1	The AWS Typology A New Approach to the Diagnosis, Management and Treatment of Alcohol Withdrawal
2	The Old Way Alcohol Withdrawal is a single condition, ranging from mild to severe Benzodiazepine monotherapy is the preferred treatment regardless of symptoms Symptoms graded on a numerical scale, based on severity
3	The AWS Typology - The New Way Alcohol Withdrawal consists of three distinct symptom clusters Drug treatment should be tailored to the symptoms present, using the agents that best treat those symptoms Symptoms graded only for absence or presence, using the AWS Type Indicator
4	Advantages of the AWS Typology Tailoring drug treatment to specific symptoms results in a more alert and cooperative patient Avoids dangers associated with over-medication Quickly identifies symptoms associated with serious complications Reduces complications, morbidity, and mortality Easily tracks development of symptoms and responses to treatment
5	The AWS Type Indicator A simple binary scale (symptoms are either present or absent) Requires minimal training Can be administered in 90 seconds or less Guides treatment decisions Monitors response to treatment Designed for clinical use, not as a research tool
6	Type A AWS (CNS Excitation) Symptoms Uneasiness Sense of Foreboding Motor Hyperactivity Dysphoria Enhanced Sensivity to Abrupt Sensory Stimuli Lability of Mood Anxiety Insomnia Preferred Agents Benzodiazepines Carbamazepine Valproic Acid
7	Type B AWS (Adrenergic Hyperactivity) Symptoms Chills Diaphoresis Fever Hypermetabolic State Hypertension Muscle Tremors Mydriasis Nausea and Vomiting Palpitations Piloerection Tachycardia Preferred Agents Clonidine Beta-Blockers Propranolol Atenolol Labetalol
8	Type C AWS (Alcohol Withdrawal Delirium) Symptoms Attentional Deficit Disorientation Hyper-alertness Impairment of Short-term Memory Impaired Reasoning Psyhomotor Agitation Visual and Auditory Hallucinations Preferred Agents Neuroleptics Haloperidol Fluphenazine Risperidone Droperidol
9	Types A, B, and C (Delirium Tremens) Symptoms Combination of A, B, and C Symptoms Preferred Agents Control of Type A Symptoms, Avoiding Benzodiazepines Control of Type B Symptoms with Clonidine or Beta-Blockers Control of Type C Symptoms with Low-dose Neuroleptics
10	Preferred Agents Agent Benzodiazepines Carbamazepine Valproic Acid Clonidine Beta-Blockers Neuroleptics
11	Disadvantages of Benzodiazepine Monotherapy Benzodiazepines are not particularly effective at controlling hyperadrenergic symptoms, including hypertension (Type B AWS) Can result in unwanted and prolonged sedation, especially in older patients Can produce cognitive and memory impairments Can worsen delirium (Type C AWS) Can result in respiratory compromise
12	Prioritizing AWS Symptoms Treat lowest level symptoms first A, then B, then C except in emergencies Re-administer Type Indicator Frequently Typical Emergencies Severe Type B symptoms, such as severe hypertension, tachycardia Severe Type C symptoms (alcohol withdrawal delirium) including agitation that poses a danger to patient or others
13	For More Information The Acohol Withdrawal Treatment Manual provides extensive and detailed information on treatment, pharmacotherapy, and the AWS Typology Available on Amazon.com Focused Treatment Systems website http://www.sagetalk.com/ includes free downloadable copies of Type Indicator, resources on other topics