Emergency Medicine

Psychiatric Emergencies 441

Alcohol and Drug Dependency and Abuse

Alcohol and drug withdrawal

DIAGNOSIS AND MANAGEMENT

1 Patients may be seen who are dependent on or abuse the following classes of
drugs:
(i) Alcohol.
(ii) Opiates.
(iii) Stimulants including amphetamines and cocaine.
(iv) Sedatives including benzodiazepines and barbiturates.
(v) Miscellaneous substances including cannabis, solvents and petrol.

2 Abrupt withdrawal of many of these drugs causes acute symptoms.
(i) Alcohol withdrawal causes agitation, irritability, tremor and
seizures, then delirium tremens (see p. 87)
(a) give a benzodiazepine i.v. or orally if symptoms are
distressing
(b) seek help for the patient from an expert drug and alcohol
dependency unit.
(ii) Opiate withdrawal causes restlessness, excitability, muscle
cramps, diarrhoea, tachycardia and sweating – known as ‘cold
turkey’
(a) give a benzodiazepine i.v. or orally if symptoms are
distressing
(b) seek help for the patient from an expert drug and alcohol
dependency unit.
(iii) Benzodiazepine withdrawal causes a rebound increase in tension,
anxiety and apprehension, with anorexia, insomnia and epileptic
seizures
(a) seek help for the patient from an expert drug and alcohol
dependency unit.

Problem drinking

DIAGNOSIS

1 Alcohol misuse is related to many emergency department presentations,
from falls, collapse, head injury and assault to non-specific gastrointestinal
problems, psychiatric problems and the ‘frequent attender’.

2 Ask the patient directly if they drink alcohol, how much on a regular daily
basis and whether their attendance is related to alcohol, or

3 Use a validated screening questionnaire such as the CAGE (see Table 16.1).