Alcohol Detoxification

Alcohol dependence and withdrawal symptoms

If you are alcohol dependent you have a strong desire to drink alcohol. In addition, your body is so used to lots of alcohol that you start to develop 'withdrawal' symptoms 3-8 hours after your last drink, as the effect of the alcohol wears off. So, even if you want to stop drinking, it is difficult because of the withdrawal symptoms.

The withdrawal symptoms include: feeling sick, trembling, sweating, craving for alcohol, and just feeling awful. Convulsions occur in a small number of cases. As a result, you drink alcohol regularly and 'depend' on it to prevent these symptoms. If you do not have any more alcohol the withdrawal symptoms usually last 5-7 days, but a craving for alcohol may persist longer.

Delirium tremens ('DTs') is a more severe reaction after stopping alcohol. It occurs in about 1 in 20 people who have alcohol withdrawal symptoms about 2-3 days after their last drink. Symptoms include: marked tremor (the shakes) and delirium (agitation, confusion, and seeing and hearing things that are not there). Some people have convulsions. Complications can develop such as dehydration and other serious physical problems. It is fatal in some cases.

What is detoxification?

Detoxification or 'detox' involves taking a short course of a medicine which helps to prevent withdrawal symptoms when you stop drinking alcohol. The most commonly used medicine for detox is chlordiazepoxide. This is a benzodiazepine medicine.

Detox with the help of your GP

Many GPs are happy to prescribe for detox from alcohol. A common plan is as follows.

• A GP will prescribe a high dose of medication for the first day that you stop drinking alcohol.
• You then gradually reduce the dose over the next 5-7 days. This usually prevents, or greatly reduces, the unpleasant withdrawal symptoms.
• You must agree not to drink any alcohol when you are going through detox. A breathalyser may be used to confirm that you are not drinking.
• Your GP or practice nurse will usually see you quite often during the time of detox.
• Also during detox, support from family or friends can be of great help. Often the responsibility for getting the prescription, and giving the detox medicine is shared with a family member or friend. For example, a partner or parent of the person going through detox.

How will I feel going through detox?
Some people manage quite easily, others find it more difficult. You can expect to:

• Feel quite nervous or anxious for a few days.
• Have some difficulty with getting off to sleep for a few nights.
• Have some mild withdrawal symptoms, but they should not be too bad, and a lot less than if you were not taking the detox medicine.

The medication used for detox does not make you stop drinking. You need determination to stop. The medication simply helps you to feel better whilst your body readjusts to not having alcohol. Even after the period of detox you may still have some craving for alcohol. So you will still need willpower and coping strategies for when you feel tempted to drink.

Vitamin supplements
You are likely to be prescribed vitamins, particularly vitamin B1 (thiamine), if you are alcohol dependent. Especially during detox. This is because many people who are dependent on alcohol do not eat properly and can lack certain vitamins. A lack of vitamin B1 is the most common. A lack of this vitamin can cause serious brain conditions.

Detox with the help of other health professionals

Some people are referred to a specialist drug and alcohol unit for detox. This is usually better for people who have other physical or mental health problems and for those who have:

• little home or social support.
• a history of severe withdrawal symptoms.
• a physical illness caused by alcohol.
• had previous attempts to stop alcohol and have failed.

The medicines used to detox in specialist units are much the same as GPs prescribe. However, these units have more staff and expertise for giving support and counselling. Some people with serious alcohol related problems are admitted to hospital to detox.

After detoxification and staying off alcohol

After a successful detox, some people go back to drinking heavily again at some point. To help to prevent a 'relapse' you may be offered medication or other help.

Medication
You may be advised to take a medicine for several months to help you keep off alcohol.

• Acamprosate is a medicine which helps to ease alcohol cravings.
• Disulfiram is another medicine which is sometimes used following a successful detox. When you take disulfiram you get very unpleasant symptoms if you drink any alcohol (such as flushing, vomiting, palpitations and headache). So, in effect, the medicine acts as a deterrent for when you are tempted to drink. It can help some people to stay off alcohol.