Alcohol Withdrawal

Alcohol dependence continues to be major publiccontinues to exist about the role of pharmacotherapy
health problem, and among its many associatedand its effectiveness in reducing the rate of major
medical problems is a well characterized alcoholcomplications such as seizures or delirium.
withdrawal syndrome. Alcohol withdrawal signs andSignificant variation in physician management of alcohol
symptoms are frequently minor but can develop into awithdrawal has been documented, even among
severe, even fatal, condition. Because of its medicalspecialists in the field, with a wide range in choice of
complications alcohol dependence is seen frequentlymedication, approaches to medication delivery and
by physicians, occurring in 15-20% of primary care andmethod of patient monitoring. Recommendations from
hospitalized patients.authoritative sources such as medical and surgical
Physicians in all areas of medicine therefore frequentlytextbooks vary even more widely, with
encounter the problem of managing alcohol withdrawal,recommendations for agents which have never been
particularly as medical encounters such as hospitaltested in clinical trials or for approaches that have
admission or pregnancy, are often a precipitating eventbeen shown to result in administration of unnecessary
for cessation of alcohol. In recent decades there hasmedication. Given the frequency with which this
been extensive research on pharmacologiccondition is encountered by physicians, the wide variety
interventions aimed at ameliorating alcohol withdrawal.of settings in which it occurs and the variation in the
However these studies are widely dispersed in theway it is managed, we felt an evidence-based
medical literature, generally involve few subjects andguideline would have widespread utility.
are often of uncertain methodologic quality. Uncertainty