Evolving Strategies for Severe Alcohol Withdrawal in the Inpatient Setting

ABSTRACT: Benzodiazepines (BZDs) remain the gold standard for the management of acute alcohol withdrawal syndrome (AWS). An evolving body of evidence suggests that adjuvant use of additional therapies can reduce costly Intensive Care Unit (ICU) utilization for those with severe alcohol withdrawal and improve patient outcomes. Adjuvant ketamine, phenobarbital, dexmedetomidine, and gabapentin are some of the identified off-label agents used to help mitigate the neurochemical storm brought about by the abrupt cessation of alcohol. Current clinical evidence supports that BZD monotherapy may be inadequate for those with severe alcohol withdrawal syndrome (SAWS), and that combination cocktails , in conjunction with Cognitive Bias Modification Therapy (CBM) may be a preferred inpatient management strateg