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Articles of Interest:

Alcohol Treatment

Alcohol Use and Abuse: An Introduction

Alcohol Dependence, Abuse and Intoxication

Alcohol Withdrawal

Addiction and Abuse Related Disorders

Alcohol Related Psychotic and Mood Disorders

Alcohol Induced Anxiety, Sleep & Sexual Disorders

Alcohol Abuse: How do you assess a problem?

Alcohol Abuse and Related Medical Illnesses

Alcoholism Gene Factors Show Up in Very Young

Negative Effects of Alcohol Abuse on Women

Negative Effects of Alcohol Abuse on Adolescents and the Elderly

Alcohol Abuse Treatment

Alcohol Abuse: Matching Treatment With Individuals

Managing Alcohol Withdrawal

Alcohol Abuse Treatment: Psychosocial Interventions   

Men Tend To Crave Alcohol More Than Women 

Addiction Recovery - The Key to Abstinence     

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Managing Alcohol Withdrawal for Treatment Success 

Alcohol withdrawal: 

The management of alcohol withdrawal through detoxification is an incredibly important initial intervention for a significant number of alcohol dependent individuals. The objective of alcohol withdrawal is maintaining some comfort as the alcoholic goes through the early stages of treatment, the prevention of treatment complications, and preparing the individual for alcohol rehabilitation.  The successful management of alcohol withdrawal is an important aspect of preparing an individual for subsequent efforts at alcohol rehabilitation. 

Medical screening for concurrent medical problems is also an important aspect of treatment at this stage of the attempted alcohol rehabilitation, in addition to the management of alcohol withdrawal symptoms.  Frequently, doctors will administer thiamine (50-100 mg by mouth or I M) and multivitamins, for a low cost, low risk intervention, for the prophylaxis and treatment of alcohol related neurological disturbances.  In addition to good supportive care and the treatment of concurrent illness, this stage will also include fluid and electrolyte repletion. 

Social detoxification which involves the nonpharmacological treatment of alcohol withdrawal has also been shown to be effective.  This involves frequent reassurance, reality orientation, personal attention, monitoring of vital signs and general nursing care.  Social detoxification is most appropriate for individuals with mild to moderate alcohol withdrawal symptoms.  Many individuals have significant medical problems associated with alcoholism which substantially complicate therapy, so it is absolutely essential that therapists refer those individuals whose conditions require medical management. 

 

Alcohol detoxification is increasingly being done on an ambulatory basis, which is much less costly than inpatient alcohol detox.  Inpatient detoxification is essential for serious medical or surgical illness and for those individuals who have a past history of adverse alcohol withdrawal reactions, or with current evidence of potentially some of the more serious withdrawal reactions such as delirium tremens. 

An assortment of medications have been used for alcohol withdrawal.  However, because they have a relatively minor side effect profile compared to some other medications, benzodiazepines have become the medications of choice for this stage of treatment.  The most frequently used benzodiazepines include diazepam and chlordiazepoxide, although all benzodiazepines have been found to suppress alcohol withdrawal symptoms.  These are frequently used because they are metabolized into long acting compounds which in effect help to self-taper these medicines from your system. Because these medications are metabolized through the liver, impaired liver functioning may complicate their use however. Oxazepam and Lorazepam are not oxidized into long-acting metabolites and thus carry less risk of accumulation. 

Although Carbamazepine appears to be useful as a primary treatment for alcohol withdrawal, it has frequently been found that the liver dysfunction that alcoholics experience may affect its metabolism, making careful blood level monitoring necessary.  Antipsychotics are not usually used in the treatment of withdrawal except in those instances where hallucinations or severe agitation appear, at which times they should be added to the benzodiazepine.  In addition to their potential for producing extrapyramidal side effects, antipsychotics also lower seizure threshold, which may be very problematic during alcohol withdrawal.

From DSM-IV-TR Mental Disorders: Diagnosis, Etiology and Treatment by Michael B. First and Allan Tasman

Additional Information and webpage by Paul Susic  MA Licensed Psychologist   Ph.D. Candidate  (Health and Geriatric Psychologist)

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