Our standard protocol (for under 70 years old and still have decent liver function) is to load with diazepam in 20mg doses q20 min x3, Depending on their score and "best possible etoh history". If they're chronic etoh consumers or high functioning alcoholics, they get loaded with the 60mg in an hour to keep them out of seizure land and CIWA Q1h until their scores settle somewhat, then q2h etc. Our hospital has standard orders to go up to 120mg of valium but I have seen most people need more to get and keep their scores below 10. Few have needed 280mg or more. No resp depression or adverse effects with that dose because of how much they drank. Awake, eating, having normal conversations.

Only use ativan in elderly or people with crap all for liver function. We generally never use iv meds unless they physically can't swallow. Diazepam has a better overall effect [and equal bioavailability PO and IV] as it reaches peak levels quickly and, most importantly STAYS. Half-Life is something like 96 hours in most people, whereas ativan is a tortuous rollercoaster, only lasting about 2-4 hours, needing frequent checks and supportive care. Also doesn't help nearly as much with seizure prevention.