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Evaluation of suspected alcohol withdrawal should start by obtaining a complete alcohol use history. Symptom-triggered treatment of alcohol withdrawal using assessment scales such as the Clinical Institute Withdrawal Assessment for Alcohol, Revised (CIWA-Ar) is the preferred method. A score of less than ten indicates the need for continued monitoring of the patient. A score of 10 to 15 indicates mild withdrawal, 16 to 20 moderate withdrawal, and greater than 20 severe withdrawal. Sedative/hypnotic (benzodiazepine, barbiturate, and related drug) withdrawal is managed by the same principles used to treat alcohol withdrawal. The consultant may be called upon to assist in managing opioid withdrawal related to illicit use, problems with prescription analgesics, or ongoing opioid agonist therapy (OAT) for addiction. Federally accredited opioid treatment programs (OTPs) can administer methadone or buprenorphine for detoxification or maintenance as part of a comprehensive treatment program.
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