Alcohol Detoxification Medications Used in Rehab
Withdrawal from alcohol dependence can be very dangerous. Nearly anyone suffering from an alcohol use disorder who wishes to overcome their addiction will likely experience it, as detoxification (detox) is a fundamental aspect of the treatment process. Happily, various medications may be prescribed prior to, during and following detox that can make withdrawal significantly safer and less unpleasant.
Alcoholism Detoxification Medication Explained
Medication can be used in the treatment of alcohol addiction for two primary purposes: reducing the quantity of alcohol the addict consumes and managing alcohol withdrawal syndrome. How these objectives are achieved varies from one medication to another; some medicines may not be appropriate for particular clients, and any medication used during addiction treatment needs to be managed by medical professionals.
The interaction of many medicines with alcohol can be very risk; never attempt to self-medicate if you are considering going through withdrawal from alcohol dependence.
It is also important to note that there is no pharmaceutical cure for alcoholism. Medication can be helpful in making treatment easier, but drugs alone cannot overcome an alcohol addiction. Alcohol addiction treatment typically consists of various elements that include medication, and different aspects of the condition require different approaches in order to maximise the chance that treatment will be successful in the long term.
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Routes of Administration of Alcohol Detoxification Medications in Rehab
How medications are administered in alcohol treatment depends on the medication in question and the circumstances and physical condition of the alcohol user. Doctors always try to “first do no harm” and look for the easiest and least distressing means of treating patients, but the efficacy of the treatment also needs to be optimised. In some instances, more uncomfortable methods of administration may be preferable if they will do the most good and have the greatest effect.
In some cases, certain types and forms of medication may be preferable but may be impossible to administer. For example, someone suffering from alcohol dependence who is experiencing severe gastric difficulties or has developed a psychological obstacle to swallowing may be unable to take medication in tablet form; someone with an alcohol use disorder who also suffers from a long-term addiction to opioids injected intravenously may have damaged their veins. In these cases, doctors will look for alternative methods of administration.
The Alcohol Withdrawal Symptoms that Medications Can Help Control
Alcohol withdrawal syndrome can cause a number of symptoms, commonly including cravings; tremors; nausea; vomiting; hallucinations; acute anxiety; seizures; insomnia; psychomotor agitation; autonomic dysfunction; and delirium tremens, a potentially fatal condition characterised by tremors, confusion, high body temperature, irregular heartbeat, shaking, sweating, hallucinations and seizures. Longer-term withdrawal symptoms can include depression, anxiety and other mood disorders.
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Fortunately, many of these symptoms can be alleviated or even suppressed altogether by the use of medication.
In some particularly severe cases, doctors judge it necessary to keep a withdrawing client sedated throughout much of the detoxification process, which can mean that many of the more unpleasant symptoms are hardly felt at all. However, strong sedation poses its own risks, and doctors try to avoid it where possible. The emphasis is on patient safety, with reducing discomfort an important but not top priority; therefore, in many cases medication can be used to alleviate symptoms but should not be expected to remove them entirely.
The Process of Detoxification using Medication
Each person’s journey through detoxification, withdrawal, therapy and recovery is unique. Moreover, different treatment facilities and organisations may have different processes for detox and for the administration of medication. There is therefore no universal roadmap for how medication is used in detoxification that can be applied to every individual.
For some people struggling with alcoholism, the detoxification process will begin weeks or months before entering into an inpatient treatment programme for detoxification and withdrawal, beginning with the prescription of medication aimed at reducing the amount of alcohol they are consuming.
It may be that their current alcohol intake is at a level that makes immediate detoxification inappropriate, or they may be unable to enter into treatment straightaway but their condition is not serious enough to require emergency attention.
In these cases, medication may be prescribed which can facilitate avoiding alcohol, possibly by reducing cravings or rendering the act of drinking alcohol unpleasant. By reducing dosages over time, the client can both limit the ongoing impact of alcohol addiction on their health and daily life and make subsequent treatment easier (including by lessening the severity of alcohol withdrawal syndrome).
When entering a treatment facility, an alcohol user will be given a full medical and psychiatric assessment to establish the nature and severity of their addiction and their physical condition. Following this assessment, and depending on its results, the first dose of any relevant medication will be given. During the following detox period, withdrawal will be monitored closely by doctors, and any relevant medication will be prescribed to deal with the symptoms of withdrawal syndrome. These steps are based on a treatment plan drawn up following the initial assessment and on any subsequent developments that may require an adjustment to that plan (for example, any unexpected or especially severe symptoms of withdrawal or any other health conditions arising that may complicate treatment).
The pharmaceutical element of treatment does not necessarily end after the detox and withdrawal phase is complete. Some withdrawal symptoms may persist long after detox — especially those of a psychological nature, including depression and anxiety — and if so, medication may be prescribed on a long-term basis to address those challenges. In addition, in some cases medication will be provided to suppress cravings during the subsequent therapy phase and possibly even for a period of time after the client has left the treatment facility in order to ensure optimal conditions for recovery.
Medications Approved for Alcohol Detox Treatment
When considering going through alcohol detox and withdrawal, it is important to bear in mind a number of factors with regard to pharmaceutical assistance.
Firstly, some medicine used in the treatment of alcohol addiction in locations outside the United Kingdom may be illegal within the UK. Attempting to procure them independently — for example, over the dark web — may constitute criminal activity, with potentially very serious consequences. Only medications that have been approved legally for use within the United Kingdom should ever be taken.
Secondly, attempting to go through alcohol detox and withdrawal independently can be extremely dangerous. If you have an alcohol dependence, under no circumstances should you ever attempt an alcohol detox without medical assistance.
Thirdly, many self-treatment kits marketed over the internet are of dubious medical value and could even be dangerous, even if they do not contain any medicine prohibited in the UK. Again, attempting to self-medicate in cases of alcohol withdrawal can be deadly; always consult a doctor and/or an addiction specialist if you suffer from an alcohol addiction and wish to undergo detox.
Various medications have been approved for alcohol addiction treatment in the United Kingdom. These medications serve different purposes and may have a wide variety of effects and side effects.
Benzodiazepines
Benzodiazepines, sometimes referred to as benzos are a class of psychoactive drugs in the family of minor tranquilizers. They typically have sedative, anticonvulsant, muscle relaxant, hypnotic (inducing sleep) and anxiolytic (anti-anxiety) properties. Besides treating alcohol dependence and withdrawal, benzodiazepines are commonly prescribed to treat a wide range of other disorders including seizures, anxiety and panic disorders, agitation, insomnia, other substance use disorders and withdrawal syndromes, muscle spasms, breathlessness and obsessive-compulsive disorder. Benzodiazepines are also often administered before surgery to reduce anxiety and prompt amnesia of any unpleasant experiences during procedures.
In the treatment of alcohol withdrawal, benzodiazepines are primarily used to alleviate potentially dangerous withdrawal symptoms including seizures and delirium and especially in the urgent treatment of delirium tremens, in which cases their administration can be life-saving. Benzodiazepines are the medication of choice for the treatment of delirium tremens, and without treatment the mortality rate of delirium tremens is between 15% and 40%. They may also be prescribed during withdrawal to treat anxiety, muscle spasms and insomnia.
Benzodiazepines are usually prescribed in tablet form but can also be administered by intravenous or intramuscular injection. Some forms of certain benzodiazepines are also available via intranasal (through the nose), rectal and vaginal administration.
Benzodiazepines act upon the brain and central nervous system (CNS) by increasing the activity and effectiveness of the neurotransmitter gamma-aminobutyric acid (GABA). GABA’s principal role is to reduce neuronal excitability throughout the CNS —basically, it has a calming effect on the activity of the nervous system, which in turn relaxes the individual. By enhancing GABA’s effectiveness, benzodiazepines can have a calming effect both physically (reducing muscular tension and muscle spasms) and psychologically (reducing anxiety and feelings of stress).
Unfortunately, benzodiazepines are themselves potentially habit-forming and can be dangerous. Not only is benzodiazepine overdose a potentially fatal condition (they are often used in intentional overdoses), but benzodiazepine withdrawal syndrome, like alcohol withdrawal syndrome, can be fatal. Benzodiazepines can also interact very dangerously with other substances, including other CNS depressants such as alcohol and some antidepressants, especially SSRIs.
Alongside the possibility of addiction and dependence, benzodiazepine consumption and abuse can have a range of negative effects over both the short and long terms. Benzodiazepines’ sedative and muscle relaxant properties can cause drowsiness and dizziness, which can lead to accidental injuries including falls and operating vehicles and heavy machinery. Sexual dysfunction, depression, disinhibition, hypotension, blurred vision, confusion, nausea and respiratory depression can all be caused by the consumption of benzodiazepines.
Because of the potential dangers associated with benzodiazepine use, their administration during alcohol withdrawal treatment must be strictly monitored by qualified medical professionals. Under no circumstances should you ever self-medicate with benzodiazepines.
In the United Kingdom, benzodiazepines are only legally available with a valid prescription. Most benzodiazepines are Class C controlled substances under the Misuse of Drugs Act 1971, with maximum penalties for unauthorised possession of two years’ imprisonment and an unlimited fine and for supply of five years in prison and an unlimited fine.
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Naltrexone
Naltrexone (available under brand names including Vivitrol, Adepend, Naltrexona, Depade, Nalerona, Abernil, ReVia and Trexan, among others) is an opioid antagonist (blocking opioid receptors in the brain) primarily used in the treatment of alcohol dependence and opioid dependence. It is also sometimes used to treat obesity in combination with bupropion.
Naltrexone’s primary purpose is to reduce cravings, and it can be administered either during a managed detox process or before treatment to reduce the quantity of alcohol consumed. It may also be provided as a supplement to recovery to minimise cravings after an addiction treatment programme. It is not considered especially effective in individuals who have stopped drinking (i.e., its effect on abstinent individuals is negligible compared with a placebo in terms of reducing instances of relapse).
Naltrexone comes in various forms, including tablets for daily consumption and extended release intramuscular injections and subcutaneous implants for long-term management of cravings. How naltrexone is administered in individual cases during treatment will depend on how it is intended to be used and on the physiology and circumstances of the client.
Naltrexone is not known to be addictive; however, it does have a number of potentially unpleasant and problematic side effects. The most common of these are gastrointestinal complaints, including diarrhoea and abdominal cramps. More seriously, naltrexone has also been associated with cases of liver damage, and it is advised that naltrexone not be given to anyone suffering from liver problems, including hepatitis, or to those who have used opioids within the last week.
In the UK, naltrexone is a prescription-only medicine, legally available only with a valid prescription.
Acamprosate
Acamprosate (sold under brand names including Campral and Regtect) is a drug sometimes used to treat alcohol dependence. When taken in combination with counselling and other forms of therapy, it can help reduce alcohol consumption and in some cases can facilitate complete abstinence. Acamprosate is available in tablet form for oral consumption.
While acamprosate’s efficacy in the treatment of alcoholism has been attested to by various studies, it is not certain how exactly the drug works.
It is believed that acamprosate stabilises and regulates chemical signals in the brain that might otherwise function abnormally during alcohol withdrawal. Acamprosate is thought to be an antagonist of NMDA receptors in the brain and also to have an effect on GABA receptors. It is also known that acamprosate reduces the impact of neurotransmitters, including glutamate, that can reach problematic levels during withdrawal from alcohol.
Acamprosate is not thought to be addictive. However, acamprosate is associated with some potentially serious side effects including hypertension, hypotension, abnormal heartbeat, suicidal ideation, major depressive disorder and some allergic reactions. It has also been observed to cause headaches, insomnia, diarrhoea, anxiety, sexual dysfunction, flulike symptoms, chills, vomiting, weight gain, fatigue, forgetfulness, tremors, difficulty breathing, abnormal vision, and pain in the stomach, back, muscles, joints and chest. Acamprosate is not metabolised by the body and is primarily removed by the kidneys; as a result, it should never be given to anyone with kidney damage.
In the United Kingdom, acamprosate is a prescription-only medicine.
Disulfiram
Disulfiram (available under the trade names Antabuse and Antabus, among others) is a drug used in the treatment of alcohol addiction because of its ability to produce an acute sensitivity to alcohol, causing many of the symptoms of a hangover almost immediately on consumption. This tends to make drinking alcohol a wholly unpleasant experience.
Someone who has taken disulfiram and then drinks alcohol, even in small quantities, can begin within minutes to experience symptoms including headache, nausea, copious vomiting, throbbing in the head and neck, sweating, extreme thirst, palpitations, chest pains, weakness, blurred vision, vertigo, confusion and a range of other hangover-like symptoms. More severe reactions to disulfiram may feature respiratory depression, arrhythmia, heart attack, unconsciousness, acute congestive heart failure, cardiovascular collapse, convulsions and death.
Disulfiram works by blocking the enzyme alcohol dehydrogenase, which breaks down alcohol in the liver to acetaldehyde and then to a harmless acetic acid derivative. By blocking this action, disulfiram causes an excessive concentration in the blood (between five and 10 times the normal amount) of acetaldehyde, which is one of the major causes of hangover. The hangover symptoms may persist for between 30 minutes and several hours.
Disulfiram does not reduce the cravings for alcohol in dependent individuals, and therefore some users who have taken disulfiram continue to drink alcohol despite knowing of the unpleasant effects to come. As a result, disulfiram is now typically provided alongside other drugs designed to reduce cravings, in particular naltrexone and acamprosate.
As well as the negative and potentially dangerous effects of consuming alcohol alongside disulfiram, the drug is also associated with a number of side effects including headaches, sexual dysfunction, liver problems, nerve inflammation, skin rashes and neuropathy. Disulfiram is known to interfere with the metabolism of drugs including paracetamol, caffeine and theophylline, though this is usually mild.
In the UK disulfiram is a prescription-only medication.
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Other Medications used for Withdrawal Management from Alcohol
As well as the medications described above, various other medicines may be prescribed in the treatment of alcohol dependence and withdrawal, most commonly to address specific symptoms. For example, antidepressants may be prescribed to minimise the impact of any depression caused by withdrawal; similarly, various anxiolytics can be given to reduce anxiety and panic. Such medication will be given on a case-by-case basis by the doctors managing each client. Because of the potential danger of interactions between drugs, it is imperative that clients going through detoxification and withdrawal do not take any substances without the knowledge and approval of their doctors.
Why Is It Necessary to Detox from Alcohol?
Overcoming an alcohol addiction is vital for anyone wishing to regain a healthy and happy life. Alcohol addiction can be deadly and even in less extreme circumstances can cause permanent damage to relationships, work and academic prospects, reputations and self-worth.
Detox is an indispensable and unavoidable element of alcohol addiction treatment. Without going through detox, a user will continue to experience the pressures of alcohol dependence and not be able to engage fully with the therapy that will allow them to stop drinking and move forward to a life free of alcohol abuse. Because of this, many treatment programmes, self-help groups, therapists and counsellors will not accept individuals who are still abusing alcohol.
Alcohol Detox Timeline and How Medication Fits In
How long alcohol detox and withdrawal last — and when, what and how much medication is provided — depends on various factors, including the duration and severity of the alcohol addiction and the physical and psychological condition of the client.
There is no one universal roadmap which can be applied to every case of alcohol addiction or every instance of treatment.
In some cases, preparation for detox begins some time in advance with the prescription of medication aimed at reducing alcohol consumption, which can be tapered down over weeks or months.
In rehab, following a medical assessment, a client will receive a treatment plan and may be given an initial dose of medication to minimise the impact of the expected withdrawal syndrome. Over the course of the next few days, other medication will be provided in accordance with this treatment plan and in response to any withdrawal symptoms requiring additional attention. In serious cases involving delirium tremens or other significant dangers, urgent treatment may be provided on site, or the individual may be moved to a hospital environment if their life is considered to be in danger.
Although every case of withdrawal is unique, a rough timeline to alcohol withdrawal symptoms may look as follows:
- Day 1: Withdrawal symptoms may begin within the first six to 24 hours and are likely to include strong cravings, headaches, intense anxiety, stomach pains, nausea and vomiting and tremors.
- Days 2-3: Symptoms will intensify and will be accompanied by increased body temperature, raised blood pressure, elevated heart rate, extreme confusion and insomnia. In some cases, delirium tremens will begin to develop.
- Days 3-5: Withdrawal symptoms will peak and in serious cases may include seizures and hallucinations, delirium tremens and the risk of death. In less serious cases, withdrawal symptoms will begin to subside from the fourth or fifth day onwards.
- Days 6-10 and onwards: Less severe cases of alcohol withdrawal are likely to subside after about a week; in more severe cases, symptoms may persist for 10 days or more. Longer term symptoms including depression, anxiety and cravings may recur for weeks, months or even years after the last instance of alcohol consumption.
Dangers of Detoxing Without Medical Assistance
Alcohol withdrawal is a potentially deadly condition and should never be attempted without medical assistance. Symptoms including delirium tremens can be fatal, whilst confusion and loss of motor control can also result in potentially fatal accidents. Alcohol withdrawal can even be so unpleasant that suicidal ideation can result.
If you are contemplating attempting alcohol withdrawal, it is imperative that you contact your doctor and request professional help. Not doing so may place your life in serious danger.
Alcohol Detox Medication Facts and Statistics
- According to the World Health Organisation, there are over 200 million people worldwide suffering from an alcohol addiction. Alcohol is a factor in around 3.3 million deaths each year worldwide.
- In Eastern Europe, more than one-tenth of the adult population is addicted to alcohol. Alcoholism is least common in Africa, affecting only 1.1% of the population.
- One study has estimated the cost to the UK of alcohol abuse at up to £20 billion per year. Worldwide, the World Health Organisation estimates that alcohol abuse costs countries between 1% and 6% of GDP annually.
- Alcoholism typically reduces a person’s life expectancy by around 10 years. Between 3% and 15% of alcoholics commit suicide, and alcohol or other drugs are a factor in over 50% of all suicides.
- Worldwide, of individuals reporting alcohol dependence, over a quarter are still dependent a year later.
- In the UK, in 2016 nearly 150,000 people were treatment for problematic or dependent drinking.
- Almost half of all people in treatment for alcohol addiction in the UK successfully complete their treatment free of alcohol dependence.
Get Help Today
Alcohol addiction is a dangerous and devastating condition. Those suffering from the burden of alcohol addiction and dependence are placing their lives at risk, as well as causing potentially permanent damage to important relationships and life prospects.
If you are addicted to alcohol, you may feel a sense of hopelessness at how alcohol has come to dominate your life. However, it is important to remember that if you are prepared to reach out for help, that help is available. There are treatment facilities across the UK specialising in the treatment of alcohol addiction that have transformed and saved countless lives.
Don’t spend any longer suffering with alcohol addiction.
Get in touch with your GP and/or an addiction specialist today to discuss the treatment options that might be available to you, including medication to help you reduce your alcohol consumption and minimise the impact of alcohol withdrawal. The sooner you make that call, the sooner you can take back control of your life and set out on the road to recovery and the happy, healthy life that can still be yours.
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