Acute management of alcohol and other drug problems

Intoxication and withdrawal syndromes are common presentations in acute medicine. A comprehensive history, including a collateral one, and thorough examination looking for patterns of signs and symptoms, backed by appropriate investigations, forms the basis of good management. A collaborative, empathic and non-judgemental approach that recognizes the patient's distress, explains the goals of management and sets clear boundaries significantly reduces potential complications and improves outcomes. An understanding of the pharmacology and clinical effects of alcohol, benzodiazepines, opioids and stimulants is essential to accurately diagnose and manage patients who may not be able to give an accurate history.