Medically supervised alcohol withdrawal in the ambulatory setting
- Joseph R Volpicelli, MD, PhD
Joseph R Volpicelli, MD, PhD
- Executive Director
- Institute of Addiction Medicine
- Scott A Teitelbaum, MD
Scott A Teitelbaum, MD
- Professor of Psychiatry
- University of Florida
The goal of alcohol detoxification is threefold: to manage symptoms of alcohol withdrawal; to prevent serious events (seizures, delirium tremens, or death); and to bridge patients to treatment for maintaining long-term recovery.
The psychiatric diagnoses, alcohol abuse and alcohol dependence, in DSM-IV-TR were replaced by one diagnosis, alcohol use disorder, in DSM-5 . Although the crosswalk between DSM-IV and DSM-5 disorders is imprecise, alcohol dependence is approximately comparable to alcohol use disorder, moderate to severe subtype, while alcohol abuse is similar to the mild subtype.
Patients with alcohol use disorder can benefit from structured intervention to reduce drinking and/or achieve and maintain abstinence. Most patients with a moderate to severe disorder are physiologically dependent on alcohol and will first require a medically supervised withdrawal [2,3].
Medically supervised withdrawal from alcohol in the ambulatory setting will be reviewed here. Non-ambulatory treatment of more severe alcohol withdrawal is reviewed separately. Screening and treatment for alcohol use disorder is also discussed separately. (See "Management of moderate and severe alcohol withdrawal syndromes" and "Pharmacotherapy for alcohol use disorder" and "Psychosocial treatment of alcohol use disorder" and "Screening for unhealthy use of alcohol and other drugs in primary care" and "Brief intervention for unhealthy alcohol and other drug use".)
PATHOPHYSIOLOGY OF WITHDRAWAL
The alcohol withdrawal syndrome results from sudden reduction in chronic alcohol use. Excessive alcohol drinking for even one week can lead to mild withdrawal symptoms, and excessive drinking for over one month leads to significant withdrawal symptoms .To continue reading this article, you must log in with your personal, hospital, or group practice subscription. For more information on subscription options, click below on the option that best describes you:
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- PATHOPHYSIOLOGY OF WITHDRAWAL
- CLINICAL PRESENTATION
- Delirium tremens
- Withdrawal seizures
- Alcohol hallucinosis
- INITIAL PATIENT ASSESSMENT
- CIWA-Ar scale
- CRITERIA FOR AMBULATORY DETOXIFICATION
- MEDICATIONS FOR AMBULATORY DETOXIFICATION
- Drug selection
- - Benzodiazepines
- - Anticonvulsants
- - Other medications
- Dosing schedules
- - Fixed schedule therapy
- - Loading dose
- - Symptom-triggered therapy
- Medication protocols
- SUPPORTIVE CARE
- Nutritional supplements
- BRIDGE TO MAINTENANCE
- INFORMATION FOR PATIENTS
- SUMMARY AND RECOMMENDATIONS