Doctors at a Scottish hospital were giving patients with alcohol use disorder too much of a vitamin B1 medicine called Pabrinex. Researchers looked at 106 patients and found that 60% were getting more doses than they actually needed, costing extra money and creating waste. After teaching doctors about the right amounts to prescribe, the unnecessary doses dropped significantly. This shows that simple education can help doctors prescribe the right amount of medicine—not too much and not too little.

The Quick Take

  • What they studied: Whether doctors were prescribing more vitamin B1 (Pabrinex) than patients actually needed, and whether teaching doctors about correct doses would reduce waste.
  • Who participated: 106 patients admitted to a Scottish hospital who had alcohol use disorder and needed vitamin B1 treatment. The study looked at patients admitted over a four-month period.
  • Key finding: At the start, 60% of patients received more doses than guidelines recommended. After doctors received education about correct dosing, unnecessary doses dropped from a median of 13 extra doses per patient down to 4.5 extra doses—a significant improvement (p=0.0087).
  • What it means for you: If you or someone you know is being treated for alcohol use disorder and receives vitamin B1 injections, this research suggests doctors are getting better at prescribing the right amount. However, it’s important that doctors don’t reduce doses so much that patients don’t get enough treatment.

The Research Details

This was a quality improvement project at one hospital in Scotland. Researchers looked back at medical records from 106 patients admitted over four months who had alcohol use disorder and received vitamin B1 treatment. They checked each patient’s medical notes to see what symptoms and risk factors they had when admitted, then compared what doctors actually prescribed to what the hospital’s guidelines said they should prescribe. The researchers did this comparison three times: once at the beginning, then after teaching doctors about correct dosing, and again after a second round of education. This approach is called PDSA (Plan-Do-Study-Act) and is commonly used to improve hospital practices.

This study design is important because it shows real-world prescribing patterns at an actual hospital and tests whether simple education can change doctor behavior. By looking at medical records rather than doing a complicated experiment, researchers could quickly identify the problem and test solutions without disrupting patient care.

Strengths: The study used clear guidelines to determine correct dosing, making comparisons objective. The researchers collected data multiple times to track improvement. Weaknesses: This study only looked at one hospital, so results may not apply everywhere. The study was short (four months), so we don’t know if improvements lasted. The researchers didn’t track whether patients actually got better or had fewer complications—they only looked at prescribing patterns.

What the Results Show

Before any intervention, doctors were overprescribing vitamin B1 to most patients. Specifically, 60% of patients received more doses than hospital guidelines recommended. On average, each patient received 13 extra doses beyond what was needed. This extra medication cost about £35 per patient just for the drug itself, plus additional costs for administration and waste. After the first round of doctor education, the number of unnecessary doses dropped to a median of 7 per patient. After the second round of education, it dropped further to 4.5 unnecessary doses per patient. This reduction was statistically significant, meaning it was unlikely to have happened by chance (p=0.0087). The percentage of patients who received the correct starting dose increased from 30% to 51.3%, though this improvement wasn’t quite statistically significant.

The study found that overprescription was a widespread problem affecting the majority of patients. The fact that improvements continued after each intervention suggests that repeated education and reinforcement may be more effective than a single teaching session. The hospital subsequently created a new, simplified guideline for vitamin B1 dosing based on these findings, which may lead to even better results going forward.

This appears to be one of the first studies specifically looking at overprescription of vitamin B1 in alcohol use disorder patients. While other research has shown that vitamin B1 deficiency is serious and needs treatment, this study highlights a new concern: that doctors may be erring on the side of caution by giving too much. The findings fit with broader healthcare trends showing that many medications are overprescribed, and that simple education can help reduce unnecessary prescribing.

This study only included patients from one hospital in Scotland, so the results may not apply to other hospitals or countries with different guidelines and practices. The study only lasted four months, so we don’t know if doctors continued prescribing correctly after the study ended or if they reverted to old habits. Most importantly, the researchers didn’t track whether patients actually had better health outcomes—they only looked at prescription patterns. We don’t know if reducing doses caused any patients to develop serious complications like Korsakoff syndrome (a serious brain condition from severe vitamin B1 deficiency).

The Bottom Line

Based on this research, hospitals should review their vitamin B1 prescribing practices and provide education to doctors about correct dosing guidelines (moderate confidence). Doctors should follow established guidelines rather than automatically prescribing high doses or long courses of treatment (moderate confidence). However, doctors should be careful not to reduce doses so much that patients who genuinely need treatment don’t receive enough (high confidence). If you’re receiving vitamin B1 treatment, ask your doctor whether the dose and duration match current guidelines.

Hospital administrators and quality improvement teams should care about this research because it shows how to reduce unnecessary medication costs and waste. Doctors who treat patients with alcohol use disorder should pay attention because it may help them prescribe more appropriately. Patients with alcohol use disorder and their families should care because it suggests their treatment is becoming more evidence-based. Insurance companies and healthcare systems should care because reducing unnecessary prescriptions saves money. People who don’t need this information: This research doesn’t apply to people without alcohol use disorder or those not receiving vitamin B1 treatment.

Changes in prescribing practices can happen relatively quickly—this study showed improvements within weeks after doctor education. However, the benefits of correct vitamin B1 dosing (preventing serious brain complications) may take weeks to months to become apparent. Long-term benefits would include reduced healthcare costs and less medication waste over time.

Want to Apply This Research?

  • If you’re receiving vitamin B1 treatment, track the number of doses you receive each week and the route (oral vs. injection). Compare this to what your doctor says the guidelines recommend. Note any symptoms like confusion, memory problems, or balance issues.
  • Ask your doctor to explain why you’re receiving the specific dose and duration of vitamin B1 treatment you’re getting. Request that they reference the current guidelines. If you’re in recovery from alcohol use disorder, use the app to track your alcohol abstinence, which may reduce your need for vitamin B1 supplementation over time.
  • Over the long term, track whether you’re experiencing symptoms of vitamin B1 deficiency (confusion, memory loss, difficulty with balance) or side effects from treatment. Monitor your healthcare costs related to vitamin B1 treatment. If you’re using an app to support alcohol use disorder recovery, note improvements in cognitive function and overall health as indicators that your treatment regimen is appropriate.

This research describes prescribing patterns at one hospital and should not be used to change your own vitamin B1 treatment without consulting your doctor. Vitamin B1 deficiency in people with alcohol use disorder can cause serious, permanent brain damage if not treated adequately. Never reduce or stop vitamin B1 treatment on your own. If you believe you’re receiving too much or too little vitamin B1, discuss your concerns with your healthcare provider who can evaluate your individual situation. This study did not track patient health outcomes, so we cannot be certain that reducing doses is safe for all patients. Always follow your doctor’s recommendations for your specific medical situation.