Hospitalist perspectives and practices in treating hospitalized patients with alcohol withdrawal syndrome in the era of phenobarbital re-emergence.

Medication treatment for moderate to severe alcohol withdrawal syndrome (AWS) is evolving, particularly with renewed phenobarbital use. However, little research has examined how hospitalists manage AWS. We conducted a multiple-methods study involving hospitalists from a national US Hospital Medicine research network. Thirty-three hospitalists from 27 tertiary hospitals completed surveys and participated in seven focus groups on August 8, 2025. Benzodiazepines remained the most common treatment, but phenobarbital use was reported in 67% of emergency departments and 44% of inpatient medical units. Four themes emerged: hospitalists are adaptable in responding to changing practices and drug shortages; a lack of consensus on AWS treatment practices leads to a "wild west approach" to therapy selection; hospitalists prioritize care-delivery outcomes when selecting medications; and patients are minimally involved in shared decision-making. Participants strongly supported additional research to guide evidence-based AWS care. These findings highlight uncertainty and the need for standardized, patient-centered approaches to AWS management.