Management of alcohol withdrawal and other selected substance withdrawal issues
Internship and Residency
© Cambridge University Press 2010.Typical consult question “The patient has a history of substance abuse. Please evaluate and help manage detox.” Differential Diagnosis: Alcohol/sedative/hypnotic withdrawal vs. opioid vs. other or no withdrawal Alcohol withdrawal Background The national prevalence of alcohol use is very high, and the prevalence of alcohol use disorders, specifically abuse and dependence, is also very high. Approximately 20% to 25% of patients admitted to the hospital may have an underlying alcohol use disorder, and healthcare workers often feel uncomfortable addressing this problem when it is uncovered during the admission process. Some hospitals maintain pre-printed alcohol “detox” order forms, and patients thought to be alcohol abusers are automatically put on these regimens. Most will end up doing well, probably because they ultimately would not have gone through withdrawal. More problematic are patients who have not been adequately screened for an alcohol problem and who start exhibiting signs of alcohol withdrawal, as well as patients whose withdrawal is not being adequately covered by the pre-printed detox sheet. It is estimated that approximately 51% of persons in the United States drink alcohol, and about 7% are considered to be heavy drinkers. By Diagnostic and Statistical Manual (DSM)-IV standards, however, not all of these people should be considered alcohol abusers. To meet criteria for alcohol abuse, the patient must demonstrate failure to meet obligations such as work duties, recurrent use of alcohol in hazardous situations, such as driving, use of alcohol despite the legal consequences, such as being arrested for driving while intoxicated, or use of alcohol despite interpersonal or social problems.
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