Achieving sobriety is the first step on the road to recovery from alcoholism. Typically, you achieve that sobriety in a structured detoxification program in which medical professionals design a plan that helps you transition from intoxication to sobriety in a safe and controlled manner.
In some cases, you will need medications to make that transition safely and smoothly. Alcohol can be remarkably persistent and very damaging, and when you suddenly stop drinking, you may experience the power of alcohol all at once. Medications can blunt that power so you will be ready for the next stage in your recovery.
There are different medications doctors can use to treat alcohol withdrawal. Here’s what you need to know about the process and the medications your doctor might try.
Alcohol is a sedative, and it works, in part, by blocking the production and/or uptake of chemical signals between cells in the brain. When alcohol is active within the body, brain cells are suppressed and sedated, and that allows for the blunted, fuzzy feelings alcohol can engender.
When alcohol is removed from the body, those brain cells begin to awaken. According to a seminal article about alcohol withdrawal, published in the journal Alcohol Health and Research World, symptoms of alcohol withdrawal typically appear six hours to 48 hours after heavy drinking stops. Those symptoms can include:
This list of symptoms might be familiar to anyone who has experienced a night of heavy drinking followed by a so-called hangover. When the brain recovers from continuous sedation, these symptoms can take hold. In a day or so, they tend to fade away.
People with a long-standing habit of regular drinking have a slightly different experience. Their brain cells are accustomed to the almost-constant presence of alcohol, and those cells have become optimized to work best when alcohol is present. When there is no alcohol left to metabolize, those cells move into a disorganized pattern of activity, and that can lead to very serious symptoms.
Delirium tremens, also known as DTs, is the formal name given to unusual brain activity caused by alcohol withdrawal. About 5 percent of people who go through alcohol withdrawal will develop delirium tremens. Symptoms begin 48 hours to 96 hours after the last drink, and they include hallucinations, disorientation, agitation, and seizures.
This is a life-threatening condition. Seizures can raise body temperatures, leading to organ damage and/or organ failure. The rapid heart rate that accompanies the terrible visions people see during delirium tremens can damage the heart and lead to cardiac arrest. People in the midst of an episode like this can also harm themselves and others while they are in the midst of a hallucination.
Since alcohol withdrawal can cause a life-threatening condition, doctors use medications to help people easing out of intoxication. Those medications are meant to help the brain taper from one state to the other while avoiding a sudden shift that can spark delirium tremens. The medications can also ease the discomfort of withdrawal, which could entice people to stay in treatment rather than relapsing to alcohol abuse to make the pain stop.
There are many different medications doctors can use to treat alcohol withdrawal, but benzodiazepines are preferred. They seem to offer the best control over symptoms, including those severe symptoms that could cause a loss of life.
In a comparative study published by Cochrane, researchers found that benzodiazepine therapy was superior to other modes of therapy in controlling seizures, and the risk of harm was low. This seems to suggest that this class of drugs does a good job of helping people to recover from the damage alcohol can cause without causing side effects that are worse than alcoholism.
There are many different types of benzodiazepines doctors can use, and each drug is a little different. Some have a quick mode of action, meaning that people can feel the impact of the drug almost as soon as they take it. Others have a long-lasting effect so that there are smooth transitions between one dose and another. Drugs that have both of these characteristics are preferred, as they offer the quickest relief and the most control.
In an article published in CNS Drugs, a researcher reports that the benzodiazepine diazepam (known by the brand name Valium) is the preferred drug to use because it works quickly and lasts for a long time. This researcher reports that the use of Valium allows people to have a smoother transition from intoxication to sobriety, and its long-lasting attributes allow for control without breakthrough episodes of discomfort.
Researchers writing in Medscape suggest that Valium can be given for alcohol withdrawal at a dose of 10 mg every six to eight hours during the first 24 hours, and then the dose can be reduced to 5 mg every six hours to eight hours as needed. Some people may need larger or smaller doses of the drug to achieve comfort, but these basic guidelines help doctors know where to start with dosing.
While benzodiazepines offer good control of symptoms of alcohol withdrawal, they are not right for all people. Benzodiazepines are known to work in the pleasure centers of the brain, bringing about euphoria. Some people grow attracted to that sense, and they begin to abuse the drug. Some doctors worry about giving a drug with the potential to cause an addiction to people in the first stages of addiction recovery.
Doctors writing for American Family Physician suggest that anticonvulsant medications such as Tegretol and Depakene can be helpful to control some of the symptoms that come with alcohol withdrawal.
But they have been associated with unpleasant side effects, including vomiting and dizziness. Also, these medications do not prevent seizures, so those at risk of developing delirium tremens may need to take benzodiazepines to stay fully safe.
Other therapies, including clonidine and beta blockers, also do not prevent seizures, but they can help with the other symptoms of alcohol withdrawal.
Since alcohol withdrawal does come with serious risks, it is best to go through the process while a professional is nearby to offer help. As an article published by U.S. Pharmacist explains, people in a structured detox program are monitored and assessed multiple times per day, and their medications may be changed accordingly. Those who develop seizures a day or two into the program, for example, might get a new benzodiazepine prescription while those who show improvement might be able to taper their dose.
In general, an inpatient program is recommended, but some people are adamantly opposed to entering a program like this. They may have obligations at home that they don’t feel comfortable leaving behind, or they may have a fear of institutionalization because of their alcoholism.
People who won’t enter a program can go through the process at home, but they will need the help of a doctor to go through it safely. They may have daily appointments to keep so that the doctor can offer ongoing monitoring, and they may be asked to check into a hospital or urgent care center if symptoms intensify.
A person who is going through at-home alcohol detoxification will also need someone to offer support and care at home around the clock. Withdrawal can come with confusion, meaning that symptoms can grow worse without the person noticing. A helper can offer that monitoring, and that person can get additional help when it is required.
That helper may also be able to administer medications to ensure that no abuse is taking place. That could be a vital part of ensuring recovery.
It’s important to note that there are no over-the-counter medications that can help to reduce your seizure risk. If you are hoping to go through withdrawal at home, you will still require a medical doctor who can provide prescription medications you’ll need to stay safe.
Anyone who drinks heavily for a long time could develop troubling symptoms of alcohol withdrawal. But as an article in The Hospitalistexplains, the only real risk factor experts can point to involves prior history. If you’ve developed symptoms of withdrawal the last time you tried to quit, you are likely to develop them again.
It is not uncommon for symptoms to trap people in a cycle of withdrawal. If you feel sick and terrified each time you try to quit, and you know that taking a sip of alcohol makes those symptoms go away, you might be very likely to run to the bottle each time you attempt sobriety and feel ill. In addition, you might grow so scared of feeling ill that you may never allow yourself to be completely sober.
This is a terrible way to live, and while you might feel like it’s inevitable, it’s not. Medications can help you to feel comfortable while your body adjusts to a lack of drugs, and monitoring can help you ensure that the process moves smoothly without adverse side effects taking hold.
(1998). Treatment of Alcohol Withdrawal. Alcohol Health and Research World. Retrieved December 2018 from https://pubs.niaaa.nih.gov/publications/arh22-1/38-43.pdf
(September 2017). Management of Moderate and Severe Alcohol Withdrawal Syndromes. UpToDate. Retrieved December 2018 from https://www.uptodate.com/contents/management-of-moderate-and-severe-alcohol-withdrawal-syndromes
(June 2011). Safety and Effectiveness of Medications for the Treatment of Alcohol Withdrawal Syndrome. Cochrane. Retrieved December 2018 from https://www.cochrane.org/CD008537/ADDICTN_safety-and-effectiveness-of-medications-for-the-treatment-of-alcohol-withdrawal-syndrome
(January 2017). Diazepam in the Treatment of Moderate to Severe Alcohol Withdrawal. CNS Drugs. Retrieved December 2018 from https://emcrit.org/wp-content/uploads/2009/09/Diazepam-in-the-Treatment-of-Moderate-to-Severe-Alcohol-Withdrawal.pdf
Diazepam (Rx). Medscape. Retrieved December 2018 from https://reference.medscape.com/drug/valium-diastat-diazepam-342902
(November 2013). Outpatient Management of Alcohol Withdrawal Syndrome. American Family Physician. Retrieved December 2018 from https://www.aafp.org/afp/2013/1101/p589.html
(2014). Treatment of Alcohol Withdrawal Syndrome. U.S. Pharmacist. Retrieved December 2018 from https://www.medscape.com/viewarticle/835689_5
(February 2007). Dealing with the DTs. The Hospitalist. Retrieved December 2018 from https://www.the-hospitalist.org/hospitalist/article/123281/dealing-dts