Dangers of alcohol withdrawal are often underestimated, yet they can be potentially deadly, especially if drinking is stopped suddenly. One unique service I provide to avoid the dangers of alcohol withdrawal is a home-detox approach. This approach works well for people wanting to stop drinking alcohol but prefer the comfort and privacy of their own home, while still safetly avoiding the dangers alcohol withdrawal. Some of the dangers of alcohol withdrawal include severe seizures of the “tonic-clonic” type with severe convulsing which can potentially lead to a severe problem called status epilepticus –which means inability to stop seizing. When people have a seizure and are not under medical supervision they can potentially choke, stop breathing or aspirate saliva and fluid into their lungs. All of these symptoms of alcohol withdrawal are clearly life-threatning and all are good reasons not to do try this without a doctors supervision.
One of the most well known dangers of alcohol withdrawal is delirium-tremens (a.k.a DT’s). Although most people know this term, they often do not know exactly what it entails. DT’s is a severe state of confusion induced by the effects of alcohol withdrawal. The confused state can cause hallucinations, delusions, paranoia and loss of the ability to recognize where you are. This usually is accompanied by severe autonomic changes including excessive heart rate, rapid shallow breaths and elevated blood pressure. These rapid change in vital signs referred to as “autonomic instability” can be some of the most severe symptoms of alcohol withdrawal and a potential cause of death. (referred to as autonomic instability because your autonomic nervous system is what controls vital signs such as blood pressure, pulse, breathing etc”.
Dangers of of alcohol withdrawal can be prevented thankfully with the use of proper medication called benzodiazepines. These include common ones such as Lorazepam (Ativan), Librium, and valium (diazepam). Benzodiazepines are medications that act on many of the same brain receptors that alcohol acts on and thus are able to be safely used to more slowly decrease activity at those receptors sites. While there are other medications that have shown efficacy such as Depakote and Tegretol (both seizure medications) benzodiazepines remain very well studied and first line. Prior to benzodiazepines being introduced, barbiturates such as phenobarbital were used as first line treatment. While they have very similar receptor activity to benzodiazepines, their margin for safety was much worse. Barbiturates have a much more severe effect on respiratory depression which can ultimately lead to stopping breathing which is mainly why they are now phased out as a first line treatment approach. They are however equally as effective and can still be used to control symptoms of alcohol withdrawal under the care of an experienced physician.
To prevent the major symptoms of alcohol withdrawal it is imperative to understand the time course which the symptoms occur:
Day 1-Worsening degree of shakiness, tremors, restlessness, diaphoresis (sweating), increasing heart rate, more rapid breaths and feeling very warm, insomnia, nausea and vomiting. Risk of seizures as early as 6hours after last drink begin
Day 2-Signifigant tremors are worsening and overall discomfort is worse. Vital signs get more unstable and heart beats faster. This is when the risk of seizures presents (although potentially can happen as early as day 1). Feeling more dizzy and light-headed. Severe insomnia and inability to lay still/restlessness. Highest risk of seizures occur between first 6 hours and 48 hours.
Day 3-90 percent of people with seizures will have them by 48 hours so seizure risk is much lower by now. ongoing tremors, shakiness and other symptoms from day 1 and 2. Risk for delirium tremens begins on day 3.
Day 4-6-Risk for delirium tremens (DT’s) continues which presents as confusion, disorientation and possible hallucinations in addition to the physical withdrawal symptoms.
How does treatment to prevent the dangers of alcohol withdrawal work? Many physicians differ on the exact technique used but in essence proper detox with benzodiazepines involve providing increasing amounts of the medications until the subjective symptoms of discomfort (nausea/vomiting/restlessness) and the objective signs (heart rate, blood pressure) are under control. Over the course of 24 hours the total dose of medication needed to control the symptoms is counted. Then over the next 1-2 weeks the dose is slowly tapered down by decreasing the total dose per day by small increments until completely off of the medication.
The most risky approach anyone who tries to stop drinking could take is trying to stop “cold turkey.” This will maximize the dangers of alcohol withdrawal and this should NEVER be attempted. Also stopping any sedatives such as sleeping pills and anti-anxiety medications such as the benzodiazepines abruptly can lead to the same dangers as alcohol withdrawal.
If a patient has a supportive family willing to be there at all times with the patient, in most cases I can safely provide detox in the comfort of a patient’s home by visiting them each day and having multiple phone-calls to discuss vital signs and subjective symptoms. In some cases depending on the severity of the addiction, a hospital in-patient detox is necessary to provide the safest environment. Regardless of who you get help from-just make sure you talk to your doctor before giving up alcohol on your own to prevent the potentially life-threatning dangers of alcohol withdrawal