Understanding Medications for Alcohol Withdrawal: A Comprehensive Overview

Guide to Alcohol Withdrawal Medications

Unlock the Science Behind Alcohol Withdrawal: SMarmore Castle Clinic’s In-depth Analysis.

Alcohol Dependence and Detox

For anyone expecting to begin an alcohol detox, the prospect can be intimidating and it helps to understand the whole process of recovery and the role that medication can play.

Medication can often be part of the rehabilitation programme but should not be seen as a substitute for therapy. People affected by addiction may find the idea of medication attractive as a way of getting better, but lasting recovery comes through personal change and psychological adjustments to attitudes and beliefs. Medication can help, especially in the relief of pain and other physical symptoms but there is likely to be work to be done on ourselves as well.

Treatment for withdrawal from alcohol dependence has evolved over time from basic supportive care to a more comprehensive and medically managed approach. In the past, alcohol detox treatment was often managed without specific addiction medicine, and the focus was primarily on support and ensuring adequate nutrition and hydration.

Alcohol Withdrawal Syndrome

Historically, the recognition of alcoholism as a medical condition, especially for those with a chronic history of alcohol dependency, at first led to a search for pharmacological treatment that would mitigate detox and unpleasant symptoms and later expanded to treating patients seeking long-term sobriety and relapse prevention.

Alcohol Withdrawal Medication UK

In the mid-20th century, benzodiazepines such as chlordiazepoxide (Librium) and diazepam (Valium) were introduced as effective medications to manage withdrawal from drinking alcohol. They helped control anxiety, prevent seizures, and promote a safer withdrawal process especially where alcohol intake had been considerable. Doctors have been successfully treating alcohol-dependent people with such drugs for over fifty years.

Advancements in Treatment Protocols:

As an understanding of the withdrawal process improved, standardised protocols for alcohol withdrawal medication and management were established. These have commonly involved, besides using benzodiazepines, prescribing the correct medication to prevent and treat other complications such as convulsions, high blood pressure, anxiety, depression and hallucinations.

Further research has been helpful in addressing alcohol dependence by using prescribed medication to treat not just the central nervous system (the source of many withdrawal symptoms) but mood disorders too.

A Wider Range of Medications

The medical community now uses medications beyond benzodiazepines – antipsychotics and anticonvulsants for example, and such drugs have been incorporated into addiction treatment plans to address specific symptoms and improve overall patient care. Increased understanding of the role of medications is now an important aspect of the way clinicians approach the treatment of alcohol addiction.

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The Different Types of Alcohol Withdrawal Medication

In an inpatient setting, the treatment process for alcohol dependence, including withdrawal, is nowadays likely to specify a particular drug in the treatment plan at certain stages of treatment, dependent on an individual’s particular needs and circumstances and any co-morbid mental disorders they may have.

Benzodiazepine Medication – These Particular Drugs Are Tried and Tested:

  1. Diazepam (Valium): Diazepam is a medication commonly used to treat alcohol dependence that helps manage anxiety, prevent alcohol withdrawal seizures, and alleviate severe withdrawals. Common side effects include drowsiness, dizziness, and the potential for dependence following prolonged use.
  2. Lorazepam (Ativan): Lorazepam is another benzodiazepine used to treat anxiety, seizures, and acute alcohol withdrawal. Side effects may include sedation, dizziness, and the potential for dependence.
  3. Chlordiazepoxide (Librium): Chlordiazepoxide is a benzodiazepine for detox from alcohol dependence, especially severe alcohol withdrawal, that helps control anxiety, relieve stress, and control ‘generalized tonic-clonic seizures’ (commonly known as ‘grand mal’ seizures). Side effects include drowsiness, confusion, and the potential for dependence.

Non-benzodiazepine Medication – These Are Somewhat Newer Drugs and Thus Less Proven:

  1. Carbamazepine (Tegretol): Carbamazepine is an anticonvulsant that can be used to prevent seizures during withdrawal. Side effects may include dizziness, nausea, and skin reactions.
  2. Gabapentin (Neurontin): Gabapentin can help manage anxiety, insomnia, and other symptoms of withdrawal. Side effects might include dizziness, drowsiness, and coordination problems.
  3. Clonidine: Clonidine is used to manage symptoms like high blood pressure and rapid heart rate during withdrawal. Side effects may include dizziness, dry mouth, and sedation.

Medications for Long-Term Recovery from Alcoholism

While Disulfiram has been used for many years, craving reducers such as Naltrexone and Acamprosate are more recent though they have nevertheless produced good results. :

  • Naltrexone (Vivitrol, Revia): Naltrexone is an opioid receptor antagonist that reduces alcohol cravings and the rewarding effects of alcohol. Side effects may include nausea, headache, and potential liver issues.
  • Acamprosate (Campral): Acamprosate helps maintain abstinence by reducing withdrawal symptoms and alcohol cravings. Side effects might include diarrhoea, upset stomach, and potential allergic reactions.
  • Disulfiram (Antabuse): Disulfiram creates a negative reaction if alcohol is consumed, acting as a deterrent to drinking. Side effects may include nausea, vomiting, and potential interactions with certain foods and medications. If a person drinks alcohol after taking Antabuse, the side effects can be extremely dangerous especially if the person reverts to severe alcohol abuse.

Benzodiazepines Versus Non-benzodiazepines – Pros and Cons

The choice between benzodiazepines and non-benzodiazepines depends on various factors, including the individual’s medical history, severity of symptoms, potential for dependence, and the overall treatment plan. Treatment staff will carefully assess each patient’s situation to determine the most appropriate medication for alcohol detox treatment while considering the benefits and risks of each option.

Benzodiazepines: 

The pros include: 

  1. effective symptom control, covering anxiety, agitation, tremors, and seizures,
  2. rapid relief from severe alcohol withdrawal,
  3. reduced risk of complications from seizures and delirium tremens,
  4. established history of use in alcohol withdrawal treatment over many years.Cons: 

The cons are:

  1. risk of dependence: benzodiazepines are addictive, especially with long-term use, and can cause their own withdrawal problems if not properly managed.
  2. sedation and impaired function causing drowsiness and impaired coordination and cognitive function.
  3. interaction with alcohol can lead to dangerous respiratory depression.

Non-Benzodiazepines:

The main pros include:

  • a lower risk of dependence than benzodiazepines.
  • less sedation and cognitive impairment.
  • a particular drug can target specific symptoms of withdrawal.
  • preferred for individuals at higher risk of benzodiazepine-related issues. 

Cons:

  • varied efficacy — they may not be as effective as benzodiazepines in managing severe detox and withdrawal symptoms.
  • less extensive research supporting their use in alcohol withdrawal.
  • they can interact negatively with other medications.
alcohol withdrawal medication uk

How Effective Is Medication for Dealing With Alcohol Withdrawal Symptoms?

Medication can be highly effective in managing alcohol withdrawal symptoms and preventing potentially dangerous complications. Clinical studies have demonstrated the efficacy of various medications in addressing different aspects of alcohol withdrawal, some notable examples being.

Benzodiazepines:

  • A 2015 study published in the US National Library of Medicine found that benzodiazepines were generally the most effective way of treating alcohol withdrawal syndrome.
  • A 2003 study published in the journal Alcohol and Alcoholism compared the efficacy of diazepam (a benzodiazepine) and chlormethiazole (a non-benzodiazepine) in alcohol withdrawal. Researchers found that diazepam was more effective in preventing seizures and reducing withdrawal symptoms.

Non-Benzodiazepines:

  • A 2014 study in Alcohol and Alcoholism found that Baclofen was efficient in the treatment of withdrawal symptoms.
  • A 2020 study in the US  investigated the use of Gabapentin (a non-benzodiazepine) for alcohol withdrawal symptoms. The researchers found that this drug was effective in reducing withdrawal symptoms and promoting abstinence for people with alcohol use disorder.

Other Medications:

Research published in 2002 by Addiction Treatment Forum USA evaluated the efficacy of Naltrexone (a medication for long-term recovery) in reducing heavy drinking among individuals with alcohol dependence. The study found that naltrexone was effective in that ‘Naltrexone appears to break the vicious, self-destructive cycle in alcoholics whereby one drink leads to another.

It’s important to note that the effectiveness of the medication can vary based on individual differences, dosage, and other factors. Healthcare providers consider these factors when determining the most appropriate treatment plan for alcohol withdrawal.

Are Alcohol Withdrawal Medications Addictive?

Alcohol withdrawal medications should only be used under medical supervision for short times. Nevertheless, some drugs, especially benzodiazepines, have addictive potential. Prescribers will therefore carefully review a person’s history of addictive behaviour in an initial assessment and may prescribe less addictive alternatives if in doubt.

These medications are typically prescribed for a short duration to manage the acute symptoms of alcohol withdrawal and to prevent potentially dangerous complications such as seizures and delirium tremens.

Benzodiazepines, which are commonly used to treat alcohol withdrawal, are known to have the potential for dependence and addiction if misused or taken in excessive doses over a prolonged period. However, when used as part of a structured withdrawal management plan and tapered off appropriately, the risk of addiction is minimised.

Other medications used for alcohol withdrawal, such as antipsychotics, anticonvulsants, and supportive vitamins like thiamine, are not typically associated with addiction.

It’s important to work closely with a healthcare provider when undergoing alcohol withdrawal treatment to ensure that the medications are used as directed and that the treatment plan is followed. If you have concerns about the potential for addiction to specific medications, it’s recommended to discuss these concerns with your healthcare provider.

The Stages of Alcohol Withdrawal

Most alcohol withdrawals range from mild symptoms like anxiety and tremors to more dangerous symptoms such as seizures, paranoia and delirium tremens (DTs). Medical supervision and appropriate treatment are essential for managing any type of alcohol withdrawal, especially for individuals with a history of heavy and prolonged alcohol use.

The Choice of Medication

Medication depends on the individual’s specific symptoms, medical history, and overall health. Medical professionals will assess the situation and determine the appropriate medications and dosages. Alcohol withdrawal can be dangerous, and sudden cessation of heavy drinking without medical supervision can lead to life-threatening complications. Therefore, seeking medical help when planning to stop alcohol consumption is crucial.

Alcohol withdrawal occurs in several stages, each characterised by distinct symptoms and timelines. These stages can vary in intensity and duration based on the individual’s drinking history, overall health, and other factors. Here’s a general summary of the stages of alcohol withdrawal:

Stage 1: Initial Symptoms (up to 6-12 Hours After Last Drink):

  • Anxiety, restlessness, and irritability
  • Insomnia
  • Nausea and vomiting
  • Tremors (shakiness)
  • Increased heart rate
  • Sweating

Stage 2: Peak Withdrawal (up to 24-48 Hours After Last Drink):

  • Severe symptoms intensify, including tremors, anxiety, and agitation
  • Hallucinations (visual, auditory, or tactile)
  • Seizures (occur in a minority of cases)
  • Delirium tremens (DTs), a severe form of withdrawal with confusion, disorientation, and potentially life-threatening symptoms

Stage 3: Subsiding Symptoms (up to 2-5 Days After Last Drink):

  • Physical symptoms gradually begin to lessen
  • Psychological symptoms, such as anxiety and mood swings, may continue

Stage 4: Resolving Symptoms (up to 5-7 Days After Last Drink):

  • Most physical symptoms subside or become manageable
  • Psychological symptoms like anxiety and depression may persist but gradually improve
  • Cravings for alcohol may persist but often decrease in intensity

Not everyone experiences all stages or the same severity of symptoms. Individuals with a history of heavy and prolonged alcohol use are at a higher risk of severe withdrawal symptoms, including delirium tremens. Medical supervision is crucial during severe alcohol withdrawal, especially for those with a chronic history of heavy drinking, as complications can be life-threatening. Proper medical care can ensure a safer and more comfortable withdrawal process and reduce the risk of complications.

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Medication for Relapse Prevention

Because some drugs used at the detox and withdrawal stage act to reduce cravings, they can also be used later on in a person’s recovery as a form of relapse prevention. It is quite normal for people who are relatively new to sobriety to experience severe cravings for alcohol even though motivated to recover.

The cravings may be triggered by emotional upheaval, stress or just the sight or smell of alcohol. In such cases, craving-reducer drugs such as Naltrexone or Acamprosate when properly prescribed, can be a useful way of managing the situation. A study by Professor J Chick and others reported in Alcohol and Alcoholism, March 2000, found Acamprosate to be effective in preventing relapse after withdrawal from alcohol.

It is worth saying here too that medication is just one part of successful relapse prevention. At Smarmore Castle regardless of their needs for alcohol withdrawal patients receive detailed help on relapse prevention including a personal continuing care plan and a course of instruction on techniques for handling cravings and difficult situations.

Medical Detox for Alcohol Addiction at Smarmore Castle Private Clinic

At Smarmore Castle, treating alcohol withdrawal symptoms is an important part of our alcohol treatment programme. Successful treatment of alcohol use disorder requires a variety of professional interventions of which detox may be the first part, if needed.

On admission, a medical and psychiatric assessment will be performed including a check for any symptoms of alcohol withdrawal. The degree and severity of your alcohol addiction will be observed and a full treatment plan including suitable medication, will be prepared. Withdrawal medications will not cure alcohol disorders on their own – they can only be used to aid medical detox in alcohol-dependent drinkers or for relapse prevention and to help in maintaining abstinence.

The nature of alcohol use disorder is such that a proportion of those seeking treatment will have been consuming alcohol recently and experience dangerous withdrawal symptoms requiring detox treatment upon admission. All our detox procedures are under strict medical supervision.

Symptoms such as severe respiratory depression, visual and auditory hallucinations, and even major depressive disorder are not uncommon but will respond to careful treatment.

Timeline: The alcohol detox timeline will vary from patient to patient depending on their physical and psychological symptoms and responses to treatment. It’s always recommended to seek medical advice and support when planning to stop or reduce alcohol consumption, especially if you have concerns about withdrawal symptoms.

We will always make every effort to ensure that your detox if needed, is as comfortable and stress-free as possible. Everyone’s circumstances are different and there is no medication or procedure that suits everyone although the most commonly used drugs for detox and withdrawal syndrome are generally some type of benzodiazepine.

Frequently Asked Questions

How Does Alcohol Withdrawal Medication Work?

Medication works by addressing the neurochemical imbalances caused by sudden cessation of alcohol, helping to alleviate withdrawal symptoms and prevent complications.

Can Medication Completely Eliminate Withdrawal Symptoms?

While medication can significantly reduce symptoms, complete elimination is unlikely to occur. Medication may also shorten the duration of symptoms.

Is a Prescription Necessary for Alcohol Withdrawal Medication?

Yes, a prescription is necessary, as it should be tailored to an individual’s needs and medical history. Withdrawal is a dangerous condition and medication should never be taken casually.

What Factors Influence the Effectiveness of Alcohol Withdrawal Medication?

Factors influencing the effectiveness include the type and severity of symptoms, individual response, and proper dosage hence the need for proper assessment and knowledge of a person’s addiction history.

What Are the Risks of Not Taking Alcohol Withdrawal Medication?

Not taking can lead to severe symptoms, including seizures, delirium tremens, and the potential for life-threatening complications.

Can You Take Alcohol Withdrawal Medication With Other Drugs?

The compatibility of this type of medication with other drugs should be discussed with a healthcare provider to prevent negative interactions.

Is Alcohol Withdrawal Medication Safe for Pregnant Women?

Always consult a healthcare provider before using alcohol withdrawal medication if pregnant, as safety varies depending on the medication.

How Is the Right Dosage for Alcohol Withdrawal Medication Determined?

The right dosage is determined by a healthcare provider based on the individual’s condition and response which is determined by careful assessment. Self-assessment and self-medication can be dangerous.

Can Alcohol Withdrawal Medication Be Used for Long-Term Treatment?

This type of medication is generally intended for short-term use during the withdrawal phase, and there may be dangers in using them long-term. For example, if benzodiazepines are used long-term they may lead to addiction.

Are There Natural or Alternative Treatments to Alcohol Withdrawal Medication?

Some natural or alternative treatments, such as dietary changes, relaxation techniques, and herbal supplements, may complement medical treatment but are best discussed with a healthcare provider. Drinking water to avoid dehydration helps too.

How Soon Will One Start to See the Effects of Alcohol Withdrawal Medication?

Effects of alcohol withdrawal medication can be seen within hours to a few days after starting treatment, depending on the medication and individual response. Benzodiazepines usually act quickest but anticonvulsants are quick too.

Self-Medication Can Be Dangerous

If you think that you may be experiencing some form of acute alcohol withdrawal as a result of alcohol abuse, it is important that you seek medical help. Stopping your alcohol intake completely can be very dangerous and should not be undertaken alone.

Contact your doctor in the first instance who may be able to prescribe suitable withdrawal medication and perhaps make a referral for further treatment via the NHS or private rehabilitation.

Self-medication without advice from a healthcare professional is not advised. If you’re not fully aware of the severity of your drinking, or if you are already taking medications for other health conditions then it can be especially dangerous to self-medicate for alcohol-related withdrawals.

Fatalities can occur among people experiencing alcohol withdrawal syndrome without proper medical supervision. These can include epileptic seizures, heart attacks or severe malfunctioning of the bodily organs due to a combination of alcohol poisoning and malnourishment.

Contact Us

If you are worried about your alcohol consumption or think that you or someone you care for might have an alcohol addiction, please don’t hesitate to call us for a chat in complete confidence. Our dedicated team of addiction psychiatrists, counsellors and therapists have extensive experience in treating alcohol use disorders arising from all kinds of alcohol misuse including mixing alcohol with other drugs.

Please don’t hesitate to give us a call, we are always ready to listen and to talk through the options to find the best ways of helping you to recover.

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References

  1. Alcohol Withdrawal Syndrome: Benzodiazepines and Beyond
  2. Evidence for the Efficacy of Naltrexone in the Treatment of Alcohol Dependence (Alcoholism)
  3. United Kingdom Multicentre Acamprosate Study (Ukmas): A 6-Month Prospective Study of Acamprosate Versus Placebo in Preventing Relapse After Withdrawal From Alcohol

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