ASAM Pocket Guidelines and Patient Guide

Alcohol Withdrawal Management

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31 Î Recommendation VII.4: For patients treated in primary care settings, regular follow-up visits, at least monthly for one year, could increase the likelihood of sustained recovery. B. Emergency Departments Î Recommendation VII.5: If patients are experiencing severe alcohol withdrawal (e.g., CIWA-Ar ≥19), or are at risk of complicated withdrawal, administer medication immediately to treat withdrawal and reduce the risk of seizures and delirium. Î Recommendation VII.6: Patients presenting with alcohol withdrawal syndrome in the Emergency Department should be evaluated for delirium as well as other conditions that mimic and/or accompany withdrawal. Patients presenting with delirium should be assessed for all potential etiologies including alcohol withdrawal. Î Recommendation VII.7: Patients in the Emergency Department should receive a complete blood count and complete metabolic panel including liver enzyme and magnesium tests. Alcohol withdrawal treatment should not be delayed while waiting for results. Î Recommendation VII.8: The following indicators should be present for discharge to an ambulatory alcohol withdrawal management setting from the Emergency Department: • Mild alcohol withdrawal (e.g., CIWA-Ar score <10). • Moderate alcohol withdrawal (e.g., CIWA-Ar score 10–18) with no other complicating factors • Not currently intoxicated (including alcohol or other drugs) • No history of complicated alcohol withdrawal (seizures, delirium) • No significant medical or psychiatric comorbidities that would complicate withdrawal management • Able to comply with ambulatory visits and therapy Î Recommendation VII.9: Patients with controlled withdrawal syndrome being discharged from the Emergency Department may be offered a short term (e.g., 1–2 day) prescription for appropriate alcohol withdrawal medication to last until follow-up with their healthcare provider.

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