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Benzodiazepines are first-line therapy for treatment of alcohol withdrawal syndrome (AWS). Longer acting benzodiazepines may provide a smoother withdrawal, while shorter-acting benzodiazepines may be preferred in patients who are elderly or have significant hepatic impairment. Front loading, fixed dose and symptom-triggered benzodiazepine dosing strategies may be used when treating moderate to severe AWS in the hospital setting. Other drugs may be appropriate as adjuncts to benzodiazepine therapy or in the treatment of mild to moderate AWS.

The acute alcohol withdrawal state (tremulous state), with mainly vegetative symptoms and without evident loss of conciousness or confusion, was evaluated as to functional psychopathological disturbances aiming to present a complete and objective record of the clinical findings and to establish a control of the course and drug treatment. We tried to meet the inherent inability to cooperate by using proven and also new test devices (flicker fusion, simple reaction time on light and tone, reaction on multiple serial stimuli, visual motor coordination, tachistoscopic perception and memory test, test of concentration and sustained performance with simple arithmetical calculation by analogy with the Pauli test) to circumvent the difficulties arising when patients have to answer long questionnaires. The tests enabled a measurement of the disturbances as objective as possible and proved to have a discriminating sensitivity for different functions. The correlations between the results were found to be similar for alcoholics and controls. The degree of the established functional cerebral and cerebellar defects which was revealed was more severe than expected in this mild stage of withdrawal.