Utilizing Alcohol Detox Medication in Treatment
For a person with advanced alcoholism, a drink is the perfect solution to almost any problem. A happy mood is a cause worth celebrating, while a really negative day must be forgotten with a drink. A party deserves a toast, while an evening alone is best spent with a bottle. In time, people like this can become accustomed to looking outside of their bodies for solutions to almost any problem, instead of leaning on their inner strength when times are tough. It’s a habit that must be broken in alcoholism rehab programs, but in those programs, people with alcoholism might be provided with medication management. It might sound unusual to lean on medications in a program that hopes to build up inner strength, but some people really do benefit from this kind of therapy. Since alcohol is such a dangerous drug, and since the changes alcohol can cause can be long-lasting and persistent, medications might prove vital in the fight for long-term sobriety. The medications that are used, and the length of time they’re provided, can vary dramatically from person to person, however.
The Withdrawal Process
The website NHS Choices suggests that a healthy, average body can break down about 10 milligrams of pure alcohol in about an hour. This means that a healthy person drinking a large glass of wine needs about three hours in order to process all of the alcohol inside that goblet. Even when sobriety returns, however, the alcohol might still be working inside that person’s body, slowing down brain cells and keeping active tissues in a persistent state of sedation. The person might not know those changes are taking place, and the differences might not be easy to feel, but the problems are real and they can become deadly when an alcoholic person decides to stop drinking altogether.
A modified, sedated brain is incapable of processing information at a normal speed. All of the cells aren’t quite ready to be connected, and they may not be ready to handle input from nearby cells. If this modified brain is exposed to sobriety and all of those sleepy cells wake up fast, electrical signals can move much too quickly from cell to cell, bouncing along at a rapid pace in a haphazard manner.
As a result, the person might feel:
Medications can soothe this process and allow people to return to a more reasonable state of functioning, but without that help, symptoms can progress. In time, people can hallucinate and become extraordinarily agitated. Their extremities may shake and they may pace and holler for help. In time, people like this may even experience seizures.
People who go through this episode even once are at an increased risk for seizures in the future, as the damage they endure tends to make their brain cells vulnerable to new alcohol withdrawal problems.
While medications might be helpful in allowing people to avoid seizures during withdrawal, other medications might be helpful in allowing people to avoid drinking in the future, so they won’t ever face these problems again.
People who are experiencing these thought changes and movement abnormalities during withdrawal are often provided with benzodiazepine medications like oxazepam. These medications seem to quiet a mind that’s overactive and wild, soothing it and slowing it to a pace it can handle. These medications can be provided at a high dose early in the process, and medical experts can slowly reduce the amount of drugs given until no drugs are needed at all.These medications can also cause some undesirable side effects, including addiction, as they tend to cause a boost in signals the brain interprets as pleasurable. These drugs also seem to be popular among people who like to mix their medications with alcohol, and the Center for Behavioral Health Statistics and Quality suggests that about 40 percent of people who enter treatment programs use both alcohol and drugs at the same time. This doesn’t mean that benzodiazepines don’t have a role to play in treating addiction, but it does mean that people who use these therapies should only lean on them for a matter of days, not a matter of months. Since these drugs have been linked to addictions, they’re just not really safe for people who have an addictive history.
Some types of seizures have been effectively handled with medications.
The seizures caused by alcohol withdrawal, however, seem to be just a little different than other kinds of seizures and they need their own special care.
There is some evidence that suggests that adding in a little anti-seizure medication to a therapy begun with benzodiazepines can be effective. These drugs can help to ease the workload a benzodiazepine medication is asked to do, and they could allow people to take smaller doses as a result. This may also reduce the risk of addictions to these therapies, as people won’t be taking such massive doses as they heal. Other medications made to treat blood pressure conditions might also be useful for people in the early stages of withdrawal, as these medications can slow down a galloping heart and keep tremors in the limbs from forming. These medications are also typically provided in concert with benzodiazepines, however, as they’re not really considered a front-line treatment for alcohol-withdrawal disorders.
Some of the very real problems experienced by people during alcohol withdrawal can be directly related to a lack of vital nutrients. For example, in a study in the journal Alcohol and Alcoholism, researchers report that thiamine (also known as vitamin B1) deficiency that could cause brain damage isn’t typically diagnosed in 80 to 90 percent of alcoholics before they lose their lives to the disease. Deficiencies like this can make clear thinking difficult, and some people develop significant movement disorders without access to the proper suite of vitamins and minerals. A supplementation program may help, as experts can provide their clients with the specific ratio of vitamins they need as they heal.Taking supplements like this is considered intensely safe, as the potions and pills aren’t considered addictive and their use typically doesn’t become compulsive and out of control. Even so, the use of supplements like this should be under the control of a medical professional, as some types of supplements have been linked to physical harm due to overdose.
Worse yet, some people with alcoholism need massive doses of vitamins that they wouldn’t possibly consider taking on their own, and without the proper doses, their temporary disabilities may be permanent. It’s best to undertake these issues with the help of an expert.
While medication management of the withdrawal stages of alcoholism is considered traditional and typical, there are some facilities that continue to provide medication when detox is through, hoping to provide people with the boost they’ll need to continue to stay sober when detox is complete.
Of the medications used, these are the most popular:
- Revia (naltrexone)
- Vivitrol (naltrexone)
- Antabuse (disulfiram)
- Campral (acamprosate)
Some of these medications work by blocking the good feelings alcohol can bring about. Others can block alcohol cravings. Still others can make people feel physically ill when they do drink alcohol.
For some people, these medications can be remarkably helpful. A woman interviewed about naltrexone by the New York Times, for example, reports that she couldn’t have made it to sobriety without the drug. It blunted her cravings, she says, and that allowed her to put her lessons from therapy into good use, and in time, she didn’t need the help of the medication. Her skills got stronger, and they took the place of the medication.
This kind of first-person experience has also been backed up by robust research. For example, an article in the British Journal of Psychiatry found that those people given disulfiram therapy were able to reduce their drinking by 162 units per week, and two-thirds of the people in this study found that the medication was so important and useful that they asked to continue with the medication when the study was complete. This kind of result seems to indicate that medications really might help some people to make great strides in therapy, and that people who get medications might enjoy the help they can provide.
Words of Warning
Just because medications can be helpful for some people doesn’t mean they’re right for everyone. Some people have different body chemistries, and their bodies just don’t seem to respond to the medications. It’s also worth noting that these medications can deliver some very nasty side effects, and some people choose not to continue with therapy as a result. The treatments only work as long as they’re continued regularly, so those who don’t take their pills may have a gap during which an addiction can creep back in.
These treatments also can’t really deal with the inner triggers that lead to an addiction. All of the memories, pain and habits that have supported the addiction are still in place, whether medications are present or not, and all of those issues are best addressed in a comprehensive treatment program.
Therapy and support group meetings can help people to deal with these problems, while taking pills can certainly leave the problems in place.
Some people who take medications like this also develop a false sense of confidence, as they don’t have intense cravings or a physical need for alcohol. People like this might skip out on their therapy sessions, as they feel “cured,” but they could be on the road to a relapse as soon as the next stressful situation hits.
Proceeding With Care
Most treatment programs provide medications to help people who are in medical crisis due to alcohol detoxification. These facilities are designed to keep people alive and to keep them well, and they’re obligated to step in with therapies when a client is about to die due to a very real medical condition. Aside from that, however, the use of medications falls into a bit of a grey area. Some facility administrators believe, with everything they have, that medication use really should end when detox ends, and that clients need to learn to use the power of the mind instead of leaning on the power of the drug. That thinking may explain why, in 2007, an editorial in JAMA suggests that “few” treatment programs provide medications like acamprosate and naltrexone. If the administrators don’t believe that medications are the answer, they may not provide them.
But even facilities that do provide medications may not hand them out to each and every person who walks through the door.
Some people may not need the hand of a pharmacy to get better, and some people have medical conditions that make medication therapy impractical.
Similarly, most facilities allow clients to weigh in on their treatment programs, and some clients may resist the idea of popping a pill to deal with an addiction. These clients may not take medications, even if they’re provided, as they may believe the drugs will hamper their healing. They may be right.
At The Orchid, we provide medications on a tailored basis, using a client’s medical history, current needs and personal preferences as a guide. When it comes to addictions, a one-size-fits-all approach is never a great idea. Instead, we strive to provide care that’s personalized, and that begins with our approach to medication management. If you’d like to know more about this, please call.