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Alcohol Withdrawal Treatment Manual

DePetrillo P, McDonough M. 244 pages. Glen Echo, MD: Focused Treatment Systems; 1999. $75.00. ISBN 0966167309. Order phone 301-320-0529. Field of medicine: Addiction medicine. Format: Softcover book. Audience: Clinicians who provide medical coverage for substance abuse programs or manage alcohol withdrawal. Purpose: To serve as a manual for management of alcohol withdrawal. Content: Clinical presentation, differential diagnosis, and treatment of alcohol withdrawal, including delirium tremens, are covered. The pharmacology of drugs recommended by the authors and common medical emergencies seen in patients in withdrawal are reviewed. Potential quality assurance monitors for treatment of alcohol withdrawal are also discussed. Highlights: The book is well organized and emphasizes specific clinical information that is of immediate practical use to the clinician. Limitations: The book offers an approach to alcohol withdrawal that is specific to the authors. In many cases, the authors' recommendations are not supported by and sometimes contradict the evidence in the medical literature, and they deviate greatly from accepted practice and recommendations of experts. The authors also recommend various medications for which no studies or only a few uncontrolled case reports have been published. For example, they advocate the use of valproic acid, labetolol, or clonidine for many cases of alcohol withdrawal; recommend neuroleptic agents, such as droperidol, over benzodiazepines for the treatment of delirium tremens; and state that there are no data on pharmacologic treatment to prevent delirium tremens. Related reading: More evidence-based and accepted approaches to alcohol withdrawal are described in current textbooks of addiction medicine (Graham and Schultz's Principles of Addiction Medicine [American Soc of Addiction Medicine, 1998] and Schuckit's Drug and Alcohol Abuse: A Clinical Guide to Diagnosis and Treatment [Plenum, 1997]) and recent reviews (Saitz R, O'Malley SS. Pharmacotherapies for alcohol abuse; withdrawal and treatment. Med Clin North Am. 1997; 81:881-907). Reviewer: Michael Mayo-Smith, MD, MPH, Harvard Medical School, Boston, Massachusetts.