The three-question Alcohol Use Disorders Identification Test–Consumption and the Single Alcohol Screening Question instrument have the best accuracy for assessing unhealthy alcohol use in adults 18 years and older. Two commonly used tools to assess withdrawal symptoms are the Clinical Institute Withdrawal Assessment for Alcohol Scale, Revised, and the Short Alcohol Withdrawal Scale. Patients with mild to moderate withdrawal symptoms without additional risk factors for developing severe or complicated withdrawal should be treated as outpatients when possible.
1. Questionnaires to detect alcohol use disorder
Alcohol withdrawal syndrome is a set of symptoms that occur when someone who is physically dependent upon alcohol suddenly stops drinking or drastically reduces their alcohol intake. Alcohol withdrawal is a potentially serious complication of alcohol use disorder. It’s important to get medical help even if you have mild symptoms of withdrawal, as alcohol withdrawal syndrome symptoms it’s difficult to predict in the beginning how much worse the symptoms could get. For mild alcohol withdrawal that’s not at risk of worsening, your provider may prescribe carbamazepine or gabapentin to help with symptoms.
- If you have alcohol use disorder and want help, a healthcare provider can guide you to resources and rehabilitation programs to help you quit.
- As the parenteral form of clomethiazole is no longer available, its application is dependent on sufficient alertness and cooperation to enable peroral treatment.
- Figure 2 illustrates how to proceed in the clinical setting of suspected AWS to confirm the diagnosis and to start sufficient therapy.
- The medication simply helps you to feel better whilst your body readjusts to not having alcohol.
- Alcohol withdrawal syndrome is a collection of symptoms that occur when an individual who has been consuming alcohol heavily for an extended period suddenly stops or significantly reduces their alcohol intake.
Therapy
Ambulatory withdrawal treatment should include supportive care and pharmacotherapy as appropriate. Benzodiazepines are first-line therapy for moderate to severe symptoms, with carbamazepine and gabapentin as potential adjunctive or alternative therapies. Physicians should monitor outpatients with alcohol withdrawal syndrome daily for up to five days after their last drink to verify symptom improvement and to evaluate the need for additional treatment. Primary care physicians should offer to initiate long-term treatment for alcohol use disorder, including pharmacotherapy, in addition to withdrawal management. The spectrum of alcohol withdrawal symptoms ranges from such minor symptoms as insomnia and tremulousness to severe complications such as withdrawal seizures and delirium tremens. Although the history and physical examination usually are sufficient to diagnose alcohol withdrawal syndrome, other conditions may present with similar symptoms.
How Is WK Syndrome Diagnosed?
In the case of outpatient treatment of AWS, pharmacists can provide counseling to the patient and/or caregiver on the proper use and side effects of the drugs prescribed to treat either AWS or the AUD itself, and can be available if and when questions arise. A severe case of alcohol withdrawal can lead to complications, some of which can be life-threatening. To prevent this, your doctor may suggest a treatment program where you stay overnight. That way, you can get 24-7 support for your mental health and physical symptoms. Alcohol withdrawal (alcohol withdrawal syndrome) is a range of symptoms that can happen if you stop or significantly reduce alcohol intake after long-term use.
Medical history and laboratory biomarkers are the two most important methods for the identification of patients at high risk. AUDs are common in patients referred to neurological departments, admitted for coma, epileptic seizures, dementia, polyneuropathy, and gait disturbances. Patients presenting with alcohol withdrawal syndrome should receive thiamine and folate supplementation as they are often nutritionally deficient.
The Time is Now!
Blood pressure, pulse, and alcohol breath analysis should be obtained whenever possible. The assessment should also include a validated measure of withdrawal symptom severity, ideally with the same instrument as the initial assessment. In the outpatient setting, mild alcohol withdrawal syndrome can be treated using a tapering regimen of either benzodiazepines or gabapentin administered with the assistance of a support person. Proposed regiments include fixed dosing with as-needed doses available. Should symptoms worsen, patients and their support person should be instructed to present to the emergency department for evaluation and further treatment. If auditory, visual, or tactile hallucinations in the setting of alcohol withdrawal are present, the patient is likely experiencing alcohol hallucinosis, which affects approximately 2%.11 The altered mental status that accompanies this presentation is concerning for alcohol withdrawal delirium.
What are the risk factors for alcohol withdrawal?
- Screening and assessment tools do not allow physicians to predict with confidence who will or will not experience life-threatening symptoms.
- AUDs are common in neurological departments with patients admitted for coma, epileptic seizures, dementia, polyneuropathy, and gait disturbances.
- The CIWA-Ar is a useful tool to assess alcohol withdrawal severity that can help guide management and prevent complications in patients diagnosed with AWS.
Alcohol consumption spans a spectrum ranging from low risk to severe alcohol use disorder (AUD). Chronic risky drinking or the presence of AUD increases the risk of alcohol withdrawal syndrome.1 Alcohol withdrawal syndrome poses a significant clinical challenge arising from the spectrum of AUD—a prevalent condition affecting a substantial portion of the United States population. Because of the Alcohol Use Disorder severity and complications that can arise from AWS, it is important to be familiar with proper treatment.
Diagnosis
To treat Wernike and the progression of neuropsychiatric manifestations, it is prudent to administer high-dose, intravenous, or intramuscular thiamine, as oral thiamine is unpredictably absorbed.14 Electrolytes, including magnesium and phosphorus, should also be checked and repleted. If you are alcohol-dependent you have a strong desire to drink alcohol. Therefore, you may start to develop withdrawal symptoms 3-8 hours after your last drink as the effect of the alcohol wears off. So, even if you want to stop drinking, it is often difficult because of the alcohol withdrawal symptoms.