighty to 95% of alcohol sufferers are also smokers. Stop smoking assistance is too infrequently offered by caregivers. Nicotine addiction is socially more acceptable and there is also a reason for not compromising alcohol withdrawal. There is, however, growing interest in smoking cessation associated with alcohol withdrawal. Nicotine substitution may be considered associated with alcohol withdrawal. It is recommended to offer simultaneous weaning as soon as the motivation of the patients to alcoholism recovery allows it, which requires to address from the outset the information on tobacco and the smoking cessation modalities. Caregivers are also advised to break their neutrality with respect to smoking cessation [ 1 ]. If the motivational context does not allow to consider smoking cessation, it is necessary that the health care team takes a date to achieve the weaning or at least to talk about it again.
Alcohol and benzodiazepines
The consumption of alcohol and BZD is likely to cause serious behavioral problems. Without therapeutic weaning, it is not advisable to prescribe BZD at the alcoholic patient. The alcohol addict is to be considered a risk subject for BZD dependence, which highlights the need for a short and limited prescription of BZD in a alcoholism recovery. System In the case of alcohol-dependence association and BZD dependence, it is necessary to exclude all brutal weaning in BZD and to admit weaning in two stages, alcohol then BZD.
Alcohol and opiates
In subjects on upload substitution treatment, alcohol withdrawal is possible but there is a risk of respiratory depression. Simultaneous withdrawal from alcohol and heroin requires hospitalization. Regarding alcohol and cocaine, there is no codified treatment for weaning.
Association with psychiatric pathologies [ 1 ]
Anxiety observed during withdrawal may be related to withdrawal or addiction. It can be a psychiatric pathology (phobia, panic disorder, generalized anxiety) justifying a specific treatment. Depressive symptoms frequently occur during weaning. Most regress in 2 to 4 weeks. However, in 10 to 15% of cases, the symptoms are more severe with sometimes melancholic features. The suicidal risk is always present. A delay of at least 2 to 4 weeks of weaning is advised before introducing antidepressant treatment. This delay is to be questioned in case of severe symptoms with increased suicidal risk. The determinants of suicidal risk in alcohol addicts are not exclusive to depression. Alcohol dependence can be