Alcohol withdrawal syndrome - Guidelines for management

Clinically significant symptoms of withdrawal frequently follow the abrupt cessation of alcohol use in alcohol-dependent individuals. Given alcohol-dependence point prevalence rates of at least 10 to 20% in most medical settings, as many as 1 in 5 patients may require treatment for withdrawal symptoms. Recently developed guidelines from the American Society of Addiction Medicine utilised an appraisal of the quality and quantity of research available on pharmacological management of alcohol withdrawal. In light of these guidelines, along with recent advances in the understanding of the biological mechanisms of withdrawal, the procedures for treating patients undergoing alcohol withdrawal are discussed. Inpatient management protocols should administer benzodiazepines for mild to moderate and severe withdrawal symptoms utilising a standardised rating instrument and information from past withdrawal episodes to inform treatment decisions. A symptom-triggered dose schedule can be used in settings with trained staff; a gradual taper dosage regimen is appropriate elsewhere. Carbamazepine and valproic acid (sodium valproate) represent promising pharmacotherapeutic agents, although further research is needed. Outpatient detoxification is also discussed. With appropriate and aggressive treatment, morbidity from alcohol withdrawal ran be minimised.