Introduction: Medication safety has become an increasingly important aspect of drug treatment in the ICU. Acute alcohol withdrawal is a common co-existing morbidity, leading to administration of multiple sedative agents which can adversely affect morbidity and mortality by causing over sedation and lack of cooperation with therapies. An ideal agent would sedate without concern for respiratory depression while controlling withdrawal symptomatology. We postulate that dexmedetomidine (DEX) would be an ideal adjunctive agent, which can be utilized without significant adverse events. The purpose of this trial is to evaluate the safety and efficacy of adjunctive DEX during the treatment of alcohol withdrawal. Methods: This was a single center, retrospective, observational study of patients who presented with concomitant alcohol withdrawal to our community ICU. Inclusion criteria were patients 18 years or older who received dexmedetomidine for alcohol withdrawal symptoms (scored by CIWA-ar) between Jan 2010 and August 2010. All patients were treated with benzodiazepines according to hospital alcohol withdrawal protocol. The primary outcome assessed was the need for intubation, hypotension and emergence of delirium tremens. Secondary outcomes assessed were average doses of dexmedetomidine used, dose of benzodiazepine administered and the need for adjunctive antipsychotic therapy. Results: The study included 25 patients who received DEX in addition to benzodiazepines for alcohol withdrawal. Patients had a mean CIWA-ar score of 19.4 prior to initiating DEX. The average lorazepam dose during dex infusion was 139.6 mg out of a total dose of 169 mg. Duration of DEX was 60.25 hours with an average dose DEX equal to 0.83 mcg/kg/hr. The duration of lorazepam administration was 168.67 hours. Secondary outcomes included an need for adjunctive antipsychotic treatment in 48% of the patients. One patient exhibited aspiration pneumonia, one patient experienced a hypotensive event, two patients developed DT's and four patients required intubation. Conclusions: DEX administration as an adjunct to care of alcohol withdrawal patients being treated with lorazepam decreased the dose of lorazepam required during DEX infusion. DEX should not be sole therapy for alcohol withdrawal as seen by the need for large doses of lorazepam after initiation of the DEX infusion and the requirement for antipsychotic treatment. Patients tolerated DEX well with few adverse events documented. Further robust investigation is required to evaluate if higher DEX doses concurrent with lorazepam would lead to decreased antipsychotic agent use and if benzodiazepine costs and adverse events are decreased compared with patients receiving both benzodiazepine and DEX.