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Alcohol Detox

While drinking alcohol in moderation is generally not associated with significant health issues, chronic alcohol abuse can lead to alcoholism, which is a serious, chronic condition characterized by compulsive drinking despite negative consequences. Alcoholism is medically diagnosed as an alcohol use disorder, which ranges in severity from mild to severe. In 2012, approximately 17 million American adults had an alcohol use disorder, and only about 1.4 million of them received addiction treatment 1.

When someone suffers from alcoholism or alcohol use disorder, they will often have developed significant physical dependence on alcohol and will experience withdrawal symptoms with abrupt cessation of or reduction in use.

Unbeknownst to many, the acute alcohol withdrawal syndrome can be debilitating and even life-threatening. Many people require medically supervised detoxification to prevent serious withdrawal symptoms, such as seizures 2. There are several alcohol detox medications used to help manage withdrawal symptoms, ensuring comfort and safety during the detox process. Additionally, there are medications approved to treat alcohol dependence by helping people deal with cravings, which can reduce the chance of relapse and promote long-term abstinence.

This article will cover the following information:

  • Alcohol detox medications.
  • Types of detox programs.
  • Benefits of medically assisted detox.
  • Alcohol abuse treatment programs.
  • Finding a detox or recovery program.

Medications Used

Alcohol Risk

Alcohol Detox Treatment Alcohol is legal, widely available and commonly used. For those reasons, it can be difficult to realize when you have a problem or if you need alcohol detox treatment. Read More

Symptoms of alcohol withdrawal range in severity from mild to severe and can be fatal without proper detox treatment. Signs and symptoms of alcohol withdrawal typically begin 6–48 hours after heavy drinking subsides. Early symptoms can include:4

  • Nausea.
  • Headache.
  • Tremor.
  • Agitation.
  • Sweating.
  • Vomiting.
  • Anxiety.
  • Irritability.
  • Sensitivity to light and sound.
  • Difficulty concentrating.
  • Disorientation.

These early symptoms typically intensify and then decrease over the course of 24–48 hours.4

As alcohol detox progresses, it becomes more dangerous. Without treatment, up to 25% of alcohol-dependent patients may experience grand mal seizures in the first 5 days of withdrawal 5. Delirium tremens (DTs), which is characterized by disorientation, tremors, severe agitation, persistent hallucinations, and increased heart rate, pulse, and blood pressure, is the most intense and dangerous complication associated with alcohol withdrawal. Should they manifest, the symptoms of withdrawal delirium typically appear within 2-4 days after the last drink 4. Without medical supervision, DTs and seizures can be fatal or permanently disabling, so the safest place for detoxification is under the supervision of medical professionals 4.

Many people struggling with alcoholism are surprised to learn that there are several medications proven to aid in detox and recovery. The medications used in detoxification can reduce the severity of symptoms and decrease the risk of dangerous complications. Alcohol detox medications include the following 4,6-9:

  • Benzodiazepines: This class of medication continues to be the primary choice for addiction professionals treating alcohol withdrawal. Benzodiazepines may be regularly administered at sufficiently high doses early in treatment before they are gradually reduced over time. By tapering the medication, the individual is less likely to suffer from the uncomfortable or dangerous effects of withdrawal. Since there are many benzodiazepines, the choice of medication depends on the treatment setting, status of the individual, and prescriber preference. Available benzodiazepines include:
    • Diazepam (Valium) and chlordiazepoxide (Librium): Available in tablet or injectable form, these drugs are a popular choice because they have long half-lives, which helps control withdrawal symptoms between doses.
    • Lorazepam (Ativan): Though technically an off-label use, as an anticonvulsant, lorazepam helps to reduce the risk of seizure.
    • Oxazepam: With a slower absorption rate and short half-life, oxazepam has some disadvantages compared to other benzodiazepines. With no reports of acute liver injury associated with oxazepam use, it a good choice for people with severe liver failure.
    • Clorazepate (Tranxene): Prescribed for the treatment of anxiety and seizures, clorazepate, like other benzodiazepines, has been shown effective in managing the distress of alcohol withdrawal.
  • Clonidine (Catapres): As an alpha adrenergic agonist, clonidine can aid in reducing the symptoms of high blood pressure and rapid heart rate during withdrawal. The drug does not lower the seizure risk, though.
  • Phenobarbital: Currently the only barbiturate used during alcohol detox, phenobarbital manages alcohol withdrawal symptoms similarly to the more commonly used benzodiazepines. Phenobarbital is only used under close supervision because the drug is highly addictive with a relatively narrow therapeutic index.
  • Beta Blockers: Like with clonidine, beta blockers do little to help with the more immediately dangerous alcohol withdrawal symptoms, but they can be useful in treating cardiac symptoms, such as hypertension and rapid heartbeat.
  • Anticonvulsants: A class of medications popular in Europe as an alcohol withdrawal treatment, anticonvulsants have less abuse potential than sedative drugs but have not been well studied in the U.S. for alcohol detox.
    • Carbamazepine (Tegretol): Has been very effective in treating mild to moderate alcohol withdrawal symptoms. This medication can also help deter early relapse more successfully than a benzodiazepine.
    • Gabapentin (Neurontin): In some studies, has been shown to be as effective as benzodiazepines in reducing withdrawal symptoms and alcohol use during withdrawal.
    • Valproic acid (Depakote, Depakene): Has limited data to confirm benefit during withdrawal, especially compared to other available drugs.
  • Relapse prevention medications: These include naltrexone and acamprosate (Campral) and can reduce the chances of relapse and increase the likelihood that a patient will remain in detox and transition into rehab.
  • Baclofen: Another medication with mixed data, the drug has some evidence suggesting baclofen can improve symptoms during withdrawal. There is additional evidence that suggests this medication can also lower the risk of relapse after withdrawal.

Types of Detox Programs

Alcohol Detoxification

If you believe you have an alcohol addiction, it can be beneficial to find a detox program that works for you. Alcohol detoxification can occur in different settings with varying levels of intensity. There is no single program that works best for everyone; substance abuse treatment professionals can help you determine the most appropriate detox program and, eventually, treatment setting to continue your recovery. Because the symptoms of alcohol withdrawal can be so dangerous, experts believe that an inpatient or hospital setting is the safest option 4.

Alcohol detox and withdrawal programs include the following:

  • Hospital setting: Patients with significant alcohol dependence and/or a history of severe withdrawal symptoms, such as seizures or delirium tremens, may be safer in a hospital setting. Additionally, people with co-occurring physical conditions, such as heart problems or liver impairment, might be best served by intensive care unit (ICU) staff. Intravenous fluids are often given to treat dehydration and electrolyte imbalances. Although a hospital setting provides you with around-the-clock supervision and management of alcohol withdrawal syndrome, it will likely not be the setting wherein longer-term substance abuse treatment begins.
  • Inpatient detox program: Specialized inpatient detox programs are often useful for people with moderate to severe alcohol use disorders. Patients live at the facility for several days or weeks and are constantly monitored by professionals. They may receive medically assisted detox support in conjunction with psychological counseling.
  • Outpatient detox program: Specialized detox programs are also available on an outpatient basis. Good candidates for outpatient detox have no co-occurring disorders that could interfere with withdrawal, have a strong and sober support system at home, and do not suffer from severe alcoholism.
  • Doctor’s office: Many people benefit from outpatient detox assistance from their primary care doctor or psychiatrist.

If you are thinking of quitting alcohol use, you don’t have to do it alone. Don’t hesitate to seek professional detox or substance abuse treatment.


Alcohol Addiction Treatment Stats:
Alcohol, or ethanol, is one of the most abused drugs among people in addiction treatment, as reported by a 2017 survey from Recovery Brands. The survey found that nearly 70% of people in recovery underwent treatment for a drinking problem, and a surprising 52.87% of those that responded sought treatment for alcohol abuse more than for any other substance.

Benefits of Medically Assisted Detox

Alcoholism is a progressive and chronic condition that affects both your mind and body. Like any condition, alcoholism should be treated by medical professionals. There are many benefits to medically assisted detox, such as:

  • Ensuring safety during withdrawal.
  • Reducing the risk of relapse.
  • Reducing the severity of withdrawal symptoms.
  • Serving as an important first step on the path to sobriety.
  • Providing a safe and controlled environment.
  • Receiving support and care from medical and mental health professionals.
  • Helping with the management of psychological issues.
  • Helping with alcohol abuse treatment planning.

Alcohol Abuse Treatment

Detoxification is a necessary first step on the road to recovery, but detox does not constitute treatment in and of itself. Without continued treatment, the chances of relapse are high. Detox is the process in which your body is eliminated of alcohol and any other toxins, but the desire to drink may still be overwhelming. A comprehensive alcohol addiction treatment program can help you address the root causes of your addiction and help you obtain and maintain long-term sobriety.

Different levels of care and intensities of treatment include:

  • Inpatient or residential programs that provide intensive treatment and require that you stay at a facility for several weeks or months. They typically offer a combination of group, individual, and family therapy sessions, as well as medication-assisted treatment.
  • Outpatient programs, which differ from residential programs in that you attend therapy sessions, then return home. They often offer group, individual, and family therapy and may gradually reduce the number of therapy sessions over time.
  • Individual psychotherapy, which involves meeting one-on-one with a therapist for one or more sessions per week. Many clients who complete inpatient or outpatient programs choose this option to build upon the skills they learned in rehab.
  • Alcoholics Anonymous, a 12-step program offered in cities across the world. It is a peer-to-peer support group in which recovering alcoholics help each other admit their powerlessness over their addiction. It is a convenient and free way for people to access long-term treatment and support.

Sources

  1. National Institute on Alcohol Abuse and Alcoholism. (n.d.). Alcohol Use Disorder.
  2. National Institutes of Health. (n.d.). Alcohol Dependence and Abuse.
  3. Moos, R. H., & Moos, B. S. (2006). Rates and Predictors of Relapse After Natural and Treated Remission From Alcohol Use Disorders. Addiction (Abingdon, England), 101 (2), 212222.
  4. Myrick, H., & Anton, R. F. (1998). Treatment of Alcohol Withdrawal. Alcohol Research and Health, 22 (1), 38.
  5. Driver Rita, K. (2013). Understanding and Managing Alcohol Withdrawal Syndrome. American Nurse Today, 8 (6).
  6. Center for Substance Abuse Treatment. (2006). Detoxification and Substance Abuse Treatment.
  7. National Institute on Drug Abuse. (2012). Principles of Drug Addiction Treatment: A Research-Based Guide.
  8. Substance Abuse and Mental Health Services Administration. (2015). Detoxification and Substance Abuse Treatment.
  9. World Health Organization. (2009). Clinical Guidelines for Withdrawal Management and Treatment of Drug Dependence in Closed Setting.

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