Abstract: Objectives: The objectives were to compare the efficacy of a benzodiazepine loading versus a symptom-triggered protocol in the management of alcohol withdrawal.Methods: We conducted a prospective, randomized, controlled trial including 47 consecutive patients admitted to one of two tertiary care medical centers who developed alcohol withdrawal syndrome. Patients were randomly assigned to either a benzodiazepine loading protocol or a symptom-triggered treatment protocol. The Clinical Institute Withdrawal Assessment for Alcohol-Revised scale (CIWA-Ar) was recorded throughout the length of stay, along with measures of autonomic system functioning.Results: The average rate of change of CIWA-Ar scores was −1.5±1.3 for the symptom-triggered group and −2.3±2.5 for the loading group. Average rate of change for systolic blood pressure was −2.7±5.3 for the symptom-triggered group and −2.3±6.4 for the loading group. There was no significant difference between the rates of change for either group on either measure. Similarly, there was no significant difference in total benzodiazepine use between groups. Within 72 h of treatment, 69.6% of patients in the loading group were free of withdrawal symptoms versus 41.7% in the symptom-triggered group, a difference not reaching statistical significance.Conclusions: This study did not reveal clear evidence of a clinical advantage for choosing either treatment method.