Abstract
BACKGROUND: Alcohol dependence syndrome (ADS) poses a significant public health issue in Nepal, necessitating effective pharmacological management. This study evaluated the real-world pharmacological management and short-term treatment outcomes of ADS patients in a rehabilitation center in Kathmandu, Nepal. METHODS: A prospective cohort study was conducted among 96 adult ADS patients between November 2023 and April 2024. Alcohol consumption severity and withdrawal risk were assessed using validated tools (Alcohol Use Disorders Identification Test [AUDIT] and Prediction of Alcohol Withdrawal Severity Scale [PAWSS]). Treatment regimens, symptom profiles, and liver enzyme levels were documented. Statistical analysis included paired and independent t-tests to assess changes in withdrawal severity and clinical markers, with significance set at p < 0.05. RESULTS: The cohort had a mean age of 37.8 years; 69% were male. At baseline, 96% were identified as problematic drinkers, and all were classified as high risk for withdrawal. Lorazepam (98.8%) and thiamine (97.9%) were the most commonly prescribed agents. A significant reduction in PAWSS scores was observed from admission to follow-up (7.06 ± 0.89 vs. 3.64 ± 0.94, p < 0.001). Liver enzyme levels also improved significantly after treatment. Antipsychotics and benzodiazepines were associated with greater symptom control, whereas antidepressants showed limited impact on withdrawal severity. CONCLUSION: Structured, evidence-informed pharmacological regimens were associated with improved clinical outcomes among ADS patients in this resource-limited setting. These findings support the integration of standardized ADS protocols in Nepalese rehabilitation centers. Multicenter studies with long-term follow-up are warranted.