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January 8, 2019

How to Treat Alcohol Withdrawal

Within the past century, medical and scientific perspectives regarding alcohol have undergone a major paradigm shirt. Once commonly believed to be a relatively harmless recreational beverage, the full extent of alcohol’s mentally and physically corrosive effects have become well-documented. Although alcohol remains an inordinately popular social magnet—available at restaurants, bars, nightclubs and a variety of other sports and entertainment venues—its popularity doesn’t change the fact that it is essentially a legal poison.

The socioeconomic burden of alcohol is extreme and its prevalence in American society virtually unmatched. Millions of people rely upon alcohol to escape from the nightmare of personal or professional burdens or self-medicate in response to physical disease or pain. Alcohol is as ubiquitous as drinking water on hundreds of college campuses, and its rampant availability and inexpensive price, when compared to many illicit drugs, contribute to its social acceptability. This reality is exacerbated by the fact that alcohol is supported by powerful lobbies and backed by an astronomically profitable advertising industry that highlights its universal appeal while strategically downplaying its dangers.

SOCIOECONOMIC BURDEN

According to the National Institute on Drug Abuse (NIDA), alcohol is the third leading cause of preventable death in the United States. The following statistics reveal the destructive impact of alcohol in terms of its socio-economic burden:

  • Approximately 90,000 people die from alcohol-related causes annually—62,000 men and 26,000 women. Based on recent empirical data and contemporary trends, this figure is projected to increase.
  • The 2015 National Survey on Drug Use and Health (NSDUH) reports that approximately 90 percent of people ages 18 or older reported drinking alcohol within their lifetime. Of that percentage, approximately 70 percent reported drinking within the past year, and 60 percent reported drinking within the past month.
  • Approximately 30 percent of people ages 18 or older reported engaging in binge drinking within the past month, and an additional 7 percent reported engaging in heavy alcohol use within the same time frame.
  • 15 million American adults over the age of 18 suffer from a clinically significant alcohol use disorder (AUD)— approximately 10 million men and 5 million women.
  • Less than 7 percent of those suffering from AUDs received treatment within the past year— a shockingly low percentage.
  • Approximately 625,000 adolescents ages 12-17 suffer from AUDs: 300,000 males and 325,000 females. Within this population, a mere 5 percent received treatment within the past year.
  • According to the Centers for Disease Control and Prevention (CDC), alcohol abuse costs the United States $250 billion annually—approximately three-quarters of that related to binge drinking. This staggering economic burden includes costs related to insurance premiums, motor vehicle crashes, the criminal justice system, medical expenses, and lost productivity in the workplace.
  • Greater than 10 percent of US children live with a parent suffering from an AUD—disrupting the family unit and setting the stage for future alcohol dependence and/or mental health disorders.

THE ROAD TO RECOVERY

Alcohol dependence is a serious, debilitating disease that negatively affects every aspect of an individual’s well-being. Mirroring the general pattern associated with other substance abuse disorders (SUDs), alcohol dependence usually begins with casual recreational use before spiraling out of control as the mind-altering effects of the drug sabotage healthy, autonomous functioning. According to the National Institute on Alcohol Abuse and Alcoholism (NIAAA), approximately 1.5 million people enter alcohol-related treatment programs annually or are admitted to a hospital as a result of alcohol dependence.

By the time an individual crosses the threshold from casual recreational drinking to full-blown alcohol dependence, withdrawal symptoms are inevitable any time there is a complete cessation in use or even mild reduction in quantity consumed. Alcohol withdrawal is a clinically significant syndrome that occurs as a result of the central nervous system (CNS) gradually adjusting to regular alcohol intake and compensating for its depressive effects, which impacts brain function as well as inter-neuronal communication. After these survival-based adjustments have been made, once alcohol use stops or the frequency or quantity are reduced, the CNS and brain remain in a volatile, hypervigilant state. This, in turn, triggers an onslaught of withdrawal symptoms.  

WITHDRAWAL SYMPTOMS, TIMELINE, AND TREATMENT

Mild alcohol withdrawal symptoms typically occur within 6 to 8 hours (and up to 24 hours in some cases) following the last drink but may linger for days or weeks. Symptoms generally peak within 24-48 hours before gradually diminishing. During this intense, unpredictable period, the most dangerous and potentially debilitating symptoms—including seizures and delirium—can occur. This nightmarish withdrawal phase is followed by a protracted withdrawal process known as post-acute withdrawal syndrome (PAWS). Although PAWS symptoms are frequently milder in intensity, and usually involve sleep or mood-related disorders, they may last for months, or even years, following the initial withdrawal period.      

The intensity of alcohol withdrawal symptoms is highly variable and directly influenced by the intensity and duration of alcohol dependence prior to quitting.  Common initial symptoms include:

  • Anxiety or general nervousness
  • Agitation and excitability
  • Difficulty focusing
  • Headache
  • Extreme fatigue
  • Depression
  • Sensitivity to light or sound
  • Disorientation
  • General irritability
  • Mood swings
  • Tremors
  • Vomiting
  • Gastrointestinal distress
  • Nightmares
  • Disorientation/ psychosis

The professional, medically managed treatment of alcohol withdrawal symptoms is an absolute necessity, and early intervention is critical to achieving optimal outcomes. The primary objectives of withdrawal treatment include:

  • Relieving physical pain and discomfort
  • Stabilizing emotional and psychological processes
  • Preventing serious, or potentially fatal, symptoms from occurring
  • Reducing cumulative effects—including the possibility of future withdrawal/relapse

Generally, those suffering from the symptoms of alcohol withdrawal should always seek an official medical diagnosis prior to enrolling in alcohol detox or other forms of professional treatment. Widely accepted clinical guidelines dictate safe withdrawal management, and, in mild cases, outpatient treatment may be sufficient to help stabilize a client. Standard treatment for mild alcohol withdrawal includes:

  • Comprehensive blood testing
  • Individual, group, and/or family therapy
  • The use of pharmacological interventions, including sedatives to help reduce the severity of symptoms
  • Psychological evaluation to determine contributing factors involved in alcohol dependence (clinical depression, generalized anxiety, the presence of personality disorders, post-traumatic stress disorder, etc.)

Moderate to severe cases of alcohol withdrawal may require hospitalization or admission into an inpatient facility specializing in alcohol withdrawal treatment. In such cases, a variety of clinical tools such as the Alcohol Withdrawal Scale are used to help quantify the severity of symptoms upon admission and guide later treatment methods. In addition to the same basic components featured in mild alcohol withdrawal treatment, the following components may be included:

  • 24/7 monitoring of blood pressure, heart rate, body temperature, and vital fluids-chemicals.
  • Administration of intravenous (IV) fluids as required
  • Ongoing treatment with pharmacological interventions such as benzodiazepines “benzos”

INPATIENT TREATMENT

Upon successful completion of medically managed detox, or following hospitalization, many clients choose to undergo treatment in a special residential facility. This highly popular, evidence-based option provides an excellent basis for stabilization and is widely considered the gold standard when treating moderate to severe cases of alcohol dependence and withdrawal. Most inpatient facilities provide live-in treatment for a period of one month or, in some cases, up to 90 days depending upon individual client needs. Reputable facilities feature industry-leading clinical care and offer an impressive variety of ancillary services and benefits. Beyond the core treatment regimen that includes medication-assisted treatment (MAT) combined with ongoing individual and group therapy, certain inpatient facilities include a comprehensive treatment protocol that features:

  • Dietary and lifestyle counseling
  • Yoga, creative and expressive therapies
  • Specialized modalities including cognitive-behavioral therapy (CBT), dialectical behavioral therapy (DBT), trauma-focused therapy (TFT), narrative therapy, motivational interviewing (MI), and family therapy.
  • Aftercare services and alumni networking
  • On-site amenities such as a gym, swimming pool, or close proximity to the ocean, mountains, or popular recreational areas
  • Inclusion of mindfulness, meditation, or other spiritual/holistic activities in addition to traditional Alcoholics Anonymous (AA) involvement.

Over 150 medications have undergone trials for the treatment of alcohol withdrawal; however, the following medications generally represent the nucleus:

  • Naltrexone
  • Acamprosate
  • Disulfiram
  • Beta-blockers
  • Anti-seizure
  • Anti-anxiety
  • Benzos

Based upon individual client needs, the presence of co-occurring substance abuse or mental health disorders, and overall progress in treatment, a broad spectrum of additional medications may be used. Although standard medications and dosage requirements inform most moderate to severe alcohol withdrawal treatment, ultimately, it is up to the discretion of a licensed doctor and highly trained clinical team to establish individual protocols and make final determinations. 

SELF-GUIDED TREATMENT

Self-guided treatment is considered extremely dangerous and should never be attempted—even in cases of mild alcohol withdrawal. Alcohol dependence is a chronic, relapsing disease that requires a structured, evidence-based treatment regimen in order to eventually overcome. Defiance of standard medical advice by resorting to at-home detox may result in fatal consequences in the worst case or a much higher probability of future relapse at best. Either way, it leads to suboptimal treatment outcomes.

A BRIGHTER FUTURE

If you or someone you love is suffering from alcohol dependence or withdrawal, contact a substance abuse professional today. Although the effects of alcohol withdrawal are challenging, and the presence of an AUD daunting, the burden of both can be eased by proper treatment.  Never be ashamed to admit that you need help, and always remember—early intervention provides the greatest probability of long-term success.

 For more about alcohol dependence and withdrawal, check out these related articles:

Sources:

  1. Industrial Psychiatry Journal. Clinical Management of Alcohol Withdrawal: A systematic review. July, 2013.
  2. U.S. Pharmacist. Treatment of Alcohol Withdrawal Syndrome. Nov, 2017.
  3. The American Journal of Emergency Medicine. The emergency management of severe alcohol withdrawal. July, 2017.
  4. Journal of Hospital Medicine. Multiple admissions for alcohol withdrawal. October, 2012.
  5. PLOS ONE. Evaluation of Un-Medicated, Self-Paced Alcohol Withdrawal. July, 2011.
  6. Neuropsychopharmacology. Neurotoxic consequences of Chronic Alcohol Withdrawal: Expression Profiling Reveals Importance of Gender Over Withdrawal Severity. June, 2007. 

 

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