Improving the Safety of Admitted Patients with Alcohol Use Disorder and Withdrawal

The aim of this chapter is to review the pathophysiology of alcohol withdrawal syndrome (AWS), discuss diagnostic strategies, identify clinical manifestations, outline appropriate management options, and address key patient safety considerations specifically as it applies to the hospitalized patient. Ethanol use causes substantial morbidity and mortality and is among the most widely abused substances in the world. Up to 40% of all hospitalized patients are at risk for suffering from alcohol withdrawal syndrome (AWS). AWS is a hyperdynamic syndrome with symptoms that can include anxiety, insomnia, tachycardia, hypertension, tremor, nausea, vomiting, seizures, coma, disability, and death. Several screening tools can help identify patients with alcohol use disorder and those at risk for AWS. Symptom based scoring systems, such as the Clinical Institute Withdrawal Assessment for Alcohol (CIWA) or Severity of Ethanol Withdrawal Score (SEWS) score, are also available for guiding treatment. Treatment options should primarily consist of Gamma-Aminobutyric Acid (GABA) agonists, including benzodiazepines and barbiturate (mainly phenobarbital) medications, however other adjunctive therapies are also available. The most important patient safety principles for the hospitalized patient with AWS include early assessment, identification, and intervention, treatment of associated medical and psychiatric complications, as well as a comprehensive multi-disciplinary approach.