2026-2027 | Live Session | Alcohol: Board Review | July 2026-Alcohol: Board Review Presentation

Alcohol: Board Review Presentation

Pdf Summary

This didactic curriculum from ACAAM focuses on alcohol use and alcohol withdrawal management in hospital settings. It emphasizes that alcohol-related ED and inpatient presentations are common, high-risk, and often under-treated. Key epidemiology includes widespread lifetime alcohol exposure, frequent binge drinking, and alcohol as a major contributor to preventable death, especially in younger people.<br /><br />The lecture reviews alcohol pharmacology, absorption, metabolism, and blood alcohol testing, then explains withdrawal physiology and timelines, including seizures, hallucinosis, and delirium tremens. It argues that traditional nurse-driven CIWA-based protocols have major limitations in hospitalized patients and promotes more clinical judgment, careful history-taking, and use of PAWSS to predict severe withdrawal risk.<br /><br />A central theme is phenobarbital-based treatment. The presentation presents phenobarbital as an increasingly preferred front-loading option over benzodiazepines for many hospitalized patients, citing predictable kinetics, long half-life, and potentially better outcomes such as fewer ICU admissions, shorter length of stay, and fewer return visits. It also discusses adjunctive agents such as gabapentin, clonidine, and valproic acid, while warning about contraindications and over-sedation.<br /><br />The curriculum strongly emphasizes that hospitalization is a key opportunity to initiate AUD treatment before discharge. It reviews medications for AUD including naltrexone, acamprosate, disulfiram, topiramate, gabapentin, and emerging GLP-1 agonist data. It also covers support options such as AA, SMART Recovery, and other peer groups.<br /><br />Finally, it highlights integrated follow-up care for alcohol-associated liver disease, including hepatology plus addiction medicine coordination, biomarker use such as PEth and EtG, and evolving transplant practices. Overall, the message is to screen, treat, and link patients to ongoing AUD care rather than simply detoxing them and discharging.

Keywords

alcohol withdrawal

phenobarbital

CIWA protocol

PAWSS

naltrexone

acamprosate

AUD treatment

withdrawal management

hepatology

addiction medicine