Alcohol Withdrawal syndrome.  Can this be managed as an outpatient?

Half of patients with alcohol use disorder who abruptly reduce or stop their alcohol intake develop signs or symptoms of alcohol withdrawal syndrome.

Why does alcohol withdrawal syndrome occur?  The central and autonomic nervous system are revved up and overactive and this can lead to insomnia, nausea, vomiting, tremors, hallucinations, agitation and anxiety.

What can occur if alcohol withdrawal is not treated?  Seizures, delirium tremens and occasionally death can occur. 

Who can be treated as an outpatient (not staying overnight in the hospital)?  Patients with mild to moderate withdrawal symptoms (without additional risk factors) can be treated as outpatients.  Mild symptoms can be treated with carbamazepine or gabapentin.  For more severe symptoms, benzodiazepines are first-line therapy.  Patients will need to be seen by their physician daily for up to 5 days after their last drink to monitor symptom improvement and evaluate the need for additional therapy.  

What else can help?  A 12-step program, like Alcoholics Anonymous, are more effective at helping patients remain abstinent up to 3 years than other forms of therapy.

Why should patients do inpatient withdrawal treatment?  –Unstable home situation or absence of caregiver support. — Other psychiatric conditions.  —Previous drinking more than 8 alcoholic drinks per day. —History of severe alcohol withdrawal symptoms less than 1 year ago. —Dependence on other addictive medications. —Unstable transportation situation.