Wherever possible, all people who are alcohol dependent (according to ICD-10 criteria) should be admitted or referred for specialist treatment. This will partly depend on the availability of local services and the wishes of the person.

• Admit people for immediate (unplanned) medically-assisted withdrawal if they are experiencing acute alcohol withdrawal and any of the following apply:
• They already have, or are at high-risk of developing, alcohol withdrawal seizures or delirium tremens. This may include those with:
• A history of alcohol withdrawal seizures or delirium tremens.
• Signs and symptoms of autonomic overactivity (for example sweating, tremor, tachycardia, palpitations) and signs of intoxication.
• They are younger than 18 years of age.
• Consider admitting people who are experiencing acute alcohol withdrawal without the above criteria but who are vulnerable (for example those who are frail, have cognitive impairment or multiple comorbidities, lack social support, or have learning difficulties).
• Refer people to local alcohol services for elective (planned) medically-assisted withdrawal if they are dependent on alcohol but are not considered to be at high risk of seizures or delirium tremens, and are not vulnerable.
• Admit urgently people with suspected Wernicke's encephalopathy for treatment with parenteral thiamine. Clinical features include confusion, loss of coordination (ataxia), eye paralysis (ophthalmoplegia), nystagmus, memory disturbance, hypothermia, hypotension, and coma.
• Refer to the appropriate speciality people who have related complications, such as:
• Alcohol-related liver disease (exclude other causes of liver disease in people who are harmful or hazardous drinkers and have abnormal liver function).
• Pancreatitis (acute and chronic, characterized by severe abdominal pain).
• Psychiatric problems (admit if they require immediate attention such as severe depression or anxiety, psychosis, or suicidal intent).