Quantification of the alcohol withdrawal syndrome in 487 alcoholic patients

While the alcohol withdrawal syndrome (AWS) is frequently encountered in a number of medical settings, its clinical management is inconsistent. Appropriate management of the AWS can be enhanced by objectively quantifying principal symptoms. The modified or Milwaukee Selective Severity Assessment (MSSA) measures 10 symptoms of the AWS, providing clinicians with a quantitative indication of the syndrome's severity. The MSSA was administered to 487 successively admitted alcoholics entering an inpatient chemical dependency treatment center. The MSSA was used to evaluate the severity, monitor progression, and determine efficacy of treatment of the AWS. The MSSA aided clinicians in deciding which patients required pharmacologic intervention for their AWS. Two groups of patients are described: 435 whose AWS was not judged to be severe enough to require medication, and 52 whose AWS was sufficiently severe to warrant pharmacologic intervention. The MSSA allowed clinicians to accurately identify patients requiring pharmacologic intervention of the AWS: only 10.6% of 487 hospitalized alcoholics required pharmacotherapy. The MSSA is a convenient, effective, and efficient tool for monitoring the AWS.