Alcohol detoxification (also known as ''detox'') is the abrupt cessation of

alcohol Alcohol may refer to: Common uses * Alcohol (chemistry), a class of compounds * Ethanol, one of several alcohols, commonly known as alcohol in everyday life ** Alcohol (drug), intoxicant found in alcoholic beverages ** Alcoholic beverage, an alco ...

intake in individuals that have alcohol use disorder. This process is often coupled with substitution of drugs that have effects similar to the effects of alcohol in order to lessen the symptoms of alcohol withdrawal. When withdrawal does occur, it results in symptoms of varying severity. As such, the term "detoxification" may be somewhat of a misnomer since the process need not refer exclusively to the removal of toxic substances from the body. Detoxification may or may not be indicated 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 alcohol use disorder. Some addiction medicine practitioners use the term "withdrawal management" instead of "detoxification".

Withdrawal symptoms

The symptoms of alcohol withdrawal can range from mild to severe depending on the level of alcohol dependence a person has experienced. Symptoms can be behavioural (anxiety, agitation, irritability), neurological (tremor, hallucinations, increased risk of seizures), and physical (changes in heart rate, body temperature, blood pressure, nausea). Symptoms typically occur between 6 and 24 hours since cessation of drinking. In severe cases delirium tremens may occur, which is a medical emergency and could result in death.

Management

Benzodiazepine Benzodiazepines (BZD, BDZ, BZs), colloquially known as "benzos", are a class of central nervous system (CNS) depressant, depressant drugs whose core chemical structure is the fusion of a benzene ring and a diazepine ring. They are prescribed t ...

s are the most common family of drugs used for alcohol detoxification,Full text
at OVID followed by barbiturates.

Benzodiazepines

s 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 to 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 scale. The scale is available online.
see appendix 2
Regarding the choice of benzodiazepine: * Chlordiazepoxide (Librium) is the benzodiazepine of choice in uncomplicated alcohol withdrawal due to its long half-life. * Lorazepam or diazepam is available as an injection for patients who cannot safely take medications by mouth. * Lorazepam and oxazepam are indicated in patients with impaired liver function because they are metabolised outside of the liver.

Nitrous oxide

Nitrous oxide Nitrous oxide (dinitrogen oxide or dinitrogen monoxide), commonly known as laughing gas, nitrous, or factitious air, among others, is a chemical compound, an Nitrogen oxide, oxide of nitrogen with the Chemical formula, formula . At room te ...

has been shown to be an effective and safe treatment for alcohol withdrawal. Over 20,000 cases of the alcoholic withdrawal state have been successfully treated with psychotropic analgesic nitrous oxide (PAN) in South Africa and Finland. In 1992 it was officially approved for the treatment of addictive withdrawal states by the medical authorities in South Africa. Consequently, patients receiving it can claim a refund from their medical insurance. The gas therapy reduces the use of highly addictive sedative medications (like benzodiazepines and barbiturates) by over 90%. The technique thus reduces the danger of secondary addiction to benzodiazepines, which can be a real problem amongst alcoholics who have been treated with these agents.

Other

Randomized controlled trials have found benefit from

atenolol Atenolol is a beta blocker medication primarily used to treat high blood pressure and angina, heart-associated chest pain. Although used to treat high blood pressure, it does not seem to improve mortality rate, mortality in those with the condi ...

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 alcohol 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 Italy, officially the Italian Republic, is a country in Southern Europe, Southern and Western Europe, Western Europe. It consists of Italian Peninsula, a peninsula that extends into the Mediterranean Sea, with the Alps on its northern land b ...

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.

Phenibut Phenibut, sold under the brand name Anvifen among others, is a central nervous system (CNS) depressant with anxiolytic effects, and is used to treat anxiety, insomnia, and for a variety of other indications. It is usually taken oral administrat ...

is used in Eastern Europe for alcohol detoxification as it has sedative and anxiolytic effects.

References