Alcohol withdrawal: Epidemiology, clinical manifestations, course, assessment, and diagnosis
- Christine Pace, MD, MSc
Christine Pace, MD, MSc
- Assistant Professor of Medicine
- Boston University School of Medicine
Minor manifestations of alcohol withdrawal include anxiety, agitation, restlessness, insomnia, tremor, diaphoresis, palpitations, headache, and alcohol craving, and often loss of appetite, nausea, and vomiting. Moderate and severe withdrawal syndromes can include hallucinations, seizures, or delirium tremens; the latter two can be life-threatening.
Most people with alcohol use disorder do not experience significant withdrawal when they stop or reduce drinking, but withdrawal is common among medical and surgical inpatients and in emergency departments.
This topic reviews the clinical manifestations, course, assessment and diagnosis of alcohol withdrawal. Ambulatory and inpatient management of alcohol withdrawal syndromes are reviewed separately. (See "Medically supervised alcohol withdrawal in the ambulatory setting" and "Management of moderate and severe alcohol withdrawal syndromes".)
The epidemiology, pathogenesis, clinical manifestations, course, screening, assessment, diagnosis, and treatment of risky drinking and alcohol use disorder are also reviewed separately. (See "Risky drinking and alcohol use disorder: Epidemiology, pathogenesis, clinical manifestations, course, assessment, and diagnosis" and "Psychosocial treatment of alcohol use disorder" and "Pharmacotherapy for alcohol use disorder".)
The prevalence of alcohol use disorder (alcohol abuse and dependence in DSM-IV) is estimated to be 14 percent in community based samples in the United States  and as high as 40 percent among hospitalized patients . Approximately half of patients with alcohol use disorder experience alcohol withdrawal when they reduce or stop drinking [3,4].
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- CLINICAL PRESENTATION AND COURSE
- Mild withdrawal
- Alcohol hallucinosis
- Withdrawal seizures
- Withdrawal delirium
- Severe alcohol withdrawal syndrome
- Patient history
- Physical examination
- Laboratory and other testing
- CIWA-Ar scale
- DSM-5 diagnostic criteria
- Differential diagnosis
- - Early withdrawal symptoms
- - Alcohol withdrawal seizures
- - Alcohol hallucinosis
- - Withdrawal delirium
- INFORMATION FOR PATIENTS