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Alcohol Detox Medication & How It Can Help

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Alcohol-related problems—which may arise from drinking too much, too fast, or too often—present a significant public health issue in the United States.Doctors can diagnose a medical condition called alcohol use disorder (AUD) in which a patient’s drinking causes distress or harm.1,2

Consistently problematic drinking behavior may signal the presence of an AUD, more commonly knowns as alcoholism, which is a serious, chronic condition characterized by compulsive drinking, a negative emotional state when not drinking, and a loss of control over alcohol intake.2,3 AUD ranges in severity from mild to severe.1,2,3 In 2017, approximately 14.5 million people aged 12 or older had an alcohol use disorder and only about 1.4 million of them received addiction treatment.4 When someone suffers from alcoholism or alcohol use disorder, they may have developed significant physical dependence on alcohol, which places them at higher risk of experiencing withdrawal symptoms when attempting to quit or abruptly cut back on their drinking.1,3,4,5

Some alcohol dependent people will experience an acute alcohol withdrawal syndrome—which can be debilitating and even life-threatening—if they abruptly stop or reduce their alcohol consumption.6 In people with significant alcohol dependence, the onset of alcohol withdrawal typically begins 6-48 hours after the last drink. Early sign and symptoms can include:6

  • Irritability.
  • Difficulty concentrating.
  • Disorientation.
  • Anxiety.
  • Agitation.
  • Tremor.
  • Headache.
  • Sensitivity to light and sound.
  • Nausea.
  • Vomiting.
  • Sweating.
  • Racing pulse and increased blood pressure.

Alcohol withdrawal can be very dangerous, and many people require medically supervised detoxification to decrease the risk of serious withdrawal symptoms, such as seizures.6 There are several medications that can be used during alcohol detox to help manage withdrawal symptoms, provide prophylaxis against serious complications (i.e., seizures), and otherwise ensure comfort and safety during the detox process. Beyond the detox period, there are medications approved to help treat alcohol dependence by discouraging continued drinking behavior, which can reduce the likelihood of relapse and help promote long-term abstinence.

Anyone considering treatment should talk to a doctor or other treatment professional as a first step.1 They can evaluate your substance abuse history as well as other factors, including addiction severity, magnitude of physical dependence, and the probability of a severe and/or complicated withdrawal, to direct their recommendations for treatment and determine whether medication management during the acute withdrawal period is necessary.1

Withdrawal Dangers

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. Some withdrawal complications can be fatal without proper detox and withdrawal management. 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.7

Some withdrawal complications can be fatal without proper detox and withdrawal management.

Delirium tremens (DTs), which involves sudden and severe mental status changes and other serious neurologic issues, is an advanced form of alcohol withdrawal that, especially when left unmanaged, may be life threatening.8 Symptoms associated with DTs include the following:8,9

  • Delirium
  • Body tremors
  • Agitation and irritability
  • Rapid mood changes
  • Sudden decline in mental functioning
  • Confusion
  • Sensitivity to light, sound, touch
  • Changes in mental function
  • Hallucinations

Should they manifest, the symptoms of withdrawal delirium typically appear within 2-4 days after the last drink.8 Without medical intervention, DTs and seizures can be fatal or permanently disabling, so the safest detoxification environment for at-risk individuals is under the supervision of medical professionals.8

Medications Used

Many people struggling with AUD are surprised to learn that there are several medications that may be used for detox and recovery. Certain medications used in detoxification can reduce the severity of symptoms and decrease the risk of dangerous complications. Alcohol detox medications include the following.1,6,7,9,10

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.

Benzodiazepines

This class of medication continues to be the first line of treatment for managing alcohol withdrawal. Benzodiazepines may be regularly administered at sufficiently high doses early in the acute withdrawal period before they are gradually reduced over time. By tapering the medication, the individual is less likely to experience the full brunt of unpleasant alcohol withdrawal symptoms or the abrupt arrival of any significantly dangerous withdrawal complications.

Since there are several different benzodiazepine drugs, the specific medication used will ultimately depend on the treatment setting, status of the individual, and prescriber preference. Benzodiazepines approved for use in alcohol withdrawal management include:

  • Diazepam (Valium) and chlordiazepoxide (Librium): These drugs are a popular choice because they have relatively long half-lives, which helps manage withdrawal symptoms while minimizing the need for frequent dosing.
  • Lorazepam (Ativan): Though technically an off-label use, as an anticonvulsant, lorazepam helps to reduce the risk of seizure or manage seizure activity that is already present.
  • Oxazepam: With a slower absorption rate and short half-life, oxazepam has some disadvantages compared to other benzodiazepines. However, with no reports of acute liver injury associated with oxazepam use, it may be an appropriate option for people with impaired liver function.
  • Clorazepate (Tranxene): Also prescribed for the treatment of anxiety and seizures, clorazepate, like other long-acting benzodiazepines, is also approved for use in managing acute alcohol withdrawal.

Clonidine (Catapres)

As an alpha-adrenergic agonist, clonidine can aid in managing certain uncomfortable withdrawal effects that aren’t well controlled by benzodiazepine administration, such as high blood pressure and rapid heart rate during withdrawal. The drug does not lower withdrawal-associated seizure risk, though.

Barbiturates

Though benzodiazepines are the most commonly utilized pharmacotherapeutic means of alcohol withdrawal management and seizure prophylaxis, in certain situations, barbiturates like phenobarbital may be used to similar ends.

Beta Blockers

As with clonidine, beta blockers do little to help with some of the more immediately dangerous alcohol withdrawal symptoms, but they can be useful in managing cardiac symptoms, such as hypertension and rapid heartbeat.

Anticonvulsants

A class of medications more prevalently used in Europe for 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 disulfiram (Antabuse), naltrexone, and acamprosate (Campral) which, via different mechanisms, may reduce the chances of relapse and decrease drinking behavior in the long term.

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 use disorder or are concerned about your alcohol withdrawal risks, finding the right detox program may be crucial to your early recovery efforts. Alcohol detoxification may take place in different settings with varying levels of intensity. There is no single program that works best for everyone;1 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, an inpatient or hospital setting will be the safest option for many people.9,10

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 the acute 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.1 Patients live at the facility for several days or weeks and are constantly monitored by professionals. In such a setting, they may undergo a supervised medically managed withdrawal in conjunction with psychological counseling.
  • Outpatient detox program: Specialized detox programs are also available on an outpatient basis. Good candidates for outpatient detox have lower-severity alcohol dependence, no history of previous withdrawal complications, no co-occurring disorders that could interfere with withdrawal, and have a strong and sober support system at home, and no history of previous withdrawal complications.1
  • Doctor’s office: Some people not at risk for severe withdrawal benefit from outpatient detox assistance with guidance and regular check-ins/progress evaluations from a primary care doctor or psychiatrist.

If you are want to quit drinking, in many cases you should not attempt to do it alone. Don’t hesitate to seek professional detox or substance abuse treatment.

Benefits of Medical Detox

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 that roughly 53% of those who responded sought treatment for alcohol abuse more than for any other substance.

Alcoholism frequently follows a chronic and progressive course. With their potentially devastating impact on both mental and physical health, alcohol use disorders are best treated by medical professionals. A supervised medical detox has many benefits for those embarking on recovery, such as:10

  • Support and care from medical and mental health professionals.
  • Increased safety during alcohol withdrawal.
  • Reduced risk of relapse.
  • Decreased severity of withdrawal symptoms.
  • Decreased risk of withdrawal complications.
  • Provides a safe and controlled environment.
  • Is a good starting point for longer-term alcohol treatment.

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 eliminates 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.9,10

Different levels of care and intensities of treatment include:

  • people in group therapy for relapse preventionInpatient 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 outside of treatment hours. They often offer group, individual, and family therapy and may gradually reduce the number of required 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 that hosts meetings 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 recovery support.

Sources

  1. National Institute on Alcohol Abuse and Alcoholism. (2014.) Treatment for Alcohol Problems: Finding and Getting Help.
  2. National Institute on Alcohol Abuse and Alcoholism. (2018). Alcohol Facts and Statistics.
  3. National Institute on Alcohol Abuse and Alcoholism. (n.d.). Alcohol Use Disorder.
  4. Substance Abuse and Mental Health Services Administration. (2018). Key Substance Use and Mental Health Indicators in the United States: Results from the 2017 National Survey on Drug Use and Health.
  5. U.S. National Library of Medicine: Medline Plus. (n.d.). Alcoholism and Alcohol Abuse.
  6. National Clinical Guideline Centre (UK). (2010). Alcohol Use Disorders: Diagnosis and Clinical Management of Alcohol-Related Physical Complications. NICE Clinical Guidelines, No. 100. London: Royal College of Physicians (UK).
  7. American Psychiatric Association. (2013). Diagnostic and statistical manual of mental disorders (5th ed.). Arlington, VA: American Psychiatric Publishing.
  8. U.S. National Library of Medicine: Medline Plus. (2017). Delirium tremens.
  9. Substance Abuse and Mental Health Services Administration. (2015). TIP 45: Detoxification and Substance Abuse Treatment.
  10. National Institute on Drug Abuse. (2019). Treatment Approaches for Drug Addiction.

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