Alcohol detoxification, or detox, for individuals with alcoholism or alcohol dependence, is the abrupt cessation of alcohol intake coupled with the substitution of alcohol with cross tolerant drugs that have similar effects in order to prevent alcohol withdrawal with it’s associated effect Delirium Tremens or Detoxification may or may not be necessary depending upon an individual’s age, medical status, and history of alcohol intake. For example, a young man who binge drinks and seeks treatment one week after his last use of alcohol may not require detoxification before beginning treatment for alcoholism. Benzodiazepines are the most common family of drugs used for this, followed by barbiturates
Benzodiazepines such as chlordiazepoxide (Librium), diazepam (Valium), lorazepam (Ativan) or oxazepam (Serax) are the most commonly used drugs used to reduce alcohol withdrawal symptoms. There are several treatment patterns in which it is used.
- The first option takes into consideration the varying degrees of tolerance. In it, a standard dose of the benzodiazepine is given every half hour until light sedation is reached. Once a baseline dose is determined, the medication is tapered over the ensuing 3–10 days.
- Another option is to give a standard dose of benzodiazepine based on history and adjust based on withdrawal phenomenon.
- A third option is to defer treatment until symptoms occur. This method should not be used in patients with prior alcohol related seizures. This has been effective in randomized controlled trials. A non-randomized, before and after, observational study found that symptom-triggered therapy was advantageous.
Dosing of the benzodiazepines can be guided by the CIWA-Ar scale. The scale is available online.
Regarding the choice of benzodiazepine:
- Chlordiazepoxide (Librium) is the benzodiazepine of choice in uncomplicated alcohol withdrawal.
- Lorazepam or diazepam are available as an injection for patients who cannot safely take medications by mouth.
- Lorazepam and oxazepam may be best in patients with cirrhosis (shorter half life).
Randomized controlled trials have found benefit from atenolol and clonidine.
A randomized controlled trial has found benefit from carbamazepine.
Some hospitals administer alcohol to prevent alcohol withdrawal although there are potential problems with this practice. Various vitamins, especially from the B group, are often used during withdrawal treatment.
Sodium oxybate is the sodium salt of gamma-hydroxybutyric acid (GHB). It is used for both acute alcohol withdrawal and medium to long-term detoxification. This drug enhances GABA neurotransmission and reduces glutamate levels. It is used in Italy in small amounts under the trade name Alcover.
Baclofen has been shown in animal studies and in small human studies to enhance detoxification. This drug acts as a GABA B receptor agonist and this may be beneficial.