Alcohol: Board Review (2025-2026 Recording)-Alcohol: Board Review Recording

Video Transcription

Video Summary

Dr. Ilan Remler gave a practical, hospital-focused overview of alcohol use disorder, intoxication, and withdrawal. He emphasized that alcohol-related ED and inpatient presentations are common and signal high future risk, not benign one-off events. He reviewed epidemiology, standard drink definitions, binge/heavy drinking trends, and the broad harms of alcohol across organ systems. He also stressed that, overall, no alcohol is safer than drinking.<br /><br />A major theme was screening: for unhealthy alcohol use, he recommended the single-item screen; for alcohol use disorder, the AUDIT-C; and for severity assessment, the full AUDIT. He explained why these tools outperform casual clinical impressions.<br /><br />He spent substantial time on alcohol withdrawal management. He described withdrawal physiology, prediction tools such as PAWSS, and the limitations of CIWA in hospitalized or nonverbal patients. He argued for front-loading treatment, especially with phenobarbital, which he presented as effective, predictable, and often preferable to benzodiazepines in his practice. He also discussed adjunctive agents such as gabapentin, clonidine, and valproic acid to reduce sedative burden and treat autonomic symptoms.<br /><br />The talk also covered medications for alcohol use disorder after stabilization: naltrexone, acamprosate, disulfiram, gabapentin, topiramate, and emerging GLP-1 data. He highlighted the importance of asking about withdrawal history, integrating addiction care with hepatology for alcohol-associated liver disease, and using hospitalization as a “teachable moment” to connect patients to long-term treatment and support.

Keywords

alcohol use disorder

alcohol intoxication

alcohol withdrawal

hospitalized patients

emergency department

AUDIT-C

AUDIT

PAWSS

CIWA

phenobarbital

benzodiazepines

naltrexone

acamprosate

gabapentin

alcohol-associated liver disease