Withdrawal from alcohol presents a unique problem: It’s potentially life-threatening. This is in contrast to withdrawal from opioids, cocaine and amphetamines, which is certainly miserable but rarely fatal. You must understand: Alcohol withdrawal can kill and must be managed by a medical professional. This doesn’t necessarily mean that alcohol detox is always an inpatient process. In fact, many cases can be safely monitored from home. The key is knowing the difference, and only a substance abuse or addiction medical professional is qualified to make this judgement. This article will discuss the following question: What is alcohol detox like and how does it work?
Alcohol is a toxic substance capable of damaging the brain and body. It affects some critical areas of the brain:
- The cerebral cortex responsible for reasoning and judgement
- The cerebellum that controls balance and coordination
- The hippocampus involved in memory and learning
- The amygdala that controls social behavior
From this list, we see why a drunk driver is so dangerous, why people make poor decisions while under the influence of alcohol and why heavy drinking can cause blackouts and memory loss.
Alcohol Withdrawal Symptoms
Alcohol withdrawal can cause a number of symptoms. Some of them, such as delirium tremens and grand mal seizures, can be fatal. It is never safe to do a cold-turkey alcohol withdrawal or to try to reduce or stop your drinking on your own once you’re addicted. Other alcohol withdrawal symptoms typically starting about 6 hours after the last intake of alcohol include:
- Tremors
- Anxiety
- Nausea and vomiting
- Sweating
- Insomnia
If allowed to progress, the syndrome may continue with:
- Hallucinations
- Seizures
- Delirium tremens or the DTs
- Confusion
Sweating may become profuse and be accompanied by heart arrhythmia, elevated heart rate, fever and high blood pressure.
Medications for Alcohol Withdrawal
Alcohol withdrawal causes dangerous reactions in the brain. That’s why it’s always treated with medication. This mostly consists of replacing the missing alcohol in the brain with a class of tranquilizer drugs called benzodiazepines. These drugs work in much the same way as alcohol does in the brain but without the toxicity and damage to the brain cells that alcohol can cause. Benzodiazepines used for alcohol withdrawal include:
- Diazepam
- Oxazepam
- Clorazepate
- Chlordiazepoxide
Benzodiazepines will both greatly reduce alcohol withdrawal symptoms and the risk of grand mal seizures. To reduce the seizure risk even further, your detox protocol may include the temporary use of certain anti-seizure medications:
- Carbamazepine
- Valproic acid
- Gabapentin
If benzodiazepine therapy fails to control symptoms sufficiently, certain barbiturates may be prescribed on a case-by-case basis. Other medications for alcohol withdrawal treatment and comfort include beta blockers and baclofen, a muscle relaxant with actions on certain brain receptors linked to alcohol use. You should definitely not feel any significant discomfort during your withdrawal. If you do, report this immediately to your physician or case manager. Your medications can always be adjusted.
Medicated alcohol withdrawal can last anywhere from 10 days to several weeks. It depends on the severity of the initial addiction. Each person is also different. The longer and more intense the alcohol use, the longer it will take to safely withdraw. Once your symptoms are under control, your medications will be slowly withdrawn until you’re taking no alcohol substitute medication at all. However, other medications to support your ongoing sobriety are available:
- Antabuse
- Naltrexone
- Acamprosate
Antabuse, an old standby drug used to prevent impulsive alcohol use, causes intense sickness to occur if someone drinks alcohol while taking it. It’s fallen out of favor recently as better alternatives have appeared.
Naltrexone is an opioid overdose rescue drug similar to naloxone or Narcan. It binds to opioid receptors in the brain and prevents any other drug molecules from docking there while the naltrexone is present. Although alcohol is not an opioid, naltrexone appears to curb alcohol cravings in many people who try it. It’s typically given as a long-acting depot injection once a month. Naltrexone is not addictive.
Acamprosate is thought to restore the brain’s balance of certain important chemicals related to alcohol abuse.
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