Alcohol abuse is a major problem worldwide, and provides trauma professionals with a never-ending stream of patients to take care of. A few of our patients partake so frequently that they are at risk for complications when they are forced to stop (e.g. admitted to the hospital).

In days gone by, one of the possible treatments for alcohol withdrawal was actual administration of ethanol in the hospital, by mouth or sometimes IV (!). For the most part, this has fallen by the wayside. However, I do get questions from readers about it from time to time, and I assume that this still happens at some hospitals. And I know of a few hospitals that still have beer on the formulary!

So what’s the answer? There is enough literature out there to convincingly say that the practice should be abandoned. Here are some factoids for you:

• Benzodiazepines are now the first-line treatment for withdrawal
• Benzos have anticonvulsant properties, which ethanol does not
• Benzos cause less respiratory depression than ethanol when dosed properly
• Using a CIWA protocol early minimizes over-medication events and can prevent progression to more serious withdrawal
• Lorazepam is a good choice because its metabolism is minimally affected by liver dysfunction
• The use of ethanol to treat withdrawal condones alcohol abuse and does not promote behavioral change or treatment

Bottom line: Don’t reach for the bottle when trying to prevent or treat alcohol withdrawal syndrome. Monitor at-risk patients closely, adopt a finely-tuned CIWA protocol (see below), and aggressively refer to treatment after your patient recovers. 

Reference: Ethanol for alcohol withdrawal: end of an era. J Trauma 74(3):925-931, 2013.