Alcohol withdrawal

Alcohol withdrawal delirium is fatal in 15% to 20% of patients if untreated.[34]Bruce M, Chick J. Misuse of, and dependence on, alcohol and other drugs. In: Johnstone EC, Lawrie SM, Sharpe M, et al., eds. Companion to psychiatric studies. 8th ed. London, UL: Churchill Livingstone; 2010:353-89.[35]Bagheri SC. Chapter 15 - medical conditions. In: Bagheri SC, ed. Clinical review of oral and maxillofacial surgery. 2nd ed. Maryland Heights, MO: Mosby Elsevier: 2014;489-538.

• Appropriate early management reduces mortality to around 1%.[9]Schuckit MA. Recognition and management of withdrawal delirium (delirium tremens). N Engl J Med. 2014 Nov 27;371(22):2109-13. http://www.ncbi.nlm.nih.gov/pubmed/25427113?tool=bestpractice.com

The patient may describe persistent insomnia and autonomic symptoms for a few months after the acute withdrawal phase. These symptoms usually last about 6 months.

About 50% of patients remain abstinent from alcohol for a year. Relapses can be prevented with counselling, self-help groups (e.g., Alcoholics Anonymous Alcoholics Anonymous Opens in new window), and pharmacotherapy.[189]O'Connor P. Alcohol abuse and dependence. In: Goldman L, Ausiello D. eds. Cecil textbook of medicine. 22nd ed. St. Louis, MO: W.B. Saunders Company; 2004:17.[190]Alcoholism and alcohol abuse (alcohol dependence, DSM-1V 303.90; alcohol abuse, DSM-1V 305.00). In: Moore DP, Jefferson JW, eds. Handbook of medical psychiatry. 2nd ed. Philadelphia, PA: Elsevier-Mosby; 2004.