What Is Alcohol Detox?
Alcohol is widely and safely enjoyed by many people and is at the heart of social gatherings in many parts of the world. However, for some people, it can become a seriously dangerous drug which takes over their life and leads to broken relationships, damaged health, lost employment, serious financial difficulty, problems with the law and, in some cases, even homelessness.
Alcohol is a behaviour changing drug. It allows people to feel relaxed and happy. Inhibitions are reduced and life worries can be temporarily put aside by a person who is under the influence of alcohol. This is regarded as a positive effect in most cases but it comes with potential problems. Particularly at weekends, Emergency Departments of hospitals are full of people who have been involved in incidents related to excessive drinking. Fights, falls and alcohol poisoning are some of the reasons for this. The issue is that alcohol is a good social lubricant but only up to a certain level. Beyond that level, problems begin to arise.
There are few people, in cultures where drinking alcohol is an accepted social activity, who have not, sometimes, accidentally (or deliberately) crossed the line between social drinking and harmful drinking. It is very easy to go from laughing and joking to being drunk and incapable. Different people react differently to excessive alcohol. Some talk louder and laugh a lot, some become aggressive and begin looking for a fight, others are more likely to end up in a sexual encounter that they wouldn't choose while sober and some just fall asleep. However, even these people drink as a part-time activity and lead normal relatively healthy lives in between sessions.
Unfortunately, some people, for various reasons, drink increasingly larger amounts and become physically and psychologically dependent on alcohol. It may be that alcohol is used to self-medicate for physical or emotional pain. Blotting out traumatic life events is achieved in the short-term by drinking and drinking can become a habit to such an extent that a person's body comes to depend on the presence of alcohol. This is physical dependence or addiction. The tolerance to alcohol will rise, meaning that the drinker will need more and more alcohol to have the desired effect. Some of these people can end up drinking up to two bottles of spirits a day, or even more.
In these cases, to stop drinking is a problem. The physical withdrawal symptoms of alcohol can be dangerous, even fatal. Many people continue drinking excessively in order to avoid these serious symptoms, even when they no longer get pleasure from alcohol.
It is possible to slowly cut down on the level of alcohol consumed over time, but it is very difficult. Most people who try to reduce their drinking like this find the consumption increasing again no matter how good their initial intentions were.
The answer is to undergo an alcohol detoxification using benzodiazepines, a group of drugs which are also used for short periods of time to alleviate anxiety and other conditions. They have a calming effect and will completely eliminate alcohol withdrawal symptoms, if given at the correct dosage. The drugs normally used are Chlordiazepoxide (also called Librium) and Diazepam (also called Valium). These drugs are, themselves, highly addictive and they are not recommended for longer term use. However, they are safe and effective for short term use (no longer than 2 to 4 weeks).
Before an alcohol detox is carried out, it is essential that a full and detailed assessment is carried out. In some cases, more intensive supervision will be required if the patient has a history of seizures, has other medical issues like heart problems or high blood pressure, serious liver damage, kidney disease, breathing problems, is already dependent on benzodiazpines, or has a history of not complying with treatment.
I have come across many cases where patients have asked their General Practitioner (family doctor) for help to withdraw from alcohol and been given 5mg of Chlordiazepoxide three times a day with no supervision. For most people who are dependent on alcohol, this is an insufficient dosage and they are likely to suffer alcohol withdrawal symptoms and revert to drinking again to deal with these. Often, their doctor sees this as a lack of motivation to stop drinking. It is actually sensible and safe to drink to alleviate withdrawal symptoms until the correct medical help is available but it is not advisable to drink while taking benzodiazepines so this situation is completely unacceptable and dangerous.
Although individual circumstances need to be taken into account, a standard regime for alcohol withdrawal is 20mg of Chlordiazepoxide 4 times a day reducing gradually over 7 days to zero. The equivalent for Diazepam is 10mg 4 times a day, again, reducing to zero over a week. In some cases, particularly when liver damage is severe, Lorazepam or Oxazepam may be used for alcohol detox.
These are high doses which will have a sedative effect on the patient and will mean that he/she should not drive or operate machinery while on the medication. A week off work is required and rest encouraged.
In most cases, the above dosages will eliminate all alcohol withdrawal symptoms, making detox safe and comfortable.
Over the first 48-72 hours, the risk of alcohol withdrawal is highest. During this period, it is essential that the patient is closely observed and that blood pressure and pulse are monitored.
Sometimes, an anticonvulsant, such as Carbamazepine may also be prescribed, particularly if the patient has a history of seizures.
People who have been drinking excessive amounts of alcohol are likely to be deficient in various nutrients and vitamin pills are prescribed to address this issue. A deficiency in Thiamine is one factor associated with alcohol-induced brain damage. Wernicke–Korsakoff syndrome is a form of alcohol-related dementia and a course of Thiamine tablets reduces the risk of this condition.
Another drug which may be used is an antiemetic (to stop nausea in the early stages of detox which can occasionally occur). An example of this is Metaclopramide. This is given on an 'if required' basis and is normally not needed after the first two days of detox.
Alcohol detox gives a person a good 7 day start to begin their new life without drinking. It does not, unfortunately, give lifelong protection against relapse. There will be times when a person, who has been physically dependent on alcohol, will crave a drink and sheer willpower will be required to avoid taking one but it is a lot easier than it was before alcohol detox because there are no physical withdrawal symptoms. There is a drug called Acamprosate which helps with cravings. It is recommended that this drug is only provided along with counselling.
Whichever approach a person takes to moving forward with their life without alcohol, the first stage must be an alcohol detox if that person is physically dependent on alcohol. Any other way is dangerous and potentially fatal.
Paul Turner (RMN, MSocSc)
Alcohol Home Treatment