The DSM-5 diagnostic criteria for alcohol withdrawal are not hard to understand and remember. Let’s go over the Setting, Sequence, Symptoms, and Specifier.
This is stating the obvious, but for the diagnosis of alcohol withdrawal.
– The person has been using significant amounts of alcohol for a significant amount of time. Note: Neither the amount nor the duration is specified by DSM-5.
– The alcohol use either stops or is reduced.
This again is stating the obvious but the symptoms/ signs of alcohol withdrawal described below start soon after the alcohol use is stopped or reduced. How soon after? A few hours to a few days.
The Symptoms/ Signs
Eight clinical features are listed by DSM-5 that may be present in alcohol withdrawal. For the diagnosis, at least two of these eight should be present.
Autonomic hyperactivity (e.g., increased sweating, tachycardia)
Increased hand tremor.
Nausea or vomiting.
Transient visual, tactile, or auditory hallucinations or illusions.
Generalized tonic-clonic seizures.
As in all DSM diagnoses, there should be either distress or functional impairment
As in all DSM diagnoses, the symptoms should not be due to another cause.
With perceptual disturbances: This specifier applies in the rare instance when hallucinations (usually visual or tactile) occur with intact reality testing, or auditory, visual, or tactile illusions occur in the absence of a delirium.
F10.239 Alcohol withdrawal without perceptual disturbances
F10.232 Alcohol withdrawal with perceptual disturbances.
The ICD-10-CM code indicates that a moderate/ severe alcohol use disorder is present. This is because alcohol withdrawal can only occur in the presence of a moderate or severe alcohol use disorder. We can’t code a mild alcohol use disorder with alcohol withdrawal.
Which benzodiazepines for alcohol withdrawal syndrome (AWS)?
Alcohol withdrawal syndrome: Benzodiazepine regimens
American Psychiatric Association: Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition. Arlington, VA, American Psychiatric Association, 2013.
Copyright 2018, Rajnish Mago, MD. All rights reserved. May not be reproduced in any form without express written permission.
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