ASAM Pocket Guidelines and Patient Guide

Alcohol Withdrawal Management

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32 Treatment C. Hospitalized Patients (1) Identification Î Recommendation VII.10: All patients admitted to the hospital should be screened for risk of alcohol withdrawal. Among hospitalized patients, the Alcohol Use Disorders Identification Test (AUDIT) and Alcohol Use Disorders Identification Test-Piccinelli Consumption (AUDIT-PC) can indicate risk of developing alcohol withdrawal. Î Recommendation VII.11: Patients undergoing elective surgery should be screened for unhealthy alcohol use and the need to undergo alcohol withdrawal management before proceeding with surgery. Patients undergoing elective surgery who are at risk of alcohol withdrawal should undergo medically managed withdrawal before proceeding with surgery. (2) Assessment Î Recommendation VII.12: Among hospitalized patients, the Prediction of Alcohol Withdrawal Severity Scale (PAWSS) can be used for predicting risk of developing severe or complicated alcohol withdrawal in the medically ill. Î Recommendation VII.13: For patients suspected of alcohol withdrawal for whom a complete medical history is not available, (i.e., are admitted from the Emergency Department or trauma unit, are in Intensive Care Unit [ICU]), or who are known to be at high risk of complicated alcohol withdrawal, medical decisions should be oriented toward a more aggressive treatment of alcohol withdrawal regardless of presenting signs and symptoms. Î Recommendation VII.14: For patients who require more than standard amounts of medication to manage alcohol withdrawal, individualized assessment by clinicians experienced in the management of withdrawal is recommended. The medication and protocol used for treating other conditions and/or alcohol withdrawal syndrome may need to be modified.

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