Alcohol addiction treatment –
withdrawal

Addiction assessment

The way how alcohol withdrawal treatment will be driven is considered individually. Every patient needs special care and assess. First step which is used in most cases by physicians is making an interview according to simple but effective alcohol scale. Patient is asked few questions and observed. Depending on intensity of some withdrawal syndromes intensity and type of pharmacological withdrawal treatment is chosen in an appropriate fashion. It's easy, quick and convenient for patients way of estimation of the problem scale.

Questions during alcohol withdrawal assessment that are always being asked by doctors are:

• Do you feel sick to your stomach?
• Have you vomited?
• Have you any itching, pins-and-needles sensations, any burning, any numbness, or do you feel bugs crawling on or under your skin?
• Are you more aware of sounds around you? Are they harsh?
  Do they frighten you?
• Are you hearing anything that is disturbing to you?
  Are you hearing things that you know aren't there?
• Does the light appear to be too bright? Is its color different?
  Does it hurt your eyes?
• Are you seeing anything that is disturbing you?
  Are you seeing things that you know aren't there?
• Do you feel nervous?
• Does your head feel different?
  Does it feel like there is a band around your head?
• What day is this?
• Where are you?
• Who am I?

You can check out whole test in detail here: 'Alcohol addiction treatment – Alcohol Scale'. Answers and doctor's observations are rated by scores. Total scores possible to get is 67, of course the less the better.

Treatment rudiments

Alcohol withdrawal syndromes are treated by benzodiazepines because they are relatively safe (comparing with other potential medicaments which might be used for this purpose) and their efficiency in decreasing delirium frequency is proven. Interestingly, benzodiazepines taken by someone who's intoxicated by alcohol are safer, than benzodiazepines taken by health, 'chemically pure' person. In consequence higher doses than normal may be introduced with lower risk. This is a so-called cross-tolerance – a pharmacological phenomenon – and it's quite a striking feature. However, cross-tolerance is rather common, and well known for physicians. Simple example of cross-tolerance from our everyday life is that people who smoke cigarettes exhibits a physiological resistance to caffeine. Hence, 'energetic' influence of coffee on their organisms is not as intensive as within no-smokers.

Treatment medicaments

Benzodiazepines used during treatment are (1) long-acting agents like chlordiazepoxide and diazepam (first one is safer because of lower abuse potential that later one), and (2) shorter-acting agents like oxazepam and lorazepam (used also during alcohol detox, read more in 'Alcohol detox' article).

Short-acting lorazepam is used for alcohol addiction treatment preferentially when treated patient is older than 65 (or there is an evidence of pulmonary or liver dysfunction) while long-acting agent chlordiazepoxide is used in all other cases.

Additional medicament during treatment is thiamine which prevents some painful neurological syndromes like loss of short-term memory, ataxia, confusion (all called Wernicke's encephalopathy). Thiamine also helps to prevent amnestic-confabulatory syndrome called Korsakoff's amnestic syndrome.

Currently, some hopes are placed on medicaments called carbamazepine and valproate as helpful agents for future alcohol withdrawal treatment improvement.