Internal and Emergency Medicine

, Volume 14, Issue 1, pp 143–160 | Cite as

Diagnosis and treatment of acute alcohol intoxication and alcohol withdrawal syndrome: position paper of the Italian Society on Alcohol

  • Fabio CaputoEmail author
  • Roberta Agabio
  • Teo Vignoli
  • Valentino Patussi
  • Tiziana Fanucchi
  • Paolo Cimarosti
  • Cristina Meneguzzi
  • Giovanni Greco
  • Raffaella Rossin
  • Michele Parisi
  • Davide Mioni
  • Sarino Arico’
  • Vincenzo Ostilio Palmieri
  • Valeria Zavan
  • Pierluigi Allosio
  • Patrizia Balbinot
  • Maria Francesca Amendola
  • Livia Macciò
  • Doda Renzetti
  • Emanuele Scafato
  • Gianni Testino


The chronic use of alcohol can lead to the onset of an alcohol use disorder (AUD). About 50% of subjects with an AUD may develop alcohol withdrawal syndrome (AWS) when they reduce or discontinue their alcohol consumption and, in 3–5% of them, convulsions and delirium tremens (DTs), representing life-threatening complications, may occur. Unfortunately, few physicians are adequately trained in identifying and treating AWS. The Italian Society on Alcohol has, therefore, implemented a task force of specialists to draw up recommendations for the treatment of AWS with the following main results: (1) while mild AWS may not require treatment, moderate and severe AWS need to be pharmacologically treated; (2) out-patient treatment is appropriate in patients with mild or moderate AWS, while patients with severe AWS need to be treated as in-patients; (3) benzodiazepines, BDZs are the “gold standard” for the treatment of AWS and DTs; (4) alpha-2-agonists, beta-blockers, and neuroleptics may be used in association when BDZs do not completely resolve specific persisting symptoms of AWS; (5) in the case of a refractory form of DTs, the use of anaesthetic drugs (propofol and phenobarbital) in an intensive care unit is appropriate; (6) alternatively to BDZs, sodium oxybate, clomethiazole, and tiapride approved in some European Countries for the treatment of AWS may be employed for the treatment of moderate AWS; (7) anti-convulsants are not sufficient to suppress AWS, and they may be used only in association with BDZs for the treatment of refractory forms of convulsions in the course of AWS.


Acute alcohol intoxication Alcohol withdrawal syndrome Pharmacological treatment 


Compliance with ethical standards

Conflict of interest

The author(s) declare that they have no conflict of interest.

Statement of human and animal rights

The Italian Society on Alcohol has followed the Ethical Statements required for a review paper.

Informed consent

For this type of study formal consent is not required.


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Copyright information

© Società Italiana di Medicina Interna 2018

Authors and Affiliations

  • Fabio Caputo
    • 1
    • 2
    Email author
  • Roberta Agabio
    • 3
  • Teo Vignoli
    • 4
  • Valentino Patussi
    • 5
  • Tiziana Fanucchi
    • 5
  • Paolo Cimarosti
    • 6
  • Cristina Meneguzzi
    • 6
  • Giovanni Greco
    • 7
  • Raffaella Rossin
    • 8
  • Michele Parisi
    • 9
  • Davide Mioni
    • 10
  • Sarino Arico’
    • 11
  • Vincenzo Ostilio Palmieri
    • 12
  • Valeria Zavan
    • 13
  • Pierluigi Allosio
    • 14
  • Patrizia Balbinot
    • 15
  • Maria Francesca Amendola
    • 16
  • Livia Macciò
    • 17
  • Doda Renzetti
    • 18
  • Emanuele Scafato
    • 19
  • Gianni Testino
    • 15
  1. 1.Unit of Internal Medicine, Department of Internal MedicineSS Annunziata HospitalCentoItaly
  2. 2.“G. Fontana” Centre for the Study and Multidisciplinary Treatment of Alcohol Addiction, Department of Medical and Surgical SciencesUniversity of BolognaBolognaItaly
  3. 3.Section of Neuroscience and Clinical Pharmacology, Department of Biomedical SciencesUniversity of CagliariCagliariItaly
  4. 4.Unit of Addiction TreatmentLugoItaly
  5. 5.Regional Centre on AlcoholCareggi HospitalFlorenceItaly
  6. 6.Alcohol UnitPordenoneItaly
  7. 7.Alcohol UnitRavennaItaly
  8. 8.Alcohol UnitMilanItaly
  9. 9.Alcohol UnitNicosiaItaly
  10. 10.Nursing Home Parco dei TigliTeoloItaly
  11. 11.Gastroenterology UnitMauriziano HospitalTurinItaly
  12. 12.“Murri” Clinic of Internal Medicine, Department of Biomedical Science and Human OncologyUniversity of BariBariItaly
  13. 13.Alcohol UnitAlessandriaItaly
  14. 14.Alcohol UnitTurinItaly
  15. 15.Regional Centre on AlcoholGenoaItaly
  16. 16.Alcohol UnitCosenzaItaly
  17. 17.Alcohol UnitSavonaItaly
  18. 18.Department of Internal MedicineMater Dei HospitalBariItaly
  19. 19.National Observatory on Alcohol, National Institute of HealthRomeItaly

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