Alcohol use disorder — detox, Wernicke, and relapse prevention (MEQ)

(i) Nosology. Seven DSM-5-TR criteria in twelve months = severe AUD (mild 2–3, moderate 4–5, severe ≥6). ICD-11 would likely frame alcohol dependence if impaired control, primacy of use, and persistence despite harm (with physiological features) are present — do not mix criterion counts with ICD labels carelessly.[6]

(ii) Assessment. ABCDE, glucose, trauma from fall, full alcohol/substance history (last drink time critical), MSE, suicide/violence/vulnerability risk, capacity regarding self-discharge, collateral. Score CIWA-Ar (ten items, max 67) to guide symptom-triggered benzodiazepines if assessable. Screen mood/psychosis/other substances (dual diagnosis). Labs: FBC, U and E, Mg/phosphate, LFTs, coags; imaging if head injury concern.[1][5][6]

(iii) Acute management. Admit — high risk (withdrawal already, fall, Wernicke features, AMA threat). Benzodiazepines first-line (e.g. diazepam or lorazepam 1–2 mg titrated if liver concern) symptom-triggered per CIWA-Ar protocol. Wernicke: Caine criteria met (malnutrition + oculomotor + cerebellar — any two suffice); give high-dose parenteral thiamine urgently (EFNS/RCP-style teaching often 500 mg IV TDS for days then step-down — follow local protocol); do not rely on oral thiamine alone; cover thiamine when giving glucose.[2][4][5] Supportive care, electrolytes, seizure precautions, continuous monitoring; escalate if evolving DT.

(iv) Relapse prevention (after stabilisation). Offer naltrexone 50 mg oral daily if opioid-free and LFTs acceptable; or acamprosate 666 mg TDS after detox if renal function allows; or supervised disulfiram 200–250 mg daily only with consent, education, and suitable candidate. State contraindications (naltrexone/opioids; acamprosate/severe renal failure; disulfiram/cardiac risk, unsupervised drinking).[3][7][8]

(v) Psychosocial and disposition. MET/CBT/mutual aid, social work for housing, safety planning for AMA risk, dual diagnosis follow-up, early outpatient addiction review, consider residential if community supports fail. Document capacity and least-restrictive options under jurisdiction-specific law without inventing foreign section numbers.[3][6]