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Alcohol - problem drinking - Management
When should I consider assisted withdrawal in primary care?

  • Ideally, people with alcohol dependence should be referred to a specialist alcohol service to determine whether assisted withdrawal (that is withdrawal using drug treatment) is necessary, and to provide psychosocial intervention by trained professionals.
  • Try to encourage the person to accept referral and advise that a considerable amount of care (including assisted withdrawal) could be carried out in a shared-care programme with members of the person's own primary healthcare team. This may motivate the person to accept specialist input, and thus increase the chance of a successful outcome.
  • If the person refuses referral, assisted withdrawal may be carried out in primary care under the supervision of a non-specialist provided the healthcare professional feels confident (that is, has previous experience with successful assisted withdrawal), knows the person, has the appropriate amount of time (including follow-up arrangements), and the social circumstances are in place to favour community withdrawal (for example the person has a good support network).
  • Assisted withdrawal may not be necessary in people with mild dependence. The decision to use assisted withdrawal should be made with the person, bearing in mind that treatment may reduce unpleasant symptoms and increase the chances of success. Drug treatment may not be necessary if:
    • The person reports drinking less than 15 units (men) or 10 units (women) per day, and does not need to drink to avoid withdrawal symptoms.
    • The person is sober at presentation with no signs of withdrawal.
    • The person is a binge drinker with periods of abstinence, unless alcohol use is very heavy (more than 20 units per day) or binges last for more than a week.
  • Community-based assisted withdrawal is contraindicated in certain situations, including when the person has a history of fits or delirium tremens, is a suicide risk, has a non-supportive home environment or a history of illicit drug misuse, or has an existing dependence on benzodiazepines — in these cases, admission or referral should be considered.

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