Detoxification is an option if you are alcohol-dependent.
Alcohol dependence and withdrawal symptoms
If you are alcohol-dependent you have a strong desire to drink alcohol. In addition, your body becomes used to lots of alcohol. Therefore, you may 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 often difficult because of the withdrawal symptoms.
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.
Detoxification 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, whilst 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.
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.
Detoxification 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 the following:
- Little home or social support.
- A history of severe withdrawal symptoms.
- A physical illness caused by alcohol.
- Previous attempts to stop alcohol which 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.
You may be admitted to hospital if you have serious alcohol-related problems such as delirium tremens or withdrawal seizures, or if you are aged under 16 and have withdrawal symptoms.
Other groups of people sometimes offered hospital admission for detox include those with learning difficulties, social difficulties or lots of different illnesses.
After detoxification and staying off alcohol
After a successful detox, some people go back to drinking heavily again at some point (a relapse). To help to prevent a relapse you may be offered medication or other help.
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. It is usually started in hospital and continued by GPs.
- Naltrexone is an alternative to acamprosate but it is usually only prescribed by specialists.
- Disulfiram is another medicine which is sometimes recommended by hospital specialists 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.
- Baclofen is a medicine that is reported in some medical studies to help some people to stay off alcohol or to reduce drinking quantity. It may also reduce craving and reduce anxiety in alcohol-dependent people. However, the evidence for the effect of baclofen is conflicting and other studies do not support these reports. More research is needed to clarify whether baclofen is helpful. Note: it is currently not licensed for the treatment of alcohol related problems.
It is thought that you are less likely to go back to drinking heavily if you have counselling, or other support to help you to stay off alcohol. Your doctor, practice nurse, or local drug and alcohol unit may provide ongoing support when you are trying to stay off alcohol. Self-help groups such as Alcoholics Anonymous have also helped many people to stay off alcohol.
If you do go back to heavy drinking, you can always try again to stop or cut down. Some people take several attempts before they stop drinking, or keep within the safe limits, for good.
Further help & information
Dr Tim Kenny
Dr Laurence Knott
Dr Tim Kenny