Recognition and Management of Withdrawal Delirium (Delirium Tremens)

At some time in their lives, 20% of men and 10% of women in most Western societies will have an alcohol-use disorder, which is defined as repetitive alcohol-related problems in at least 2 of 11 areas of life.(1,2) These conditions can decrease the life span by a decade and are associated with severe impairments in social functioning, as well as high rates of medical problems. Although alcohol-related conditions occur in persons from all social strata and affect more than 20% of patients in most medical settings,(2,3) few physicians have been adequately trained in identifying and treating these serious problems. About 50% of persons with alcohol-use disorders have symptoms of alcohol withdrawal when they reduce or discontinue their alcohol consumption; in 3 to 5% of these persons, grand mal convulsions, severe confusion (a delirium), or both develop.(1) It is essential that clinicians know how to prevent, recognize, and treat these severe withdrawal states to minimize costly hospitalizations and avoidable deaths.