ABSTRACT
Alcohol withdrawal syndrome (AWS) is a common state in patients suffering from chronic alcoholism who stop intake or reduce the amount of alcohol. AWS should be treated with psychopharmacologic agents, if the CIWA-Ar score is higher than 8 (see alphabetical list of psychometric screening instruments in the section on useful data and definitions for the test form). In patients with a history of uncomplicated AWS, high motivation, good social background, and little craving, an outpatient setting may be sufficient. Patients with severe AWS in the past, a history of withdrawal seizures, or relevant concomitant diseases should be treated with inpatient care. Patients with delirium tremens must be treated in an intensive care unit. Benzodiazepines are drugs of first choice in all states of AWS, even delirium tremens. Patients with a history of benzodiazepine abuse and mild to moderate AWS can be treated with the anticonvulsant carbamazepine. Sympatholytics may be of help as concomitant medication in patients with predominately anxiety and autonomic hyperactivity. Thiamine is an essential adjunctive treatment in AWS. Alcohol is absolutely contraindicated in the treatment of AWS. The treatment of AWS should be in the hands of specialists and has to be followed by the offer for a long-term treatment with psychotherapeutic and psychopharmacological strategies (see Chapter 9 on psychotherapy).
