Alcohol drinking cessation is the most critical step when you become aware of the short-term and long-term damage of alcoholism. However, self-detoxification is very difficult in these patients. Discontinuing alcohol consumption suddenly may result in a rapid onset of the symptoms mentioned above, and some of them can lead to death when not treated. Thus, if you are experiencing withdrawal syndrome, it is recommended that your detoxification be guided by a professional, especially if your symptoms are becoming severe. This increases the likelihood of detoxification success and improves your quality of life in the process.
The first step to treat patients during detoxification is evaluating the severity of their withdrawal symptoms. There are clinical tools for that, and one of the most recommended is known as Clinical Institute Withdrawal Assessment or CIWA-Ar. Patients who receive a CIWA-Ar score of 7 or less can complete detoxification outside an institution. If the score is 8 or higher, they are recommended to undergo their withdrawal syndrome in an institution. Even if you’re a candidate to be an outpatient, you still need managed supportive therapy and may require pharmacological interventions to reduce the burden of the symptoms listed above. If your score is greater than 15, or you had recent surgery, are pregnant, do not have social support, or suffer from psychiatric problems, you will likely need hospitalization to complete the detoxification.
Pharmacological management during a withdrawal syndrome usually includes one of the following drugs or a combination:
- Benzodiazepines: They help modulate the burden of withdrawal syndrome by binding to GABA receptors. The most common benzodiazepines used in these patients are diazepam and chlordiazepoxide. They both have anticonvulsant properties, which may also be helpful according to each patient. However, you should be aware that chronic use of these drugs also causes tolerance, dependence, and cognitive deterioration.
- Carbamazepine: This is a GABA receptor agonist. It is also used to reduce the symptoms in these patients, especially in cases of manic-depressive illness, neuropathic pain, and seizures.
- Chlormethiazole: This is a modulator of the GABA receptor. It changes the receptor’s structure and makes it more easily stimulated. This medication has a better success rate when given at an early stage of alcohol withdrawal syndrome.
- Adjuvant treatment: Depending on the symptoms, patients may also need supportive therapy such as atenolol and propranolol to reduce their blood pressure and heart rate. They are particularly useful in coronary artery disease patients and can be used with benzodiazepines. Another adjuvant treatment used in some cases is acupuncture, which may have some utility in the treatment in some cases.
- Herbal remedies: Some herbal remedies may also reduce the withdrawal symptoms. One of the most important is Passiflora incarnata, which counters the dependence on alcohol and other addiction-prone substances such as morphine, nicotine, and even benzodiazepines. The naturally occurring root valerian also has a mild anxiolytic effect that improves the quality of life in some cases. Other herbs include the aqueous extract of kudzu or purified puerarin, which is also known to reduce the severity of the symptoms.
We should also discuss other treatment strategies that contribute to these patients and increase the likelihood of success. They include:
- Psychosocial Management: Another important part of the therapy is the psychological treatment, which helps patients reduce the risk of relapse. The psychosocial approach considers the emotional, spiritual, social, and mental health of the patient. Therapists will consider different interactions between the patient and the environmental factors associated with his genetics and risk factors. One of the best tools for these patients is cognitive-behavioral therapy to change the behavior of drinking alcohol. This type of therapy may also address the risk of relapse by identifying the triggers and creating coping skills and refusing skills that will be helpful when required. A social worker can also be a part of the team to reduce the economic and social consequences of alcoholism in the family and society.
- Pharmacogenomics: This is a field of pharmacology that chooses treatments depending on the genetic variabilities of each patient. For example, studies have found that naltrexone is more effective in patients with a polymorphic OPMR1 gene. Relapses are reduced significantly when using acamprosate in patients with a GATA4 polymorphism. The idea is to identify genetic variants in each patient and choose the drug therapy accordingly.
Alcohol is a legal recreational drug, but that doesn’t mean that it is harmless. Chronic alcohol consumption may trigger addiction, and detoxification in such cases causes a withdrawal syndrome. This syndrome features physical and mental health symptoms such as rapid heartbeat and anxiety. In some patients, severe symptoms happen in the case of delirium tremens.
Treatment of withdrawal syndrome in alcoholism features pharmacotherapy, a psychological approach, and sometimes alternative therapy. Depending on your symptoms, you may require to be monitored or hospitalized. Even in an outpatient modality, the symptoms can reduce your quality of life and make you at risk of relapses if you don’t look for supportive therapy. However, if your detoxification is followed up and guided by a professional, the chances of recovery are higher, and you may not experience the most severe side effects of quitting alcohol.