2026-2027 | On-Demand Session | Alcohol: Board Review | July 2026-Alcohol: Board Review Recording

Video Transcription

Video Summary

Dr. Ilan Remler’s didactic session focused on alcohol use in hospital and ED settings, using a board-review style format. He emphasized that alcohol-related presentations are common, high-risk, and often under-treated, making the hospital a key intervention point.<br /><br />Key epidemiology points included that most Americans drink at some point in life, binge drinking remains common, and heavy drinking and alcohol use disorder have generally declined over time, though survey changes complicate trends. Alcohol-related ED visits and admissions are frequent in California and nationally, but evidence-based AUD medications are started for only a small fraction of eligible patients.<br /><br />He reviewed alcohol’s acute and chronic harms: intoxication, withdrawal, injury, psychiatric transfer, self-directed discharge, mortality, fetal alcohol effects, cancer, liver disease, and other organ damage. He argued there is no truly “safe” alcohol dose, especially for young adults and women of childbearing age.<br /><br />A major focus was withdrawal management. He reviewed physiology, kindling, seizure and delirium risk, and the limitations of symptom-triggered CIWA-style protocols in hospitalized or sedated patients. He strongly favored early risk stratification using history and PAWS, and he advocated for phenobarbital front-loading as an increasingly evidence-supported approach, often preferable to benzodiazepine-only protocols. He also discussed adjuncts such as gabapentin, clonidine, and dexmedetomidine in selected cases.<br /><br />Finally, he covered AUD treatment after stabilization, including naltrexone, acamprosate, topiramate, and support groups, stressing discharge medication initiation and integrated follow-up—especially for alcohol-associated liver disease—through multidisciplinary addiction care.

Keywords

alcohol use disorder

emergency department

hospital medicine

alcohol withdrawal

phenobarbital

CIWA protocol

naltrexone

acamprosate

topiramate

binge drinking

kindling

delirium tremens

PAWS

addiction treatment

alcohol-related harm