Alcohol Withdrawal & Problem Drinking

Key points

• Withdrawal features start 6–12 hours after last drink; seizures at 12–48 h; delirium tremens at 48–96 h (mortality up to 5%).
• Management: benzodiazepines (chlordiazepoxide) on a reducing regimen; Pabrinex (vitamins B & C) — thiamine before glucose to prevent Wernicke's.
• Delirium tremens: coarse tremor, confusion, hallucinations, autonomic overactivity.
• Maintaining abstinence: acamprosate (reduces craving), disulfiram (aversive — aldehyde dehydrogenase inhibitor), naltrexone.
• Chlordiazepoxide is the usual benzodiazepine of choice for detox.

Decision points in this pathway

• Abstinence maintenance?

The full step-by-step algorithm, including what to do at each branch, opens in the app for approved members.