Last reviewed: June 2020
Last updated: June  2018



History and exam

Key diagnostic factors

  • withdrawal
  • tolerance
  • increased/decreased liver size, jaundice, ascites

Other diagnostic factors

  • nicotine dependence comorbidity
  • social, economic, legal, or psychological problems
  • nausea, vomiting, abdominal pain, hematemesis
  • muscle cramps, pain, tenderness, altered sensory perception
  • hypertension and tachycardia
  • impaired nutritional status
  • cutaneous manifestations
  • alterations in normal dental hygiene
  • broad-based gait

Risk factors

  • family history of alcoholism
  • antisocial behavior (premorbid)
  • high trait anxiety level
  • lack of facial flushing on exposure to alcohol
  • low responsivity to the effects of alcohol
  • history of gastric bypass

Diagnostic investigations

1st investigations to order

  • diagnostic interview
  • alcohol level (breath and blood)
  • Clinical Institute Withdrawal Assessment for Alcohol--revised (CIWA-Ar)
More 1st investigations to order

Investigations to consider

  • carbohydrate-deficient transferrin (CDT)
  • gamma glutamyl transpeptidase (gamma-GT), alanine aminotransferase (ALT), aspartate aminotransferase (AST)
  • CBC
  • urinary ethyl glucuronide
More investigations to consider

Treatment algorithm


Professor of Addiction Psychiatry

Addictions Department

National Addiction Centre

Institute of Psychiatry, Psychology and Neuroscience

King's College




CD declares that he has no conflicting interests.

Dr Colin Drummond would like to gratefully acknowledge Dr Julie R. Pittman, Dr Philip H. Chung, Dr Robert M. Swift, and Dr Lorenzo Leggio, previous contributors to this topic. JRP, PHC, and RMS declare that they have no competing interests. LL is an author of a reference cited in this topic.

Peer reviewersVIEW ALL

Royal Prince Alfred Hospital and Discipline of Medicine

University of Sydney




PSH is an author of a reference cited in this topic.

Bernard B. Brodie Department of Neuroscience

University of Cagliari




RA is an author of a number of references cited in this topic.

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