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Alcohol Abuse and  Withdrawal

Approximately 111 million Americans are users of alcohol. There are an estimated 22 million alcoholics in the United States, and up to one-third of adult inpatients have problems related to alcohol.

Alcohol abuse is defined as a pattern of problem drinking that results in health consequences, social problems, or both. Alcohol dependence, often called alcoholism, refers to a disease that is characterized by abnormal alcohol-seeking behavior that leads to impaired control over drinking.

Alcohol dependence by DSM-IV criteria is characterized by development of three or more of the following symptoms over a 12-month period: loss of control over use, development of tolerance or withdrawal symptoms, inability to fulfill roles, neglect of activities, and continued use despite problems.

Clinical Assessment of Alcohol Use and Abuse

Determine the amount and frequency of alcohol use and other drug use in the past month, week, and day. Determine whether the patient ever consumes five or more drinks at a time (binge drinking).h Previous abuse of alcohol or

Effects of use on the patient's life may include problems with health, family, job or financial status or with the

History of blackouts or motor vehicle crashes, and affect on family members or friends should be

The CAGE Questionnaire

1. Have you ever felt you should Cut down on your drinking?

2. Have people ever Annoyed you by criticizing your drinking?

3. Have you ever felt bad or Guilty about your drinking?

4. Have you ever had a drink first thing in the morning to steady your nerves or to get rid of a hangover (Eye-opener?)

Two positive answers indicate a high likelihood of alcohol dependency.


The Brief Michigan Alcoholism Screening Test




1. Do you feel you are a normal drinker?

2. Do friends or relatives think you are a normal drinker?

3. Have you ever attended a meeting of Alcoholics Anonymous?

4. Have you ever lost friend/boyfriend/girlfriend because of drinking?

5. Have you ever gotten into trouble at work because of drinking?

6. Have you ever neglected your obligations, your family, your work for two or more days in a row work because of drinking?

7. Have you ever had delirium tremens or severe shaking, or heard voices or seen things that weren't there after heavy drinking?

8. Have you ever gone to anyone for help about your drinking?

9. Have you ever been in a hospital because of drinking?

10. Have you ever been arrested for drunk driving or driving after drinking?

Alcohol Withdrawal Syndromes

Signs and symptoms of AWS range from tremulousness to delirium tremens.

Mild alcohol withdrawal usually occurs less than 24 hours after cessation of alcohol intake. It may include tremulousness, anxiety, nausea, vomiting, diaphoresis, hyperreflexia, and minor autonomic hyperactivity.

Moderate alcohol withdrawal is characterized by hallucinosis but an otherwise clear sensorium. Seizures

Alcohol Withdrawal Syndromes

1. Hangover is the mildest form of withdrawal, occurring within several hours of cessation of alcohol. It consists of a period of psychomotor impairment that follows an acute exposure to

2. Alcohol Withdrawal Tremor. Chronic alcoholics develop increasing tremors and craving for

3. Alcohol withdrawal hallucinations are noted as early as 24 hours after the last drink and last

4. Delirium Tremens

a. Delirium tremens (DT) is a severe, life-threatening complication of alcohol withdrawal, characterized by increasingly pronounced disorientation, agitation,

5. Alcohol-Related Seizure

Alcohol Abuse and   Withdrawal

a. Seizures related to alcohol are a common cause of adult convulsions. Seizures occur in 10% of people withdrawing from alcohol. They are usually generalized

IV. Evaluation of the Patient with Symptoms of Alcohol Withdrawal Syndrome

A. Initial Assessment

1. Maintenance of airway, breathing, and circulatory status should take first priority. Tachycardia, fever, and hypertension or hypotension may be found.

2. In the patient with moderate to severe signs of withdrawal, a secure IV should be placed. If frank mental

B. History. Prior episodes of AWS, recent trauma, known seizure disorder, use of prescription or