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Managing Alcohol
Withdrawal for Treatment Success
Alcohol withdrawal:
 The management of
alcohol withdrawal through detoxification is an incredibly important
initial intervention for a significant number of alcohol dependent
individuals. The objective of alcohol withdrawal is maintaining some
comfort as the alcoholic goes through the early stages of treatment,
the prevention of treatment complications, and preparing the
individual for alcohol rehabilitation. The successful management of
alcohol withdrawal is an important aspect of preparing an individual
for subsequent efforts at alcohol rehabilitation.
Medical screening
for concurrent medical problems is also an important aspect of
treatment at this stage of the attempted alcohol rehabilitation, in
addition to the management of alcohol withdrawal symptoms.
Frequently, doctors will administer thiamine (50-100 mg by mouth or I
M) and multivitamins, for a low cost, low risk intervention, for the
prophylaxis and treatment of alcohol related neurological
disturbances. In addition to good supportive care and the treatment
of concurrent illness, this stage will also include fluid and
electrolyte repletion.
Social
detoxification which involves the nonpharmacological treatment of
alcohol withdrawal has also been shown to be effective. This involves
frequent reassurance, reality orientation, personal attention,
monitoring of vital signs and general nursing care. Social
detoxification is most appropriate for individuals with mild to
moderate alcohol withdrawal symptoms. Many individuals have
significant medical problems associated with alcoholism which
substantially complicate therapy, so it is absolutely essential that
therapists refer those individuals whose conditions require medical
management.
Alcohol
detoxification is increasingly being done on an ambulatory basis,
which is much less costly than inpatient alcohol detox. Inpatient
detoxification is essential for serious medical or surgical illness
and for those individuals who have a past history of adverse alcohol
withdrawal reactions, or with current evidence of potentially some of
the more serious withdrawal reactions such as delirium tremens.
An assortment of
medications have been used for alcohol withdrawal. However, because
they have a relatively minor side effect profile compared to some
other medications, benzodiazepines have become the medications of
choice for this stage of treatment. The most frequently used
benzodiazepines include diazepam and chlordiazepoxide, although all
benzodiazepines have been found to suppress alcohol withdrawal
symptoms. These are frequently used because they are metabolized into
long acting compounds which in effect help to self-taper these
medicines from your system. Because these medications are metabolized
through the liver, impaired liver functioning may complicate their use
however. Oxazepam and Lorazepam are not oxidized into long-acting
metabolites and thus carry less risk of accumulation.
Although
Carbamazepine appears to be useful as a primary treatment for alcohol
withdrawal, it has frequently been found that the liver dysfunction
that alcoholics experience may affect its metabolism, making careful
blood level monitoring necessary. Antipsychotics are not usually used
in the treatment of withdrawal except in those instances where
hallucinations or severe agitation appear, at which times they should
be added to the benzodiazepine. In addition to their potential for
producing extrapyramidal side effects, antipsychotics also lower
seizure threshold, which may be very problematic during alcohol
withdrawal.
From DSM-IV-TR Mental
Disorders: Diagnosis, Etiology and Treatment by Michael B. First and
Allan Tasman
Additional
Information and webpage by
Paul Susic
MA
Licensed Psychologist Ph.D. Candidate
(Health and Geriatric Psychologist)
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