People who struggle with alcohol addiction often need to detoxify as they enter the recovery process. The goal of the detoxification process is to rid toxins from the body of an individual who is acutely intoxicated and/or dependent on alcohol – and to do so in a way that minimizes physical harm.
When a person decides to stop drinking, she/he can experience withdrawal symptoms that are sometimes quite severe. These symptoms can generally begin six to 24 hours after the patient takes his last drink, and acute withdrawal may begin when the patient still has significant blood alcohol concentrations.
The signs and symptoms of alcohol withdrawal vary but may include:
- The signs and symptoms of alcohol withdrawal vary but may include:
- Restlessness, irritability, anxiety, and/or agitation
- Anorexia, nausea, and/or vomiting
- Tremor, elevated heart rate, and/or increased blood pressure
- Insomnia, intense dreaming, and/or nightmares
- Poor concentration and/or impaired memory and judgment
- Increased sensitivity to sound, light, and/or touch
- Hallucinations that can be auditory, visual, and/or tactile
- Delusions, usually of paranoid or persecutory varieties
- Grand mal seizures and/or DTs, delirium tremens (severe delirium with trembling)
Fluctuations in body temperature, pulse, and blood pressure are also potential outcomes of severe alcohol dependence, which can lead to death or disability.
Because of the potential for immediate health risks, many individuals need to detoxify in a medical setting, with physicians and skilled nurses available to ensure that alcohol withdrawal occurs safely. The medical detoxification process includes evaluation, stabilization, and ideally, helping a person prepare to enter long-term treatment. The latter can help determine how successful the detoxification process is. If an individual can enter and stay in rehabilitation and also remain compliant with what is required, then the process is considered successful.
Only a minority of patients with alcoholism will go into significant alcohol withdrawal requiring medication or intensive medical management.
Three categories of patients that require immediate medication treatment are:
- those who have a history of the most extreme forms of alcohol withdrawal (including seizures and delirium)
- patients who are going through the process and demonstrating moderate symptoms
- those who are still intoxicated and have only been abstinent for a few hours.
For individuals in the latter group, a physician would take a number of factors into consideration, including direct observation over several hours, before determining whether or not to administer medication.
Benzodiazepines are the most widely used medications to treat alcohol withdrawal. When administered at the onset of symptoms, this class of medications can prevent further withdrawal reactions from proceeding to serious consequences. However, Benzodiazepines can have limitations when used in outpatient treatment. For patients with a history of DTs or seizures, early Benzodiazepine treatment is indicated when they embark on recovery for the first time. Patients with severe withdrawal symptoms, multiple past detoxifications, and co-occurring unstable medical and psychiatric conditions can also benefit from Benzodiazepines.
Three other medications have been FDA–approved for treating alcohol dependence: Naltrexone, which blocks opioid receptors involved in the rewarding effects of drinking and the craving for alcohol; Acamprosate, which can reduce the symptoms of protracted withdrawal, especially in patients with severe dependence; and Disulfiram, a medication that interferes with alcohol’s degradation and leads to unpleasant reactions such as flushing, nausea, and palpitations if the patient drinks while taking it.
There is a social model of detoxification in which individuals rely on a supportive non-hospital environment rather than on medication to detoxify. These programs are short-term, non-medical treatment services that offer room, board, and interpersonal support to intoxicated individuals and individuals in withdrawal. However, scientific studies or evidence-based methods have not yet provided clear evidence for the successful management of alcohol withdrawal without medication. And, since the course of alcohol withdrawal is unpredictable, it is impossible to tell who will or will not experience life-threatening complications.
The Theory Into Practice, or TIP, database provides several guidelines for social detoxification programs. For instance, such programs should follow local governmental regulations regarding licensing and inspection. Furthermore, primary care practitioners who have some substance abuse treatment experience should first assess individuals entering social detoxification programs. Finally, particular attention should be paid to individuals who have undergone multiple withdrawals in the past and for whom each withdrawal appears to be worse than previous experiences. Patients with a history of moderate or severe withdrawals are not good candidates for social detoxification.
It is important to recognize that as individuals make the courageous leap to free themselves from alcohol addiction, physical detoxification is only the primary step in an ongoing process of recovery. For continued success, it is critical for people to address the underlying issues, which contribute to the behavioral pattern of alcohol addiction. Physical pain, unresolved emotions and traumatic experiences can all be contributing factors that require healing and attention. It is also crucial to recognize the tremendous importance of developing detailed relapse prevention plans to successfully respond to challenging situations in the future. Individuals must have access to resources that best suit their needs. Patient safety is of the utmost importance, as is a supportive social network that includes family and friends.