Navigating Alcohol Withdrawal Management: Strategies and Insights

In this episode of ASAM Practice Pearls, Dr. Stephen Taylor and Dr. Tessa Steel explore the management of alcohol withdrawal in ambulatory, hospital-based, and ED-initiated care settings. They discuss best practices, risk stratification, medication strategies, and emerging approaches to support effective withdrawal management.

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Host

Stephen M. Taylor, MD, MPH, DFAPA, DFASAM

Dr. Stephen M. Taylor is ASAM’s President-Elect and is board-certified in general psychiatry, child and adolescent psychiatry, addiction psychiatry, and addiction medicine. With over 30 years of practice experience, Dr. Taylor is dedicated to helping adolescents and adults overcome addiction and co-occurring psychiatric disorders. He has served as the Medical Director of the NBA and NBPA Player Assistance and Anti-Drug Program for 16 years and is the Chief Medical Officer of Pathway Healthcare, which operates multiple outpatient addiction and mental health treatment offices across six states.

Expert

Tessa Steel, MD, MPH

Dr. Tessa Steel is an Assistant Professor, physician-scientist, and Pulmonary Critical Care Medicine doctor at Harborview Medical Center, a county safety-net hospital operated by the University of Washington in Seattle. She is board-certified in Internal Medicine, Pulmonary Medicine, and Critical Care Medicine. Her clinical and research interests include improving hospital-based treatments for alcohol withdrawal syndrome and using hospitalizations to help people with addiction launch their process of recovery. 

📖 Show Segments

• 00:05 – Introduction
• 00:16 – Common Alcohol Withdrawal Scenarios 
• 01:53 – Assessing Alcohol Withdrawal Severity 
• 09:24 – The Emergency Department's Role 
• 12:28 – Inpatient Alcohol Withdrawal Management 
• 19:28 – Outpatient Alcohol Withdrawal Management 
• 21:02 – Challenges and Future Directions 
• 27:44 – Conclusion and Additional Learning Opportunities

📋 Key Takeaways

• Patient Risk Stratification: Understanding patient history, especially previous alcohol withdrawals, is crucial for predicting the severity of withdrawal symptoms and determining appropriate care settings (home vs. inpatient). 
• Role of Emergency Departments: Emergency departments are critical access points for initiating alcohol withdrawal management and facilitating the transition to ongoing care for alcohol use disorder (AUD). 
• Medication Strategies: Consider the various medications beyond benzodiazepines that can treat alcohol withdrawal, such as phenobarbital or gabapentin,  to align medication selection with the individual’s needs and the underlying neuropathology of alcohol withdrawal. 
• Outpatient vs Inpatient Care: Consider a patient’s history and current symptoms to determine whether they can safely undergo withdrawal in an outpatient setting or if they require inpatient care. 
• Monitoring and Safety: Carefully monitor patients when using sedating agents for alcohol withdrawal management, as they may cause respiratory suppression. 
• Holistic and Individualized Treatment: Address the AUD in addition to the withdrawal symptoms. Stay open-minded and familiarize yourself with various medication options. Treating alcohol withdrawal requires an individualized, patient-centered approach. 
• Team-Based Support and Ongoing Education: Interdisciplinary support and continuous education are important in advancing successful system-wide care. Share success stories to engage healthcare providers in AUD care. 
• Call for Research and Funding: Additional research, including comparative effectiveness research on medications, and funding are needed to improve the quality of alcohol withdrawal care and to further promote transitions from withdrawal management to long-term AUD treatment. 

🔗 Resources

• PCSS-MAUD Education: Free, comprehensive training, guidance, resources, and mentoring on the prevention, diagnosis, and treatment of AUD.  
  • Assessment and Management of Alcohol Withdrawal – Online Course
  • Alcohol Withdrawal Syndrome in the Emergency Department – Mini Video 
• The ASAM Clinical Practice Guideline on Alcohol Withdrawal Management: Access HERE
• Emergency Department Screening and Interventions for Substance Use Disorders: Hawk K, D'Onofrio G. Addict Sci Clin Pract. 2018;13(1):18.
• Emergency Department Peer Support Program and Patient Outcomes After Opioid Overdose: Treitler P, Crystal S, Cantor J, et al. JAMA Netw Open. 2024;7(3):e243614.
• Executive Summary of the American Society of Addiction Medicine (ASAM) Clinical Practice Guideline on Alcohol Withdrawal Management: Lindsay DL, Freedman K, Jarvis M, et al. J Addict Med. 2020;14(5):376-392.
• Inpatient Addiction Medicine Consultation and Post-Hospital Substance Use Disorder Treatment Engagement: A Propensity-Matched Analysis: Englander H, Dobbertin K, Lind BK, et al. J Gen Intern Med. 2019;34(12):2796-2803.
• Inpatient Addiction Consultation for Hospitalized Patients Increases Post-Discharge Abstinence and Reduces Addiction Severity: Wakeman SE, Metlay JP, Chang Y, Herman GE, Rigotti NA. J Gen Intern Med. 2017;32(8):909-916.
• Research Needs for Inpatient Management of Severe Alcohol Withdrawal Syndrome: An Official American Thoracic Society Research Statement: Steel TL, Afshar M, Edwards S, et al. Am J Respir Crit Care Med. 2021;204(7):e61-e87.
• The ASAM Criteria: The most widely used and comprehensive set of standards for placement, continued service, and transfer of patients with addiction and co-occurring conditions.
• ASAM Criteria Curriculum: Explore the different trainings ASAM offers on both the 3rd and 4th Edition ASAM Criteria.

📢 Join the Discussion

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