Detoxing from alcohol is the first step in the rehab process for a person looking to recover from alcohol use disorder (AUD). When excessive or chronic alcohol consumption leads to tolerance, physical dependence, or addiction, the individual could develop withdrawal symptoms upon cessation from the substance.
Those who are heavily dependent on alcohol could experience severe withdrawal symptoms that could be fatal. For those people, doctors might prescribe medications to alleviate the discomfort and minimize the chances of further withdrawal complications.
Acute Alcohol Withdrawal Symptoms
Those who go through the withdrawal process after long-term alcohol abuse under medical professionals’ care are less likely to develop severe symptoms. The symptoms of acute alcohol withdrawal could be mild or dangerous. Mild symptoms could occur in as little as eight hours after your last drink.
Depending on the severity of your physical dependence, additional symptoms may occur beyond 24 hours. At the two to four-day point, they could get severe without intervention. The most common symptoms of alcohol withdrawal include:
- Mood swings
- Hand tremor
- Nausea or vomiting
- High blood pressure
- Increased heart rate
- Delirium tremens (DTs)
Alcohol Withdrawal Syndrome Treatment
Those who fail to treat their alcohol addiction will experience uncomfortable or potentially fatal alcohol withdrawal symptoms. Despite its legality, alcohol withdrawal is among the most dangerous of any drug on the planet. Thus, it’s crucial for someone tasked with alcohol withdrawal to attend medical detox and effectively manage their symptoms to decrease the risks. Not only will you avoid severe symptoms, but it can help prolonged abstinence in the long-term.
One part of this process is to provide medication at the onset of symptoms until they subside. All of this must be done under careful medical supervision. Although more than 150 drugs have been explored to treat alcohol withdrawal, there is still disagreement among professionals about the best pharmacological approach for withdrawal management.
Delirium Tremens (DTs)
In certain situations of alcohol dependence or addiction and severe withdrawal, the individual could experience a neurological syndrome known as delirium tremens, which is characterized as significant changes in mental status and autonomic nervous system excitation. Although it’s considered rare, DTs are the most commonly experienced in a person who’s abused alcohol for ten years or more, drank daily, or binged for months on end.
The symptoms of delirium tremens include:
- Severe confusion and disorientation
If you or someone you love is experiencing alcohol withdrawal symptoms, you must seek immediate medical attention. This must be treated as an emergency, and if delirium tremens goes untreated, it could be fatal.
Medications Used for Alcoholism and Alcohol Withdrawals
In severe cases of alcohol withdrawal, detox professionals might administer medications to ease symptoms. Although some withdrawals will not appear to require pharmacological intervention, not using medicine could cause adverse consequences for future withdrawal episodes. Failing to manage withdrawal symptoms with medicine adequately could result in a phenomenon known as “kindling.” This will put a person at a greater risk of seizures later on if they go through withdrawals again.
Alcohol Withdrawal and Benzodiazepines
Although benzodiazepines were initially formulated to treat anxiety, panic disorders, and certain types of seizures, they are also used for alcohol withdrawal. Benzodiazepines fall under a class of sedative medications, and the drugs are a doctor’s choice to manage the more problematic alcohol withdrawal symptoms. Benzos are useful in preventing the risk of seizures in a person dealing with alcohol withdrawal symptoms.
The most commonly prescribed benzodiazepines for alcohol withdrawal include diazepam (Valium) and chlordiazepoxide (Librium). Longer-acting benzos with active metabolites are common medications because use results in a lower chance of seizures or recurrent withdrawals. Shorter-acting benzos may also play a role in withdrawal management for those with chronic liver issues or the elderly.
The following are the only FDA-approved benzodiazepines used to treat acute alcohol withdrawal syndrome, and they include:
- Oxazepam (Serax)
- Clorazepate (Tranxene)
- Chlordiazepoxide (Librium)
- Diazepam (Valium)
In other cases, physicians might rely on other medications to manage acute withdrawal symptoms during alcohol withdrawal. Benzodiazepines may not be feasible in some cases, and alternatives are necessary. Other drugs used to help address alcohol withdrawal include:
- Gabapentin (Neurontin)
- Oxcarbazepine (Trileptal)
- Carbamazepine (Tegretol)
- Valproic Acid (Depakene)
The medications considered by medical professionals will vary from one person to another, and seizure medications could be used as a replacement for benzodiazepines or be used alongside benzos. One positive aspect of anticonvulsants is that they cannot be abused, unlike benzodiazepines. However, the medications don’t typically prevent grand-mal seizures or delirium tremens.
Alcohol Withdrawal and Barbiturates
Another class of drugs known as barbiturates can be used to treat alcohol withdrawal symptoms. These are typically used as a last-case scenario due to their potential for addiction. They’re most often used by the emergency department and in the intensive care unit (ICU) for severe cases of alcohol withdrawal. However, barbiturates and alcohol withdrawal is a topic that requires additional studying.
FDA-Approved Medications for Alcoholism and Dependence
For those looking to stop drinking, other medications will be used to help with recovery. The most common medications include:
Disulfiram is a useful medication to stop someone from drinking alcohol. It can lead to unpleasant effects when a person has a small amount of the substance. When used as prescribed, effects can be felt as soon as ten minutes after consuming an alcoholic beverage. They include headaches, anxiety, flushing of the face, blurry vision, nausea, and vomiting.
The side effects can be severe and should discourage a person from drinking. It should lead to them associating drinking with these adverse symptoms, which could last for one hour or more.
Naltrexone (Vivitrol, Revia)
Naltrexone was initially developed and approved in 1994 for alcohol dependence but is widely used for opioid use disorders. Although how it decreases drinking behaviors isn’t understood, those who have used the medication reported it removed their urge and desire to drink, helping them to stay abstinent.
Naltrexone has the potential to cause liver damage in higher doses and should never be used on individuals with liver disease or hepatitis.
Acamprosate is used in conjunction with social support and counseling. It’s believed to restore a balance in the central nervous system (CNS) between gamma-aminobutyric acid (GABA), glutamate, excitatory and inhibitory neurotransmitters. The medication does not prevent alcohol withdrawal symptoms and isn’t useful for those who haven’t stopped drinking or abusing other substances.
Compared to other FDA-approved treatments for alcohol dependence, acamprosate does not adversely interact with the liver and can be used in those with hepatitis or liver disease.