How to manage chronic dizziness secondary to alcohol and substance use disorder?

From the Guidelines

Managing chronic dizziness secondary to alcohol and substance use disorder requires a comprehensive approach focusing on both substance cessation and symptom management, with the most recent evidence suggesting that combined pharmacotherapy and cognitive behavioral therapy is the most effective approach 1. This approach should prioritize complete abstinence from alcohol and substances, as continued use will perpetuate vestibular dysfunction. Medical detoxification under healthcare supervision is recommended, often using medications like benzodiazepines to manage withdrawal symptoms safely. For persistent dizziness, vestibular suppressants like meclizine or diazepam can provide short-term relief, but should be used cautiously due to addiction potential. Nutritional supplementation is crucial, particularly thiamine to prevent or treat Wernicke's encephalopathy, along with a multivitamin containing B vitamins and magnesium. Vestibular rehabilitation therapy performed by a physical therapist can significantly improve balance and reduce dizziness through specialized exercises. Patients should maintain adequate hydration, follow regular sleep patterns, and avoid triggers like caffeine and nicotine. Long-term recovery requires addressing the underlying substance use disorder through counseling, support groups, and possibly medications like naltrexone or acamprosate to reduce cravings, as supported by recent studies 1. Key points to consider include:

• The importance of combined pharmacotherapy and cognitive behavioral therapy in managing substance use disorders 1
• The need for medical detoxification and management of withdrawal symptoms 1
• The role of nutritional supplementation and vestibular rehabilitation therapy in improving symptoms and reducing dizziness 1
• The importance of addressing underlying substance use disorder through counseling, support groups, and medications to reduce cravings and improve long-term recovery 1.

From the FDA Drug Label

Advise patients that dizziness may occur with naltrexone hydrochloride treatment, and they should avoid driving or operating heavy machinery until they have determined how naltrexone hydrochloride affects them The FDA drug label does not provide specific guidance on managing chronic dizziness secondary to alcohol and substance use disorder. However, it does mention that dizziness may occur with naltrexone hydrochloride treatment.

• Patients should be advised to avoid driving or operating heavy machinery until they have determined how naltrexone hydrochloride affects them.
• The label does not provide a clear recommendation for managing chronic dizziness, and it is essential to consult with a healthcare provider for personalized advice. 2

From the Research

Management of Chronic Dizziness

Chronic dizziness secondary to alcohol and substance use disorder can be managed through various approaches. The following are some strategies that have been studied:

• Vestibular Rehabilitation: Exercise-based vestibular rehabilitation has been shown to be effective in improving symptoms of chronic dizziness in adult patients 3. This type of therapy can help alleviate primary and secondary problems associated with vestibular pathology.
• Psychiatric Considerations: Psychiatric and functional causes, consequences, and comorbidity of vestibular syndromes should be considered in the management of dizzy patients 4. Conditions such as panic attacks, generalized anxiety, and depression can contribute to chronic vestibular symptoms.
• Home-based Vestibular Rehabilitation: Home-based vestibular rehabilitation has been found to be a feasible and effective therapy for persistent postural-perceptual dizziness (PPPD) 5. This approach can improve quality of life, dizziness handicap, and mental health in patients with PPPD.
• Alcohol Withdrawal Management: For patients with alcohol use disorder, management of alcohol withdrawal syndrome is crucial 6. This can include supportive care, pharmacotherapy, and monitoring for symptom improvement.
• Autonomic Dysfunction: Autonomic dysfunction is a common consequence of chronic and excessive alcohol consumption 7. Abstinence from alcohol appears to lead to significant improvement in autonomic investigations, and further research is needed to explore other management strategies.

Key Considerations

When managing chronic dizziness secondary to alcohol and substance use disorder, the following key considerations should be taken into account:

• Comprehensive Assessment: A comprehensive assessment of the patient's condition, including psychiatric and functional considerations, is essential.
• Individualized Treatment: Treatment should be individualized to address the patient's specific needs and symptoms.
• Multidisciplinary Approach: A multidisciplinary approach, involving healthcare professionals from various specialties, may be necessary to effectively manage chronic dizziness secondary to alcohol and substance use disorder.
• Patient Education: Patient education and support are crucial in helping patients manage their symptoms and improve their quality of life.