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July 5, 1965

Alcohol Withdrawal

JAMA. 1965;193(1):78-79. doi:10.1001/jama.1965.03090010083034

To the Editor:—  Dr. Gessner's proposal to treat delirium tremens on the model of barbiturate addiction is interesting and clinicians who to our knowledge have attempted such treatment should be encouraged to report even negative results. It is unfortunately true that we still lack sufficient basic information about the mechanisms underlying tolerance and their relationship to the development of delirium tremens. There are, however, practical and conceptual difficulties in using the barbiturate model to rationalize a treatment regimen, to explain the etiology of delirium tremens, or to construct an adequate test for severity of the disorder.Withdrawal from alcohol is, without doubt, a major, often necessary, but not sufficient etiological factor. The continued ingestion of alcohol produces direct toxic effects2,3 as well as metabolic disturbances, which among other factors (including sleep deprivation) complicate the picture. Nor is the relation between amount and duration of alcohol ingestion and delirium tremens

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