Epidemiology

The World Health Organization estimates that 43% of the world population consumes alcohol, with 18.2% of drinkers aged over 15 years engaging in heavy episodic alcohol consumption.[11] In 2016, the global prevalence of alcohol-use disorders, defined as harmful use of alcohol or alcohol dependence, was 5.1% among drinkers aged over 15 years.[11]

Hazardous and harmful drinking are commonly encountered among people attending hospital.[1] In the UK, approximately 20% of patients admitted to hospital for illnesses unrelated to alcohol are drinking at potentially hazardous levels.[12]

Up to 25% of people in alcohol withdrawal experience hallucinations, while seizures occur in 10% of patients.[13] If alcohol withdrawal is not treated or is inadequately treated, 5% of patients will progress to alcohol withdrawal delirium (also known as delirium tremens), typically 48 to 72 hours after the last drink.[9][14][15] Alcohol withdrawal delirium-related mortality is less than 1% if early and appropriate treatment is given.[9]

Risk factors

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history of alcohol withdrawal syndrome (AWS) and alcohol withdrawal delirium

Prior AWS and alcohol withdrawal delirium (also known as delirium tremens) reliably predicts the course of subsequent episodes.[31]

abrupt withdrawal of alcohol

Suspect acute or imminent alcohol withdrawal in any patient who is alcohol-dependent and has stopped or reduced their alcohol intake within hours or days of presentation.[1][2][3]

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