St Vincent's Hospital, FairviewMental Health Addiction Service

Detoxification

Stopping drinking suddenly or a severe reduction in intake can cause withdrawal symptoms, particularly for the heavy or dependent drinker. These symptoms vary from mild e.g. insomnia and mild anxiety to symptoms as severe as withdrawal seizures and delirium tremens (D.T.’s)

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The purpose of detoxification is to reduce or minimise the occurrence of withdrawal symptoms. Although detoxification from alcohol is a fairly common, vigilance is still required to ensure that it is safely managed and to detect complications.

Detoxification as an outpatient is effective and safe for people with mild to moderate symptoms and may, but not always, include the prescribing of medications to manage symptoms. Most people withdrawing from alcohol can be effectively treated by their GP.

If you are discussing stopping alcohol with your doctor, tell them if;

1.  You are taking other medication
     This includes both prescribed, over the counter and herbal preparations
2.  You are using any drugs other than alcohol e.g. cannabis, ecstasy, cocaine etc.
3.  You want to abstain totally from alcohol or want to cut down
4.  You have had other outpatient detoxifications
5.  You drank recently
6.  You are benzodiazepine dependent

 

Factors that may predict more severe withdrawal are

(a)   Recent high levels of alcohol consumption
(b)   Previous history of severe withdrawals
(c)   Previous history of seizures or delirium
(d)   Use of other psychoactive drugs
(e)   Poor physical health
(f)    High levels of anxiety and other psychiatric / mental health disorder
(Rastrick, 2001)

Repeated withdrawals /detoxifications, over time may increase the likelihood of severity – known as the kindling effect. For more information on this topic see: www.niaaa.nih.gov and use their search facility



Medications Used in Outpatient Alcohol Detoxification:

Benzodiazepines are the main group of drugs used in outpatient settings for alcohol detoxification. They are usually prescribed in reducing doses over a few days.


There is evidence to support the use of Chlordiazepoxide as the first drug of choice for the management of alcohol withdrawal. (Williams & McBride, 1998, Rastrick, 2001)
    1.   It has a higher margin of safety if taken with alcohol
    2.   Has a lower addictive potential and
    3.   Can be uniquely identified in toxicology screening

As its half-life is 6–30hrs and has active metabolites with half-lives of up to 78 hours, there is a risk of it building up, particularly in the elderly. Lower dosages may be used in the elderly or for persons with liver damage

Shorter acting benzodiazepines may be preferred with the elderly or in patients with markedly impaired liver function however; their short half-life increases the addictive potential and also risks the occurrence of seizures if tapered too severely.
(Rastrick, 2001)


Where high dosages of chlordiazepoxide are required, it may be preferable to use Diazepam.

For full prescribing information on these and other medications visit www.hpra.ie or www.medicines.ie