As an inpatient clinician with an interest and significant experience in managing alcohol withdrawal and AWD, I found the article by Mayo-Smith et al1 a useful summary of where we are to date on this challenging medical condition. I would, however, like to make an important point.
Although benzodiazepines are considered by many to be the treatment of choice in alcohol withdrawal and AWD, it is important to clearly recognize their limitations. They are not effective in treating or controlling delirium. In fact, it is well accepted that they are a common cause of altered consciousness and cognition in hospitalized patients2 and may cause the similar mental status changes in AWD, thus confounding the clinical picture.3 They are effective in sedating as well as controlling autonomic hyperactivity and reducing seizure risk in patients experiencing AWD.3
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