Alcohol Withdrawal

Alcohol withdrawal syndrome is a potentially life-threatening condition that can occur in people who have been drinking heavily for weeks, months, or years and then either stop or significantly reduce their alcohol consumption.

Alcohol withdrawal symptoms can begin as early as two hours after the last drink, persist for weeks, and range from mild anxiety and shakiness to severe complications, such as seizures and delirium tremens (also called DTs). The death rate from DTs — which are characterized by confusion, rapid heartbeat, and fever — is estimated to range from 1% to 5%.

If you have mild to moderate withdrawal symptoms, your doctor may prefer to treat you in an outpatient setting, especially if you have supportive family and friends. Outpatient detoxification is safe, effective, and less costly than inpatient detoxification at a hospital or other facility.

However, you may require inpatient treatment if you don’t have a reliable social network, are pregnant, or have a history of any of the following:

Severe withdrawal symptoms
Withdrawal seizures or DTs
Multiple previous detoxifications
Certain medical or psychiatric illnesses
The goals of treatment are threefold: reducing immediate withdrawal symptoms, preventing complications, and beginning long-term therapy to promote alcohol abstinence.

Prescription drugs of choice include benzodiazepines, such asdiazepam (Valium), chlordiazepoxide (Librium), lorazepam (Ativan), andoxazepam (Serax). Such medications can help control the shakiness, anxiety, and confusion associated with alcohol withdrawal and reduce the risk of withdrawal seizures and DTs. In patients with mild to moderate symptoms, the anticonvulsant drug carbamazepine(Tegretol) may be an effective alternative to benzodiazepines, because it is not sedating and has low potential for abuse.

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To help manage withdrawal complications, your doctor may consider adding other drugs to a benzodiazepine regimen. These may include:

  • An antipsychotic drug, which can help relieve agitation and hallucinations
  • A beta-blocker, which may help curb a fast heart rate and elevatedblood pressure related to withdrawal and reduce the strain of alcohol withdrawal in people with coronary artery disease
  • Clonidine (Catapres), another blood pressure drug
  • Phenytoin (Dilantin), an anticonvulsant which doesn’t treat withdrawal seizures but may be useful in people with an underlying seizure disorder

If you have severe vomiting, seizures or delirium tremens, the safest place for you to be treated is in a hospital. For delirium tremens, treatment in an intensive care unit (ICU) is often required. In an ICU, your heart rate, blood pressure, and breathing can be monitored closely in case emergency life-support (such as artificial breathing by a machine) is needed.

Medicines called benzodiazepines can lessen alcohol withdrawal symptoms. Commonly used medicines in this group include chlordiazepoxide (Librium) and lorazepam (Ativan).

Most alcohol abusers who are having withdrawal symptoms have a shortage of several vitamins and minerals and can benefit from nutritional supplements. In particular, alcohol abuse can create a shortage of folate,thiamine, magnesium, zinc and phosphate. It also can cause low blood sugar.