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Treatment
C. Alcohol-Induced Psychotic Disorder
Î Recommendation VI.22: If available and applicable, existing
institutional/hospital-associated delirium protocols can be used for
supportive care of patients with an alcohol-induced psychotic disorder.
Î Recommendation VI.23: The treatment of alcohol-induced psychotic
disorder may require consultation with a psychiatrist.
Î Recommendation VI.24: The treatment of alcohol-induced psychotic
disorder may require addition of antipsychotics.
Î Recommendation VI.25: For patients experiencing hallucinations,
diazepam may be considered a treatment option.
D. Resistant Alcohol Withdrawal
Î Recommendation VI.26: If available and applicable, existing
institutional/hospital-associated delirium protocols can be used for
supportive care of patients with resistant alcohol withdrawal.
Î Recommendation VI.27: Phenobarbital may be used as an adjunct to
benzodiazepines to control resistant alcohol withdrawal syndrome in
settings with close monitoring.
Î Recommendation VI.28: Propofol may be used with patients in the
ICU experiencing resistant alcohol withdrawal who already require
mechanical ventilation.
Î Recommendation VI.29: Dexmedetomidine may be used with patients
in the ICU experiencing resistant alcohol withdrawal.
VII. Specific Settings and Populations
A. Primary Care
Î Recommendation VII.1: If patients are experiencing severe withdrawal
(e.g., CIWA-Ar scores ≥19), refer them directly to the nearest
Emergency Department.
Î Recommendation VII.2: If withdrawal is mild (e.g., CIWA-Ar <10),
patients presenting to primary care can be prescribed a few doses of
benzodiazepine. Whenever possible, medication can be supervised by
a caregiver at home or staff at a nonmedical withdrawal management
center. Do not prescribe medication to patients for ambulatory
management of alcohol withdrawal without performing an adequate
assessment or to patients without adequate support.
Î Recommendation VII.3: If withdrawal does not resolve (e.g., fall below
a CIWA-Ar score of 10) after an adequate dose of medication (e.g., 80
mg diazepam), or patients appears sedated, transfer to an Emergency
Department or other inpatient withdrawal management setting.
