- Design
- Multiple-methods survey and focus-group study
- Population
- 33 hospitalists from 27 US tertiary hospitals
- Primary outcome
- Reported treatment practices and decision factors
- Effect
- Phenobarbital reported in 67% of emergency departments and 44% of medical units
A multiple-methods study gathered surveys and focus groups from 33 hospitalists at 27 US tertiary hospitals in August 2025.
Benzodiazepines remained the usual treatment for moderate to severe alcohol withdrawal, but phenobarbital was reported in use in 67% of emergency departments and 44% of inpatient medical units. Participants described choosing therapy without consensus, often driven by drug shortages and by ward logistics such as nursing workload and length of stay, and said patients were rarely involved in the choice.
The study does not compare outcomes. What it shows is variation: the same patient may get a symptom-triggered benzodiazepine on one ward and a phenobarbital load on another. That makes a written local protocol, with clear monitoring for whichever agent is used, more important than the choice of drug itself.
- Check whether your hospital has a written alcohol withdrawal protocol, and which agent it names.
- Score withdrawal with a validated tool before and after each dose, whichever drug is used.
- If phenobarbital is used, monitor sedation and respiratory rate closely, especially with other sedatives.
- Give thiamine before glucose in any patient at risk of Wernicke encephalopathy.
- Discuss treatment choice with the patient where they can take part.
Why it matters
Variation between wards, not the drug chosen, may be the bigger risk to these patients.
Don't overread it
A small survey and focus-group study cannot say whether phenobarbital or benzodiazepines give better outcomes.
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