In this ResusX video Dr. Rory Spiegel discusses the use of phenobarbital for treating alcohol withdrawal. He explains the physiology of alcohol withdrawal, which involves an imbalance between excitatory and inhibitory neurotransmitters in the brain, mainly glutamate and GABA, leading to symptoms like tachycardia, seizures, and agitation. Traditionally, benzodiazepines, which work by augmenting the effects of GABA, have been used for treating alcohol withdrawal. They require the presence of GABA in the system to work effectively. Rory prefers a symptom-triggered approach for treatment, which means the severity of the disease state determines the medication dosage. This approach has been found to be more effective and less likely to lead to complications compared to a fixed dosing approach. He critiques lorazepam, a commonly used medication for alcohol withdrawal, for its short half-life and the need for constant re-dosing, which necessitates intensive monitoring and an ICU stay. Dr. Spiegel suggests phenobarbital as a superior option due to its predictability in dosage and effect, wide therapeutic effect, safety, and long half-life that allows for a built-in taper. This makes the monitoring process simpler and reduces the need for ICU stays.