[Alcohol withdrawal--biological background, diagnosis and treatment]

Abstract

Alcohol withdrawal reveals a condition of central nervous system (CNS) hyperexcitability opposite to that of the primary effect of the drug. Adaption to the decreased activity of the CNS during chronic ethanol ingestion may at least partly explain several of the symptoms of alcohol withdrawal. Benzodiazepines are therefore useful in the withdrawal state. The benzodiazepine loading dose technique, giving diazepam 20 mg every hour until the patient shows signs of clinical improvement and mild sedation, is the choice of treatment in cases of moderate to severe alcohol withdrawal. In general, neuroleptics should be avoided, because of increased risk of convulsions, but haloperidol can be used to control hallucinations and severe agitation. This treatment should then be combined with benzodiazepines. Most patients with mild withdrawal symptoms respond to non-pharmacological supportive care, except for those with a history of withdrawal seizures. These patients may need treatment with carbamazepine or diazepam.