Author: Gary Jackson

Alcohol Withdrawal Syndrome: Outpatient Management

Alcohol facilitates GABA action, causing decreased CNS excitability [Figure 1b]. In the long-term, it causes a decrease in the number of GABA receptors (down regulation). This results in the requirement of increasingly larger doses of ethanol to achieve the same euphoric effect, a phenomenon known as tolerance.

• All patients with seizures or DT should have immediate intravenous access for administration of drugs and fluids.
• Pharmacists should be well educated on AUDs and their treatment and on the treatment of AWS to facilitate and optimize timely and appropriate patient care, which could ultimately lead to saving a patient’s life.
• The main management for severe symptoms is long-acting benzodiazepines — typically IV diazepam or IV lorazepam.

Several different treatment models have been developed for alcohol withdrawal. The three most commonly encountered are the symptom-triggered approach, fixed-dose model, and multimodal therapies. Symptom-triggered regimens tailor medication administration according to a predefined set of signs and symptoms commonly experienced during alcohol withdrawal. This necessitates a clearly defined protocol and extensive staff education and training. Pharmacotherapy is only provided if the patient demonstrates signs of withdrawal.

What is the prognosis for someone with alcohol withdrawal?

Consider Critical Care consultation for patients with hemodynamic or respiratory instability, progression of symptoms despite maximum appropriate therapy, or high-intensity nursing requirements. Transfer to a higher level of care is a multidisciplinary decision between the treating physician, consulting physician and nursing staff. Do not use novel agents for the inpatient treatment of AWS at this time, due to insufficient evidence supporting their efficacy.

Common medications include benzodiazepines to help treat symptoms like anxiety, insomnia, and seizures. You might also take anti-seizure meds and antipsychotics, along with other drugs. The main ways to prevent alcohol withdrawal are to avoid alcohol altogether or to get professional help as soon as possible if you think you’re developing alcohol use disorder. Your healthcare provider will recommend and encourage treatment for alcohol use disorder. Motivational interviewing is a type of counseling that helps people identify their reasons for wanting to change their behavior.