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Supervised WithdrawalSupervised withdrawal is used to manage acute withdrawal and its complications, ensure a supportive environment in which to initiate sobriety, and link the patient to specialty treatment. Most patients with alcohol dependence can withdraw without supervision or medication. For patients in mild-to-moderate withdrawal and for those who live in an unstable environment for recovery, clinically managed residential detoxification programs deliver supportive care; some are medically supervised and provide medication. A medically monitored inpatient or residential setting is appropriate for patients at risk for severe withdrawal (e.g., persons with acute medical illness, an age of 60 years or older, misuse of sedative hypnotic agents, daily consumption of 20 or more standard drinks, or a history of severe withdrawal, seizures, or alcohol withdrawal delirium), for whom long-acting or intermediate-acting benzodiazepines are the standard of care. Symptomtriggered doses of benzodiazepines administered by trained personnel using a withdrawal-severity tool are preferable to fixed doses, except for patients who are unable to communicate, those receiving medications that mask withdrawal manifestations (e.g., beta-adrenergic antagonists), and those at highest risk for severe withdrawal (who should receive medical care in a hospital).
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