Alcohol Withdrawal Medication – Alcohol withdrawal refers to a cluster of symptoms that occur from abrupt cessation of alcohol use following chronic or prolonged consumption. Withdrawal management (also commonly referred to as a medical detox) is a process in which a patient is supervised and treated while his or her body is eliminating toxins associated with drug or alcohol use.
Withdrawal management is designed to help those recovering from a substance use disorder to better cope with withdrawal symptoms once they discontinue the use of their substance of choice. During a medical detox, a variety of alcohol withdrawal medications may be used to relieve certain symptoms and prevent dangerous complications.
Medications Used for Alcohol Withdrawal Management
According to the American Society of Addiction Medicine (ASAM), the standard protocol to treat alcohol withdrawal symptoms is through the use of benzodiazepines (benzos). Benzos are primarily used to treat anxiety, control seizures, and to promote sleep. Research has also found that benzos are effective in managing even more complex withdrawal symptoms in those who are attempting to recover from alcohol use disorders.
The process usually involves administering a dose of a benzodiazepine (e.g., Librium, Ativan, Valium, or some other long-acting benzo) to manage the majority of the withdrawal symptoms a person is experiencing. Using this protocol, most symptoms, including hallucinations, anxiety, and seizures, can be reduced or prevented. In some instances, several other medications can be used, but the standard procedure is to use a benzo as the primary alcohol withdrawal medication.
Unfortunately, benzos also have the potential for abuse and induce symptoms comparable to alcohol intoxication when misused. For this reason, persons who receive benzo medications during the withdrawal process may be weaned immediately following discharge from detox or supervised closely by a physician over weeks or months, during which time the dosage is gradually tapered down.
Some research has suggested that certain antihypertensive medications, such as Catapres (clonidine), may be useful in treating alcohol withdrawal. The drug may assist in managing mild or non-complicated alcohol withdrawal symptoms, such as moodiness, high blood pressure, sweating, tremors, anxiety, and irritability.
Anticonvulsants and Muscle Relaxers/Antispasmatics
Certain types of anticonvulsant drugs may be beneficial in the treatment of some symptoms of alcohol withdrawal, including those used for seizure control. The drug Neurontin (gabapentin) has been used to treat seizures in persons undergoing alcohol withdrawal and may help to address some other symptoms, including nausea, tremors, anxiety, and high blood pressure.
The drug Topamax (topiramate) is FDA-approved to treat seizures but has not been approved to treat complications associated with alcohol use disorders. Its mechanism of action is comparable to the drug Campral (acamprosate) and may help in managing alcohol cravings. The drug Lioresal (baclofen) is a muscle relaxant that may also be helpful in reducing cravings during the withdrawal process that occur in those recovering from alcohol use disorders.
People who are experiencing hallucinations may receive antipsychotic medications to control hallucinations until the condition has stabilized. Antipsychotic drugs may be beneficial in treating individuals who are psychotic and aggressive and may allow treatment professionals to initiate other medical procedures to help stabilize them.
If individuals encounter other mild symptoms, they may be prescribed medications to address these issues, as well. These problems can include discomfort associated with headaches, nausea, irritability, insomnia, etc.
Medication for the Treatment of Alcoholism
The Food and Drug Administration (FDA) has approved three medications for the treatment of alcohol use disorders. These medications include disulfiram, naltrexone, and acamprosate, none of which directly address withdrawal symptoms.
Disulfiram (Antabuse) was the first alcohol withdrawal medication approved by the FDA. When a person uses Antabuse, the body can no longer metabolize acetaldehyde, a toxic byproduct that is produced by alcohol consumption. This action causes the toxin to accumulate in the systems of those who drink. The presence of large amounts of acetaldehyde causes extremely uncomfortable side effects, including nausea and vomiting, sweating, and headaches.
Ideally, Antabuse should cause an adverse reaction to alcohol that is so incredibly unpleasant that the alcoholic will avoid drinking at all costs. Nevertheless, alcoholism is a chronic and often unyielding disease, and many people in its grip continue to drink even after taking Antabuse, or simply stop using it.
For this reason, Antabuse has a high rate of non-compliance among patients, so physicians are often hesitant to prescribe the drug. Nonetheless, research indicates that Antabuse can be effective when used as part of a comprehensive treatment program that also includes behavioral therapy and other evidence-based approaches. Even so, because Antabuse causes a buildup of toxins, drinking heavily while using Antabuse can lead to serious complications, including death.
Naltrexone is commonly sold under the brand names ReVia (oral tablets) and Vivitrol (monthly injections). Its primary mechanism of action is as an opioid antagonist, meaning that it alters the way in which the brain responds to opioid exposure, as well as exposure to alcohol, as a side effect. Naltrexone hinders some of the neural receptors that respond to the presence of alcohol, thereby reducing its pleasurable effects.
When consumed orally as a tablet, naltrexone must be used exactly as directed for the drug to be effective. When delivered via injection, however, the drug only needs to be administered once a month. This ease of use may foster compliance because there is no need to take a pill daily, so the patient cannot suddenly decide to skip a dose in favor of relapse.
However, the injectable formulation of naltrexone can also cause problems of its own, including pain, infection, or tissue damage at the injection site. Naltrexone in either form can produce side effects such as headaches, nausea, and fatigue. Using too much naltrexone can also cause liver damage.
Acamprosate (Campral) is the most recent drug to be approved for the treatment of alcoholism. Like naltrexone, acamprosate acts on the brain by altering it’s response to alcohol, so that the person taking it is less likely to experience cravings. Acamprosate may also reduce some of the chronic physical effects of alcohol withdrawal, such as depression, jitteriness, and sleep disturbances.
Research has revealed that alcoholics who had taken acamprosate experienced lower relapse rates and a greater number of sober days than people who hadn’t use it. Naltrexone and acamprosate are commonly prescribed together, and this combination can make treatment even more effective.
Treatment for Alcoholism
While medication-assisted therapy can be very effective at reducing withdrawal symptoms and helping people remain sober long-term, they are not a substitute for formal therapy. Rather, they should be used in conjunction with a comprehensive treatment program that also includes psychotherapy, individual and group counseling, peer support groups, health and wellness programs, and aftercare planning.
Harmony Recovery Center offers these services in both partial-hospitalization and intensive outpatient formats. We employ highly-skilled addiction specialists who facilitate these services and provide patients with the tools, resources, and support they need to experience a full recovery and begin to reclaim the health and satisfying lives they deserve.
If you or a loved one is struggling with an alcohol use disorder, please contact us today. Discover how we help people free themselves from the grips of substance abuse so they can experience long-lasting sobriety, happiness, and wellness!
Related: What Is Post-Acute Withdrawal Syndrome (PAWS)?