Uncomplicated Alcohol Withdrawal

This is the most frequent and benign type, usually occurring some 12-48 hours after alcohol intake is reduced, although it can develop as early as 6 hours after drinking has stopped. The essential features are a coarse tremor of the hands, tongue, and eyelids, together with at least one of the following:

• Nausea and vomiting.

• Malaise and weakness.

• Autonomic hyperactivity (raised blood pressure and tachycardia).

Anxiety, depressed mood, and irritability.

• Transient hallucinations and illusions.

Headache and insomnia.

If symptoms are mild, it is safe to recommend simple observation, but significant tremor and agitation will usually require sedation. The drugs of choice are long-acting benzodiazepines, which will not only treat alcohol withdrawal symptoms but will also prevent later complications (178). The starting dosages depend on the severity of the withdrawal, but 20 mg of chlordiazep-oxide, or 10 mg of diazepam, both given four times a day, will generally be appropriate (179).

Usually the benzodiazepines should not be started until such time as the blood alcohol level has reached zero (180). However, detained persons with marked alcohol dependence may develop withdrawal symptoms before this point is reached. In these circumstances, it is both safe and reasonable to initiate therapy when the blood alcohol level has reached 80 mg/100 mL or thereabouts.

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