Alcohol detoxification, or 'detox', for individuals
with alcohol dependence is the abrupt cessation of alcohol intake
coupled with the substitution of alcohol with cross-tolerant drugs
that have similar effects in order to prevent alcohol withdrawal.
Detoxification may or may not be necessary depending upon an
individual's age, medical status, and history of alcohol intake. For
example, a young man who binge drinks and seeks treatment one week
after his last use of alcohol may not require detoxification before
beginning treatment for alcoholism. Benzodiazepines are the most
common family of drugs used for this, followed by barbiturates.
Benzodiazepines
Detoxes are performed in multiple ways:
1. The first option takes into consideration the varying degrees of
tolerance. In it, a standard dose of the benzodiazepine is given
every half hour until light sedation is reached. Once a baseline
dose is determined, the medication is tapered over the ensuing 3-10
days.
2. Another option is to give a standard dose of benzodiazepine based
on history and adjust based on withdrawal phenomenon.
3. A third option is to defer treatment until symptoms occur. This
method should not be used in patients with prior alcohol related
seizures. This has been effective in randomized controlled trials. A
non-randomized, before and after, observational study found that
symptom triggered therapy was advantageous.
Dosing of the benzodiazepines can be guided by the CIWA-Ar scale.
The scale is available online.
Regarding the choice of benzodiazepine:
* Chlordiazepoxide (Librium®) is the benzodiazepine of choice in
uncomplicated alcohol withdrawal.
* Lorazepam or diazepam are available parenterally for patients who
cannot safely take medications by mouth.
* Lorazepam and oxazepam may be best in patients with cirrhosis
(shorter half life).
