Clinical Alcohol Detox Medication Protocol

If you’re struggling with alcohol dependence or excessive intake, you might be nervous about getting treatment. You could also be apprehensive about what abstinence from use could mean for your life. One significant source of hesitation could be your fear of withdrawal symptoms. 

Undoubtedly, the alcohol withdrawal detox process can be difficult, but an alcohol detox medication protocol at an alcoholism treatment facility can help with life-threatening symptoms. Drug therapy options can reduce the symptoms of withdrawal significantly – including cravings. Medications can also relieve severe symptoms like seizures. 

When you choose a treatment program, talk to them about what type of alcohol detox medication protocol they use and what you can expect. For example, you might go to an inpatient detox program that is part of a rehab center. Then, once your clinical condition improves, you can move directly into treatment. 

 

Alcohol Dependence Diagnosis

When you have an alcohol use disorder, you are also likely to have a dependence. A dependence diagnosis means your brain and body adjust to the effects of liquor. Dependence can change the levels of chemicals in your brain. If you’re dependent on alcohol and you suddenly stop drinking, which is known as abrupt cessation, you may have withdrawal symptoms.

  • Detox can include mild, moderate symptoms or severe symptoms of acute withdrawal associated with the cessation of use. In some cases, symptoms can even be deadly, although this is rare.
  • The most severe symptoms usually occur anywhere between two and five days after the last time you drink.
  • If you drink daily, your central nervous system adapts to the presence of the drug. Excessive and ongoing use irritates and over-excites the central nervous system. Taking away that stimulus is what causes the symptoms of AWS.
  • If you’re wondering who’s most at risk for withdrawal symptoms, heavy drinking is more than eight drinks a week if you’re a woman, and for a man, heavy drinking is considered 15 drinks or more a week.
  • When you drink heavily, GABA effects increase. GABA is a brain neurotransmitter that causes feelings of euphoria and calm. Excessive drinking also decreases glutamate, a neurotransmitter that leads to feeling excited.
  • Heavy consumption makes it harder for your body to increase GABA and decrease glutamate, but you need more and more liquor for that to happen. Your body responds to your ongoing use by producing less GABA and more glutamate resulting in brain hyperexcitability. Once you stop drinking, your body is still producing too much glutamate and not enough GABA so that you can experience hyperarousal.

Along with heavy drinking, other risk factors for a more severe diagnosis of withdrawal include underlying physical and mental health issues, how long you’ve been drinking large amounts of booze, and whether or not you simultaneously use other substances—your general health factors into how severe the symptoms are in the alcohol detox phase too. 

 

Symptoms of Alcohol Withdrawal

The alcohol detox phase includes:

  • Anxiety
  • Fatigue
  • Shakiness
  • Mood swings
  • Anger
  • Depression
  • Brain fog and impaired attention
  • Nightmares
  • Dilated pupils
  • Nausea
  • Vomiting
  • Fast heart rate
  • Pale skin
  • Loss of appetite
  • Tremors
  • Suicidal ideation
  • Extreme cravings 

 

Severe Symptoms 

The severe form of symptoms can occur in patients with dependence and use disorder as soon as 24 hours after the last drink; anywhere from 3% to 5% of people going through withdrawal experience something called delirium tremens. Delirium tremens or DTs can be deadly if untreated. If you or a loved one is experiencing any symptoms of DTs, you should get emergency care right away.

According to the National Institute on Alcohol Abuse and Alcoholism, typical side effects of withdrawal delirium include:

  • Extreme agitation
  • Fever
  • Confusion
  • Seizures
  • Auditory hallucinations or auditory disturbances 
  • Visual hallucinations
  • Tactile hallucinations
  • High blood pressure

Risk factors for delirium tremens include: 

  • Being an adult man
  • Having a history of seizure
  • Prior withdrawal 

If you have these risk factors, outpatient treatment may not be appropriate for you. The Clinical Institute Withdrawal Assessment for Alcohol is a scale to assess the severity of symptoms and your clinical condition. The scale uses ten questions assessing specific symptoms, including seizures.

This scale can help determine the proper pharmacologic treatment for you, whether you have mild, moderate withdrawal symptoms or severe symptoms. The Clinical Institute Withdrawal Assessment for Alcohol is a guide for clinical management of your detox. 

 

Alcohol Withdrawal Seizures

In a report from 2015, around one-tenth of patients going through withdrawal had a seizure, considered among the worst severe withdrawal symptoms. Seizures related to withdrawal are known as grand mal seizures or tonic-clonic seizures. When you have a grand mal or tonic-clonic seizure, it affects your brain functions, including breathing, and you may lose consciousness.

Patients have to be carefully monitored for seizures, according to the American Society of Addiction Medicine. The seizure threshold is usually within one to two days after having the last drink. If a patient experiences a seizure, they are more likely to have delirium tremens then. The primary treatment for seizures in this situation is benzodiazepines.

 

Alcohol Detox Steps 

The alcohol detox medication protocol you follow will depend on individual factors and other medical conditions you may have. These factors include the severity of your alcohol addiction and how long your dependency has been happening, as well as your health and the symptoms you might be experiencing.

  • If you have psychiatric conditions that affect you, this is considered when planning the treatment of withdrawal. 
  • For some people with mild symptoms, the treatment of withdrawal can be at home, but only with approval from your doctor. You may need to visit your doctor each day during detox to ensure you stabilize if you’re going through withdrawal in outpatient settings. 
  • If you have mild symptoms, you may also experience them for a shorter duration than someone with a more severe AUD. 
  • Your doctor might also prescribe certain medicines you can use during this time.
  • If you have severe symptoms rather than mild symptoms, you may need inpatient care or hospitalization.
  • Go to an addiction treatment center that offers on-site detox; you will have a team of healthcare providers monitoring you around the clock and providing you with the needed doses of medication.

 

 

What is the Alcohol Detox Medication Protocol?

If you go to inpatient treatment to detox, there are medications that you can take to help alleviate discomfort, reduce symptoms, and improve your safety. You may also be able to take some of the medicines to treat alcoholism in an outpatient program. 

 

Clinical management of alcohol withdrawal can include:

Benzodiazepines

Benzodiazepines are sedatives. Benzodiazepine addiction treatment is for anxiety and panic disorders, as well as some types of seizures. Taking a benzodiazepine can reduce the risk of seizures. If you have a history of seizures, and especially a history of withdrawal seizures, it’s essential to let your care team know this. 

Specific doses of benzodiazepines that may be part of your treatment plan include diazepam, the generic name of Valium, and chlordiazepoxide, which is the generic name for Librium. Long-acting benzodiazepines are the most common first-line treatment for patients with dependence. Along with Valium and Librium, Serax and Tranxene are types of benzodiazepine therapy that you might receive during detox. 

 

Anticonvulsants 

Your treatment team might prescribe medicines for severe acute withdrawal syndrome, including anticonvulsants. Anticonvulsants to manage your withdrawal symptoms are:

  • Gabapentin
  • Valproic acid
  • Carbamazepine

The benefit of using anticonvulsants is they reduce the seizure risk like benzodiazepines, but they don’t have abuse potential. 

 

Additional Medication 

Beyond the drug therapy options above, which are primarily for severe symptoms, if you’re in a professional detox center receiving inpatient treatment, you can receive other medicines for specific symptoms you have. For example, if you’re experiencing nausea or vomiting, you can receive medication for that particular symptom. You might receive treatment to help you sleep or to stay calm if you have severe anxiety.

If you experience dehydration and get care in an inpatient setting, you can receive intravenous fluids as you need them during inpatient detox. Depending on the treatment setting, you might also receive other types of supportive care to help with the cessation of drinking. 

Since some medicines you might receive during inpatient detox aren’t specifically for detox and these drugs are adjunctive medication options. Some treatment centers will also offer various alternative medications to help improve your well-being during detoxification. 

 

Effective Treatment for Alcohol Dependence

Beyond treating the acute phase of detox, other medicines can help people with dependence. Examples of these medicines that help with the cessation of drinking include:

  • Antabuse: The generic name of this medication is disulfiram. Disulfiram is a maintenance medication, so if you take it and consume even a tiny amount, you’ll experience highly uncomfortable side effects. 
  • Vivitrol: The generic version of Vivitrol is called naltrexone. This medication is for treating opioid use disorders but also has FDA approval for dependence treatment. Naltrexone can reduce the urge to drink, and if you do drink, it can interrupt the desire to continue.
  • Campral: Also called acamprosate, Campral this medicine can bring back balance to the central nervous system. Campral does not, however, prevent symptoms.

 

Why Supervised Detox Is So Important

Since care providers can follow an alcohol detox medication protocol, it’s essential to seek medical supervision before attempting to detox.

  • The risk of delirium tremens is one reason to go through detox in an inpatient facility, but there are others. 
  • Symptoms can be severe or fatal. During supervised detox, a treatment team constantly monitors your vital signs. Your care team can help you through the process. 
  • Supportive care can help you stay comfortable and avoid the more severe adverse effects possible with withdrawal. 
  • If you don’t get the proper treatment after detox, it raises your chances of relapsing.
  • It can be challenging to anticipate symptom severity, which is why at a minimum, you should receive outpatient detoxification treatment before you attempt to stop drinking. 
  • Despite the medications available for patients with dependence, individualized treatment is always the top priority. One medication or treatment that works well for someone else might not work for you. 
  • The duration of treatment you require will vary, again, depending on your individual needs and any medical comorbidities you may have. 
  • If you receive the correct type of treatment for acute alcohol withdrawal syndrome, it can improve the likelihood of long-term abstinence. 

To learn more about detox options available to you, we encourage you to contact our team of addiction specialists. Our team at our specialized recovery center helps dependent patients go through withdrawal symptoms safely and comfortably and then move into inpatient treatment or, if appropriate, an outpatient program. 

The goal at Opus Health is to help you get to the point of long-term abstinence; call 855-953-1345 today and get advice from our team of medical professionals, therapists, and counselors to help provide treatment of alcoholism and improve your quality of life. 

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