Alcohol withdrawal syndrome: diagnostic and therapeutic methods

Riv Psichiatr. 2018 May-Jun;53(3):118-122. doi: 10.1708/2925.29413.


Alcohol withdrawal syndrome (AWS) is a medical emergency, rare in the general population, but very common among alcoholic individuals, which can lead to severe complications when unrecognized or late treated. It represents a clinical condition which can evolve in few hours or days following an abrupt cessation or reduction of alcohol intake and is characterized by hyperactivity of the autonomic nervous system resulting in the development of typical symptoms. According to DSM-5 criteria, the alcohol withdrawal syndrome is defined as such: if patients present at least two of typical signs and symptoms. The Clinical Institute Withdrawal Assessment of Alcohol Scale, revised version (CIWA-Ar), is the tool for assessing the severity of AWS. The support to patient with AWS includes pharmacological intervention as well as general support, restoration of biochemical imbalances and specific therapy. Regarding the pharmacological treatment, benzodiazepines represent the gold standard, in particular long-acting benzodiazepines, administered with a gradual reduction up to cessation.

Publication types

  • Review

MeSH terms

  • Alcohol Withdrawal Delirium / diagnosis*
  • Alcohol Withdrawal Delirium / drug therapy
  • Alcohol Withdrawal Delirium / physiopathology
  • Alcohol Withdrawal Delirium / therapy
  • Alcohol Withdrawal Seizures / drug therapy
  • Alcohol Withdrawal Seizures / physiopathology
  • Alcoholism / blood
  • Alcoholism / complications
  • Anticonvulsants / therapeutic use
  • Antipsychotic Agents / adverse effects
  • Antipsychotic Agents / therapeutic use
  • Autonomic Nervous System / physiopathology
  • Benzodiazepines / administration & dosage
  • Benzodiazepines / therapeutic use
  • Combined Modality Therapy
  • Counseling
  • Delayed Diagnosis
  • Drug Therapy, Combination
  • Emergencies
  • Ethanol / adverse effects*
  • Ethanol / blood
  • Humans
  • Kindling, Neurologic
  • Palliative Care
  • Severity of Illness Index
  • Symptom Assessment
  • Thiamine / therapeutic use


  • Anticonvulsants
  • Antipsychotic Agents
  • Benzodiazepines
  • Ethanol
  • Thiamine