Diagnosis and management of acute alcohol withdrawal

ALCOHOL ABUSE PRODUCES A CONSIDERABLE BURDEN OF ILLNESS in the Canadian pop ulation. The diagnosis of alcohol dependence and withdrawal can be difficul t, particularly in the setting of covert intake or comorbidity. Two validat ed scales, the CAGE questionnaire to screen for alcohol abuse and dependenc e and the Clinical Institute Withdrawal Assessment for Alcohol (CIWA-Ar) sc ale to assess the severity of withdrawal, are valuable tools for clinicians to use on a regular basis. For the treatment of alcohol withdrawal, compel ling anecdotal evidence supports the routine administration of thiamine, bu t not necessarily other vitamins. Phenytoin has not been shown to be superi or to placebo for uncomplicated withdrawal seizures. Neuroleptics are not r ecommended for routine use; Sedation with benzodiazepines guided by the CIW A-Ar results is recommended. There is good evidence that the management of alcohol withdrawal can be improved with the routine use of the CIWA-Ar scal e to assess severity, treatment with adequate doses of benzodiazepines and follow-up monitoring of patients in alcohol withdrawal.