Treatment for alcohol withdrawal symptoms

Medically Reviewed by Dr Sravya, MBBS, MS

Introduction

When people abruptly stop drinking alcohol or significantly cut back on their chronic alcohol use, they experience alcohol withdrawal syndrome (AWS), a complicated physiological and psychological reaction. It is essential that the person going through withdrawal is properly treated medically to guarantee their safety and comfort because the subsequent withdrawal symptoms can range widely in intensity. The complexity of alcohol withdrawal symptoms will be further explored in this article, along with a variety of comprehensive treatment approaches, emphasizing the value of individualized attention and a multidisciplinary approach.

Table of Contents

Understanding the signs of alcohol withdrawal:

Alcohol has a significant effect on how the brain and nervous system function. Chronic alcohol use causes brain adaptations, and abrupt cessation upsets this delicate balance, causing withdrawal symptoms. Based on their severity, these symptoms can be divided into three categories:

1. Mild Symptoms
2. Moderate Symptoms
3. Severe Symptoms

1. Mild Symptoms:

Mild alcohol withdrawal symptoms include

Anxiety
Restlessness
Irritability
Tremors
Sweating
Mild gastrointestinal discomfort
Nausea and vomiting
Difficulty sleeping

These symptoms typically emerge within 6-12 hours after the last drink and can last for several days.

2. Moderate Symptoms:

Moderate symptoms involve more pronounced physiological and psychological manifestations.
These include:

Increased heart rate
Elevated blood pressure
Confusion
Agitation
Vivid hallucinations
Insomnia
Seizures may also occur during this phase

3. Severe Symptoms:

The most severe end of the spectrum includes

Delirium tremens (DTs), a potentially life-threatening condition characterized by profound confusion.
Severe agitation.
Visual
Auditory hallucinations
Seizures
Elevated body temperature
Excessive sweating
Tremors.

DTs demand urgent medical attention due to the risk of cardiovascular collapse and seizures.

Treatment Approaches:

1. Medical Supervision

Medical supervision is essential due to the potential unpredictability of alcohol withdrawal, especially for people who have a history of heavy and protracted alcohol use. Timely intervention is ensured by continuous monitoring of vital signs, mental state, and fluid balance.

2. Benzodiazepines

The cornerstone of pharmacological treatment for alcohol withdrawal is this group of drugs. They have sedative effects that reduce anxiety, lower the chance of seizures, and encourage sleep. Benzodiazepines like chlordiazepoxide, lorazepam, and diazepam are frequently used.

3. Antipsychotic Medications

Antipsychotic medications can be used to treat severe agitation and hallucinations in order to manage these symptoms and increase patient comfort.

4. Fluids and Nutrition

Dehydration and malnutrition can result from alcohol withdrawal. Balanced nutrition and adequate hydration aid the body’s natural healing processes and help to avoid complications.

5. Thiamine (Vitamin B1) Supplementation

Thiamine deficiency is a problem in long-term drinkers and can result in crippling neurological disorders. In order to avoid or lessen these potential problems, it is essential to administer thiamine supplements. Supplementing with thiamine is essential to avoiding diseases like Wernicke-Korsakoff syndrome.

6. Psychosocial Support

Beyond pharmaceutical interventions, group therapy, counseling, and psychological support are essential parts of alcohol withdrawal therapy. They aid in long-term recovery by addressing the behavioral and emotional aspects of alcoholism.

Counseling and therapy: It's crucial to address the psychological aspects of alcoholism. Sessions in individual and group therapy assist patients in understanding the underlying triggers and creating coping mechanisms.
Support Groups: Participating in support groups, like Alcoholics Anonymous, gives people access to a network of peers who are familiar with the difficulties of recovery.

7. Outpatient vs. Inpatient Care

The degree of withdrawal symptoms determines whether outpatient or inpatient care is best. Individuals who need intensive monitoring and support may benefit from inpatient care because they have severe symptoms, a history of complications, or a dangerous home environment.

8. Detoxification

Detoxification is the process of safely and effectively weaning a person from a psychoactive substance by gradually cutting back on the dependence-inducing substance or by switching it out for a cross-tolerant pharmacological agent and gradually cutting back on that as well. This method expedites the process of abstinence from the substance in a more humane way while minimizing withdrawal symptoms, avoiding complications, and speeding up the process.

9. Symptom-triggered treatment(STT)

Saitz et al. proposed the STT in 1994, in which chlordiazepoxide was administered when CIWA-Ar ratings were eight or higher. The STT needs to be closely monitored while a patient. Non-verbal patients (such as those in a stupor from a head injury) might not be a good fit for this regimen because they might not be able to communicate any withdrawal symptoms to the nursing staff. Because withdrawal seizures can happen even in patients who don’t exhibit overt autonomic arousal or other signs of alcohol withdrawal, this protocol is not safe for patients with a history of such seizures.When compared to a fixed dose regimen, STT shortens the detoxification process and reduces the amount of benzodiazepine that is necessary, which may be helpful for patients who have never experienced difficult withdrawals.

Behavioral Treatments

Behavioral treatments, also referred to as alcohol counseling, entail working with a health professional to identify and assist in changing the behaviors that lead to heavy drinking. Certain characteristics of behavioral therapies can include:

Types of Behavioral Treatments

1. Cognitive–Behavioral Therapy

Small groups or one-on-one sessions of cognitive behavioral therapy with a therapist are both options. The goals of this type of therapy are stress management and identifying the emotions and circumstances (referred to as “cues”) that trigger binge drinking. The objective is to alter the thought patterns that result in alcohol abuse and to build the coping mechanisms needed to deal with commonplace circumstances that could result in problem drinking.

2. Motivational Enhancement Therapy

For a brief period of time, motivational enhancement therapy is used to develop and reinforce the desire to stop drinking. The therapy focuses on identifying the pros and cons of seeking treatment, forming a plan for making changes in one’s drinking, building confidence, and developing the skills needed to stick to the plan.

3. Marital and Family Counseling

Marriage and family counseling involves partners and other family members in the therapeutic process and can be very helpful in mending and enhancing family bonds. In comparison to patients receiving individual counseling, studies show that strong family support through family therapy increases the likelihood of maintaining abstinence (stopping drinking).

4. Brief Interventions

Brief interventions are time-constrained, brief one-on-one or small-group counseling sessions. The therapist details the client’s drinking history and any associated risks. Following personalized feedback, the counselor will collaborate with the client to set goals and offer suggestions for how to effect change.

The decision to seek treatment may ultimately be more significant than the method employed, provided that the method avoids intense confrontation and includes empathy, motivational support, and a focus on altering drinking behavior.

Available FDA Approved Medications

Certain drugs have been proven to be an effective way to help people cut back on or stop drinking while preventing relapse.

Current Medications:

Three drugs for treating alcoholism have been approved by the U.S. Food and Drug Administration (FDA), and more are being tested to see if they work.

1. Naltrexone – Reduce Heavy Drinking
2. Acamprosate – Maintain abstinence
3. Disulfiram – Blocks breakdown of alcohol in the body.

While it is important to keep in mind that not everyone will respond to medications, for a certain group of people, they can be a crucial tool in the fight against alcoholism.

A wider selection of pharmaceutical treatments that could be customized for each patient is being developed by scientists. People may be able to try a variety of medications as more become accessible to determine which one they respond to the best.

Isn't using medication just adding another addiction to the list?

Although this is a common worry, the short answer is “no.” All drugs that have been approved to treat alcoholism are not addictive. Similar to how someone might take medications to manage their asthma or diabetes, these medications are intended to help manage a chronic disease.

A Future Perspective on Treatment:

As scientists look for fresh approaches to treating alcoholism, progress is being made. The National Institute on Alcohol Abuse and Alcoholism (NIAAA) is working to identify important cellular or molecular structures—called “targets”—that could result in the development of new medications by researching the underlying causes of AUD in the brain and body.

Personalized Medicine:

In a perfect world, medical professionals would be able to determine which AUD treatment will work best for each patient. Research is being done by the NIAAA and other organizations to find the genes and other elements that can predict a person’s response to a specific treatment. These developments might improve the way treatment choices are made in the future.

Current NIAAA Research: Setting the Stage for Future Discovery:

The following drugs, which are already authorized for other purposes, have demonstrated promise in the treatment of alcoholism and problem drinking:

Varenicline, an anti-smoking medication sold under the brand name chantix, significantly decreased alcohol consumption and cravings in AUD patients.
It has been demonstrated that the drug gabapentin, which is used to treat epilepsy and pain conditions, increases abstinence and decreases heavy drinking. Additionally, those taking the medication reported reduced alcohol cravings as well as enhanced mood and sleep.
Topiramate, an anti-epileptic drug, has been shown to reduce problem drinking, especially in people with a particular genetic profile that may be related to the treatment's efficiency.

Conclusion:

A comprehensive and unique strategy is required for managing alcohol withdrawal symptoms effectively. Healthcare professionals can help people navigate the difficulties of alcohol withdrawal by combining medical knowledge, pharmacological interventions, psychological support, and lifestyle changes. It’s not just about easing the immediate symptoms; it’s also about addressing the underlying causes of alcohol dependence and opening the door for long-term recovery. Remember that getting professional medical help is a crucial first step towards having a safer and more successful sobriety journey if you or someone you know is struggling with alcohol withdrawal symptoms.