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Managing Alcohol Withdrawal In A Clinical Setting

Published on June 28, 2021
Clinical Management Of Alcohol Withdrawal

Symptoms of alcohol withdrawal syndrome can be hard to deal with on your own, especially for severe withdrawal symptoms. 

Management of acute alcohol withdrawal is likely more effective when done by professionals in a treatment facility, hospital, or other clinical settings.

Professional management of alcohol withdrawal focuses on reducing withdrawal symptoms. Doctors may use pharmacotherapy (approved medications) in fixed dosing schedules or treat symptoms as they occur.

The CIWA-AR System

The Clinical Institute for Withdrawal Assessment for Alcohol-Revised scale, or CIWA-AR, can give doctors an idea of how serious a patient’s withdrawal will be. 

The severity of the following symptoms can also be a sign of whether a patient will need substance use treatment or not:

  • nausea
  • vomiting
  • anxiety
  • altered perceptions
  • visual or auditory hallucinations
  • tremors
  • sweating
  • levels of disorientation

The effects of alcohol can reach the central nervous system, vital organs, and thought processes. The CIWA-AR can help doctors and clinicians find out your level of alcohol dependence and suggest appropriate addiction medicine treatments.

Methods For Managing Alcohol Withdrawal

Alcohol detoxification, or detox, is almost always the first step for alcohol dependence and withdrawal treatment. Detoxing cleanses alcohol from your system, which is necessary for any patient trying to quit alcohol. 

Withdrawal symptoms can occur within a matter of hours after your last drink.

Fixed Dosing Programs

Generally, patients with less severe alcohol withdrawal will be recommended a fixed dosing program, where they are given a consistent amount of medications per day. Acute alcohol withdrawal can last up to 2 weeks, so treatment programs are likely planned accordingly.

Patients who scored higher on the CIWA-AR, or patients with other serious medical conditions, may be put on a symptom-monitored loading dose plan, where they are treated as symptoms occur.

Benzodiazepines

Benzodiazepines can treat or reduce symptoms of severe alcohol withdrawal. They are often given to patients suffering from alcohol withdrawal seizures. Benzodiazepines can also treat one of the most serious forms of alcohol withdrawal, known as delirium tremens (DTs).

Delirium tremens, also known as alcohol withdrawal delirium, is one of the most life-threatening forms of alcohol withdrawal. It can lead to tachycardia (increased heart rate), hypertension (high blood pressure), excessive sweating, and seizures.

Benzodiazepines can reduce and even eliminate these harmful side effects, and are likely an effective treatment option for someone with a history of heavy alcohol consumption. 

Benzodiazepines that can be prescribed for alcohol withdrawal include:

  • chlordiazepoxide
  • lorazepam
  • diazepam
  • oxazepam

Anticonvulsants

Anticonvulsants can be given instead of benzodiazepines to stop or reduce seizures. Gabapentin is a commonly given anticonvulsant for this reason.

Compared to benzodiazepines, anticonvulsants have a lower substance abuse potential. However, benzodiazepines can be given to a wider range of patients, making anticonvulsants a less common treatment option.

Barbiturates

Barbiturates can be given as alternatives to benzodiazepines or anticonvulsants to treat delirium tremens. Barbiturates act on the same GABA neurotransmitters as alcohol, helping to restore normal brain activity.

Barbiturates can cause powerful sedation on their own, which can be harmful. To some professionals, the downsides outweigh the benefits, and barbiturates are not always used.

Vitamin Supplements

Vitamin supplements, especially ones rich in vitamin B1 (also known as thiamine), may be given during your treatment program. This is partly due to Wernicke-Korsakoff syndrome, a condition sometimes seen in patients suffering from alcohol withdrawal.

Wernicke-Koraskoff syndrome can lead to different forms of encephalopathy (brain damage) if untreated. 

Other Medications

Other medications that may be used to address alcohol withdrawal in a clinical setting include hypertension medications like clonidine and muscle relaxants like baclofen.

Psychotherapy

Alcohol withdrawal is likely one part of a larger alcohol use disorder. An alcohol use disorder is a mental health issue that can be treated with psychotherapy. Psychotherapy can help you learn coping skills and healthy habits to avoid alcohol abuse.

Treatment Of Alcohol Withdrawal

Alcohol withdrawal affects every patient differently. Withdrawal with only mild symptoms may only need treatment in an outpatient setting, or even no treatment at all. More severe symptoms likely need inpatient treatment.

While alcohol addiction treatment can be difficult and painful, many people emerge from their treatment pattern with greatly improved health and better coping skills. To find a treatment program for you or your loved one, talk to your healthcare professional or contact us today.

Written by Ark Behavioral Health Editorial Team
This page does not provide medical advice.
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