Alcohol Detox : Evaluation and Treatment
The goals of alcohol detoxification is to: 1. Diagnose and treat symptoms of alcohol withdrawal 2. To prevent serious events (seizures, delirium tremens, or death) 3. Bridge patients to psychosocial treatment for maintaining long-term recovery.
Mild alcohol withdrawal syndrome presents when excessive alcohol drinking occurs for even one week. Withdrawal symptoms in the early phase present as agitation, anxiety, restlessness, insomnia, tremors, fluctuating tachycardia and hypertension, headache, and cravings. Patients may experience loss of appetite, nausea, and vomiting. Most of these symptoms resolve in a day or two. Seizures and hallucinations can also occur early in the course of withdrawal and in the absence of other symptoms.
Severe alcohol withdrawal presentation like delirium and tremors can present as fever, severe tachycardia and hypertension, agitation, drenching sweats, hallucinations, and disorientation. Initial step in treating a patient with an alcohol addiction is to assess the need for alcohol detoxification. A patient who has been sober for five days or more and shows no signs of withdrawal is unlikely to develop significant withdrawal symptoms and can be referred for ambulatory care.
A medical exam should be performed to rule out serious medical or psychiatric conditions that would complicate alcohol withdrawal treatment, and conditions that indicate a need for inpatient management, such as:
Clinical Institute Withdrawal Assessment from Alcohol-revised (CIWA-Ar) scale is used to assess the severity of withdrawal in patients with a history of recent drinking (within the past five days).
Who are the patients that can be managed at an outpatient detox setting? These are the patients that can take oral medications and have no coexisting severe medical or psychiatric disorders and have no concurrent polysubstance use.
Medication used for alcohol detox: Two commonly used drugs are sedatives and anticonvulsants. The most common sedatives used are benzodiazepines and are typically either Diazepam(valium) or Librium (chlordiazepoxide). Short acting benzos like Ativan are used especially for patients with Liver disease. Anticonvulsants like baclofen are used in cases where benzodiazepines alone are not sufficient enough to treat the symptoms of withdrawal.
Medications for longer term abuse of alcohol include naltrexone, acamprosate and topiramate and when combined with psychosocial interventions, these appear to encourage treatment retention
Psychosocial treatment after initial detoxification is very critical. Commonly used interventions are:
1. Motivational interviewing: This is a counseling technique for eliciting behavior change by helping the patient explore and resolve ambivalence about change. 2. Cognitive behavioral therapy (CBT) is a structured goal-directed form of psychotherapy in which patients learn how their thought processes contribute to their behavior. 3. Residential programs provide a 24-hour, drug and alcohol-free environment. They vary widely in the intensity of clinical services provided and the treatment models employed. 4. Mutual help groups, including 12-step programs and other models, are a common component of treatment for alcohol use disorder. Although there are differences among them, they commonly emphasize working toward abstinence through group sharing and support.