OUTPATIENT

MANAGEMENT OF
ALCOHOL
WITHDRAWAL
Mobola Adetimehin
PGY1
 INTRODUCTION
• Alcohol use disorder (AUD) is a chronic disorder characterized by
an impaired ability to stop or control alcohol use despite adverse
social, occupational or health consequences
• Patients with AUD may experience withdrawal symptoms if
alcohol is discontinued abruptly
• Withdrawal symptoms range from anxiety, palpitations to
hallucinations and seizures
• Patients with mild symptoms can be managed in the ambulatory
setting
ASSESSMENT
• Assessment of patients should include
• Substance use history
• When was your last drink?
• Number of previous supervised withdrawal episodes
• Any history of withdrawal seizures or delirium tremens
• Physical examination
• Lab work up –CBC, glucose, CMP
• Withdrawal symptoms using the CIWA-Ar scale
ASSESSMENT
• CIWA-Ar scores + patient’s history (+/-) of withdrawal seizures or
delirium tremens are used to categorize withdrawal:
• Very mild: <10
• Mild: 10-15
• Moderate:15-20
• Severe: >20
INDICATIONS FOR OUTPATIENT
MANAGEMENT
• Mild symptoms (CIWA-Ar score of 15 or less)
• Asymptomatic patient, history of withdrawal symptoms in the past
• No history of withdrawal seizures or delirium tremens
• Patient must also be:
• Cognitively intact
• Able to take PO meds
• Able to commit to daily office visits
• No comorbid medical or psychiatric conditions
CONTRAINDICATIONS
• Patients with any of these symptoms should be managed inpatient
• Fever
• Diaphoresis
• Severe tachycardia
• Hypertension
• Pregnancy
• Concurrent substance use
• Markedly abnormal lab values
MEDICATIONS
• Benzodiazepines
• Gabapentin
• Less sedating than BZDs
• Does not reduced likelihood of seizures or DT
• Carbamazepine
• Multivitamin
TREATMENT
• Duration of treatment usually 1-2 days (may be as long as 7)
• Patients seen daily (phone assessment on alternative days)
• Medications are dispensed on a daily basis
• Family member/close contact recruited to stay with patient
throughout the withdrawal period
COMPLICATIONS
• Patients can discontinue treatment
• Alcohol use may be resumed
• Electrolyte abnormalities
• If these occur, patient needs to hospitalized/referred to an addiction
specialist