6
Diagnosis
II. Initial Assessment of Alcohol Withdrawal
A. General Approach
Î Recommendation II.1: First, determine whether a patient is at risk
of developing severe and/or complicated alcohol withdrawal, or
complications from alcohol withdrawal. In addition to current signs
and symptoms, a validated risk assessment scale and an assessment
of individual risk factors should be utilized.
Î Recommendation II.2: A history and physical examination should be
included as part of the comprehensive assessment process. Clinicians
should conduct this examination themselves or ensure that a current
physical examination is contained within the patient's medical record.
Î Recommendation II.3: Additional information about risk factors can
be gleaned by interviewing family, friends, and caregivers about a
patient's history of alcohol withdrawal, seizures, and delirium, as
appropriate. Whenever possible in non-emergent situations, obtain
written or verbal consent from the patient before speaking with or
consulting with collateral sources.
Î Recommendation II.4: Clinicians should seek information about the
time elapsed since the patient's cessation of (or reduction in) alcohol
use. The timeline of symptom onset and severity helps determine the
risk window for developing severe or complicated withdrawal.
B. Risk Factors for Severe or Complicated Withdrawal
Î Recommendation II.5: Assess for the following factors associated with
increased patient risk for complicated withdrawal or complications of
withdrawal:
• History of alcohol withdrawal delirium or alcohol withdrawal seizure
• Numerous prior withdrawal episodes in the patient's lifetime
• Comorbid medical or surgical illness (especially traumatic brain injury)
• Increased age (>65)
• Long duration of heavy and regular alcohol consumption
• Seizure(s) during the current withdrawal episode
• Marked autonomic hyperactivity on presentation
• Physiological dependence on GABAergic agents such as benzodiazepines or
barbiturates
Î Recommendation II.6: The following individual factors may increase
a patient's risk for complicated withdrawal or complications of
withdrawal:
• Concomitant use of other addictive substances
• Positive blood alcohol concentration in the presence of signs and symptoms of
withdrawal
• Signs or symptoms of a co-occurring psychiatric disorder are active and reflect a
moderate level of severity
