PCSS-MAUD Webinar: Outpatient Management of Alcohol Withdrawal-Slide Materials

Slide Materials

Pdf Summary

This webinar on outpatient management of alcohol withdrawal emphasized that alcohol use disorder (AUD) is common, but only a small fraction of people receive treatment. A key message was that most patients with AUD can safely undergo medically supervised withdrawal as outpatients when properly selected and monitored.<br /><br />The presentation reviewed alcohol withdrawal syndrome (AWS), which can begin within 6–24 hours after stopping or reducing heavy alcohol use. Early symptoms may include tremor, anxiety, and autonomic symptoms, while more severe complications such as delirium tremens typically occur later (48–72 hours) and can be fatal. Hallucinations can occur early without delirium in alcoholic hallucinosis.<br /><br />Risk assessment focused on identifying patients who are poor candidates for outpatient care. Absolute contraindications include prior delirium tremens or withdrawal seizures, active moderate/severe withdrawal in clinic, or concurrent benzodiazepine use. Relative contraindications include significant medical comorbidity (e.g., CHF, decompensated cirrhosis, CKD, COPD on oxygen), unstable psychiatric illness, pregnancy, major psychosocial barriers, or multiple active substance use disorders. The PAWSS tool was highlighted as a way to predict complicated withdrawal.<br /><br />Treatment options discussed included benzodiazepines, especially longer-acting agents like diazepam, and gabapentin in some cases. Daily follow-up is essential, ideally by telemedicine or in-person visits, to monitor for worsening withdrawal or oversedation and to escalate to inpatient care if needed.<br /><br />A major point was that withdrawal management is not the same as treatment for AUD itself. Patients should also be offered long-term AUD treatment, such as naltrexone, therapy, mutual-help groups, and other recovery supports. A case example illustrated successful outpatient withdrawal combined with treatment of the underlying AUD.

Keywords

alcohol use disorder

outpatient withdrawal

alcohol withdrawal syndrome

delirium tremens

withdrawal seizures

PAWSS tool

benzodiazepines

gabapentin

naltrexone

medically supervised withdrawal