What criteria should I use to determine whether a patient with alcohol withdrawal requires referral to secondary care?

Patients with alcohol withdrawal should be referred to secondary care if they have a history of withdrawal seizures or delirium tremens, or if they are assessed to be at high risk of developing these complications ¹.

Inpatient or residential assisted withdrawal should be considered if the patient drinks over 30 units of alcohol per day, has a SADQ score of more than 30, or has a history of withdrawal-related seizures or delirium tremens ².

Patients who require concurrent withdrawal from alcohol and benzodiazepines, or who have significant psychiatric or physical comorbidities such as severe depression, psychosis, or chronic liver disease, should also be referred to secondary care ².

Vulnerable groups, such as homeless or older individuals, may warrant a lower threshold for referral ².