Thiamine hydrochloride (vitamin B1) is strongly supported by scientific evidence for use in the context of alcoholism, particularly to prevent and treat Wernicke-Korsakoff syndrome (WKS), a serious neurological disorder resulting from thiamine deficiency. Chronic alcohol use interferes with thiamine absorption, storage, and utilization, causing many individuals with alcohol use disorder to become deficient. WKS manifests as a triad of confusion, ataxia, and ophthalmoplegia, and can progress to irreversible memory impairment (Korsakoff psychosis) if not treated promptly.

Numerous clinical guidelines recommend routine thiamine supplementation in hospitalized patients with known or suspected alcohol dependence, especially before administering glucose, since glucose can precipitate acute Wernicke’s encephalopathy in thiamine-deficient individuals. Thiamine is also given prophylactically to those at risk of deficiency due to malnutrition related to alcoholism. The standard of care is parenteral (intravenous or intramuscular) thiamine, as oral absorption may be unreliable in these patients.

The use of thiamine in alcoholism is not based on tradition but on robust scientific understanding of the pathophysiology of thiamine deficiency in this population and the severe, sometimes fatal, neurological consequences if left untreated. There are decades of observational data, clinical studies, and expert consensus supporting this practice.