When you first thought about doing it, it seemed rather easy. But it surprised you with its ferocity and proved to be way more stubborn than you'd imagined it to be. I am, of course, talking about alcohol withdrawal. It is notoriously difficult to deal with, and the current treatment strategies use a combination of different approaches gleaned from many decades' worth of studies on this problem.
Symptoms to Look for
The symptoms of alcohol withdrawal can be mild, moderate or severe, depending upon an individual's drinking history. The most common symptoms include nausea, vomiting, headache, anxiety, sweating, tremors, irritability, hallucinations, etc. The symptoms may start as early as 6 hours after the last bout of drinking, or may take as long as 36 - 48 hours. They usually begin to fade after about 24 hours, but may take longer.
The severest symptoms of alcohol withdrawal, which are known by the term Delirium Tremens, are tremors, restlessness, hallucinations, agitation, disorientation and severe seizures. The autonomic nervous system goes into overdrive and there is an increase in blood pressure and heart rate along with an increase in pulse and respiratory rate. Delirium Tremens may prove to be fatal if untreated.
The treatment for alcohol withdrawal works on several levels and there isn't a one-size-fits-all plan for every individual trying to quit drinking. It depends on several factors such as:
- Nutritional status
- Concurrent medical conditions
- History of previous alcohol withdrawals
If a person has not experienced previous seizures related to alcohol withdrawals, has no major chronic illness or chronic disorder, is able to care for himself/herself, and has someone to watch over him/her, then such a person can be treated as an outpatient. In case of such a person, a lot depends on self-restraint or the ability of those who care for such a person, to put in place strict restrictions.
Hospitalization/Institutionalization is necessary, when even one of the conditions mentioned above in the criteria for outpatient treatment is not met. In addition, of course, for an emergency like Delirium Tremens, or if the individual is a pregnant woman, there is no option but to be treated as an inpatient.
The drugs in this class of sedatives are the medications of choice for treating mild or moderate symptoms of alcohol withdrawal, especially if the patient has seizures. Some of the Benzodiazepines used in AW are, Chlordiazepoxide, Lorazepam, Diazepam, Halazepam, Midazolam and Oxazepam. These drugs are valuable in controlling the anxiety, tremors and agitation associated with withdrawal.
If a person has impaired liver function, the short acting Benzodiazepines are preferred, like Diazepam and Lorazepam. In other cases, long acting Benzodiazepines like Chlordiazepoxide are preferred as there is less of a risk for abuse of these very effective sedatives.
However, these drugs are not without their adverse effects. They lose their effectiveness if used for long periods at constant doses. They produce withdrawal symptoms of their own upon discontinuation, produce drowsiness, interact with antihistamines and steroids, and can be lethal when combined with alcohol.
Beta Blockers and Alpha Blockers
Both classes of drugs are used to manage symptoms such as irregular cardiac rhythm (arrhythmia) and increased blood pressure. Clonidine is an Alpha-adrenergic blocker used in AW, while beta-blockers used are Atenolol and Propranolol. Cravings are also said to decrease with the use of beta-blockers.
These are used to manage seizures, the most complicated aspect of alcohol withdrawal. Carbamazepine as well as Valproic acid and its derivatives are often used to decrease the incidence and development of seizures in AW. Phenytoin, along with Benzodiazepines, is used in persons who have a history of seizures unrelated with alcohol consumption.
These drugs (e.g., Haloperidol) are sometimes used if the person being treated has severe hallucinations and is extremely agitated.
Fluids and Electrolytes
Alcoholics often suffer from dehydration. Alcohol is a diuretic and it causes increased frequency of urination. Along with water, the body also loses electrolytes. This can hamper normal functioning of the body because these electrolytes need to be maintained at a certain critical concentration for the cells to work. It is, therefore, extremely essential to replenish both water and electrolytes in alcoholics.
Alcohol interferes with the absorption of vitamins and so, vitamin deficiencies are common in persons who are hard drinkers and have been drinking for a long time. Thiamine (Vitamin B1) is the most common, closely followed by deficiencies of fat-soluble vitamins like A, D and E. Folic acid deficiency can also be found in many alcoholics.
Treatment of alcohol withdrawal is also complicated by the phenomenon of "kindling", which refers to the increased severity of seizures and other symptoms in alcoholics, who have relapsed and withdrawn many times before. Each time they withdraw, it leads to even more severe CNS symptoms due to increased neuroexcitability.
Thus, the history of a person's alcohol abuse is the most useful pointer toward how the treatment should be tailored according to his/her individual needs.
Disclaimer: This Buzzle article is for informative purposes only, and should not be used as a replacement for expert medical advice.