Alcohol Withdrawal Setting — MRCPsych Paper B MCQ

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ModerateSubstance MisuseAlcohol Withdrawal SettingMRCPsych Paper B

A 30-year-old man presents to the emergency department in acute alcohol withdrawal. He is tremulous, sweating, nauseated and agitated, and scores 25 on the Clinical Institute Withdrawal Assessment for Alcohol, revised (CIWA-Ar). During a previous withdrawal episode, he had a generalised withdrawal seizure. What is the most appropriate setting for his withdrawal management?

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Correct answer: C — Hospital-based medically assisted withdrawal

Explanation lettering: C = shown as A · A = shown as B · B = shown as C

The correct answer is B. This is acute, unplanned alcohol withdrawal in someone at high risk of complications because he has previously had a withdrawal seizure. NICE CG100 recommends hospital admission for medically assisted withdrawal when a person has, or is at high risk of developing, withdrawal seizures or delirium tremens. CIWA-Ar supports assessment and monitoring but is an adjunct to clinical judgement rather than a stand-alone placement threshold. Community or outpatient withdrawal (A and C) is appropriate only for suitably assessed, lower-risk planned withdrawal. Non-medical residential rehabilitation (D) cannot provide the required acute medical management, and self-managed home withdrawal (E) is unsafe. CG115 similarly identifies previous withdrawal seizures as an indication to consider inpatient or residential planned withdrawal, but directs acute unplanned presentations to CG100.

Reference: National Institute for Health and Care Excellence. Alcohol-use disorders: diagnosis and management of physical complications (CG100), sections 1.1.1.1 and 1.1.2.2. Published 2010; last updated 2017, with minor changes in 2026. https://www.nice.org.uk/guidance/cg100/chapter/recommendations