The Rationale for, and Use of, Benzodiazepines in Alcohol Withdrawal

This review covers the rationale for, and the mechanisms of action of, benzodiazepines (BZs) in the treatment of alcohol withdrawal syndrome (AWS), a potentially life-threatening condition that arises after the abrupt cessation of, or drastic reduction in, chronic heavy drinking. Following a case presentation that illustrates the clinical features of severe AWS, strategies for the assessment of risk, selection of an appropriate BZ regimen, and guidance for further treatment are discussed. In addition, the roles of short-acting versus long-acting BZs are discussed, with an emphasis on fixed-dose versus symptom-triggered approaches. Adverse effects and contraindications of BZs, as well as BZ-sparing strategies, are also presented to guide safe and efficacious management, particularly in those with comorbid medical conditions.