Dr. Nisavic explains how phenobarbital offers advantages over benzodiazepines for alcohol withdrawal management, particularly in patients with benzodiazepine resistance. He details weight-based loading protocols, monitoring strategies, and the dual GABA/glutamate mechanism that may make phenobarbital superior for severe withdrawal cases.

Dr. Gunderson provides expert guidance on recognizing and managing delirium tremens, challenging conventional wisdom about withdrawal timelines and offering practical approaches to risk stratification. He details his treatment approach for patients at high risk of developing withdrawal complications and discusses the differential diagnosis of delirium in hospitalized patients with alcohol use disorder.

New rapid induction strategies are allowing clinicians to start buprenorphine in acute care settings.

When bipolar disorder and substance use disorders co-occur patients can be difficult to diagnose and treat, particularly because they often present with mixed states rather than classic mood episodes. This article reviews evidence-based treatment approaches for specific substance combinations, including valproate for alcohol use, citicoline for stimulant use, and considerations for managing this complex dual diagnosis.