Substance Withdrawal and Treatment Options

Get support from your doctor, friends, and family when you’re ready to stop drinking. That way, they can help you alcohol withdrawal syndrome symptoms manage the discomfort and respond quickly in case of a medical emergency. It also serves a lot of other important functions, such as keeping your nervous system healthy. Many people who go through alcohol withdrawal no longer have enough thiamine in their body. If your doctor feels you’re at risk, it will be important for you to have a thiamine supplement by IV for several days.

• In patients who present with seizures, a thorough neurological and general medical evaluation is a must to detect alternative cause of seizures.
• The most effective approach is medically supervised detoxification, which involves tapering alcohol intake or using medications such as benzodiazepines to manage withdrawal symptoms safely.
• A doctor can often diagnose alcohol withdrawal syndrome by taking a person’s medical history and performing a physical exam.

Recognizing Patients at Risk for AUD

Articles not relevant to clinical management were excluded based on the titles and abstract available. Full-text articles were obtained from this list and the cross-references. There were four meta-analyses, 9 systematic reviews, 26 review articles and other type of publications like alcoholism symptoms textbooks. Complicated alcohol withdrawal presents with hallucinations, seizures or delirium tremens. Benzodiazepines have the best evidence base in the treatment of alcohol withdrawal, followed by anticonvulsants.

General supportive care

Individuals with mild alcohol use disorder who drink moderately are less likely to experience withdrawal, as their nervous system does not undergo neurochemical adaptations. Alcohol withdrawal starts between 6 to 24 hours after the last drink, depending on the severity of alcohol dependence and individual metabolism. Early symptoms, including anxiety, tremors, nausea, and headaches, emerge as the brain compensates for the absence of alcohol’s depressant effects. Symptoms of alcohol withdrawal range from mild (e.g., anxiety, tremors, sweating) to severe (e.g., seizures, hallucinations, delirium tremens). In these cases, we recommend that patients should be started immediately on a SML dose regimen, while monitoring the withdrawal severity (CIWA-Ar ratings) and clinical signs of tachycardia and hypertension. A fixed dose regimen can be safely used in such patients in case adequate trained personnel are not available or if outpatient treatment is advised.

Substance Withdrawal: Symptoms and Treatment Options

Symptoms of opioid withdrawal vary based on the type of opioid used. Abruptly stopping short-acting opioids (e.g., heroin, hydrocodone) generally causes more severe opioid withdrawal symptoms, with symptom onset occurring 12 hours after the last dose. While most symptoms of nicotine withdrawal are not life-threatening, nicotine may increase symptoms of depression and anxiety for some time. Trials comparing different AWS treatment strategies did not find clear evidence of the superiority for one of these regimens 62–64.

In general, the course of alcohol withdrawal is highly variable and somewhat unpredictable. Screening and assessment tools do not allow physicians to predict with confidence who will or will not experience life-threatening symptoms. Those experiencing mild alcohol withdrawal symptoms or who are concerned about experiencing withdrawal symptoms will benefit from the advice of a physician or clinician trained to assess and treat patients in alcohol withdrawal. Symptoms outside of the anticipated withdrawal period or resumption of alcohol use also warrants referral to an addiction specialist or inpatient treatment program. Because of the severity and complications that can arise from AWS, it is important to be familiar with proper treatment.

What Are the Risk Factors of Alcohol Withdrawal?

This guideline describes AWS and offers recommendations for identification, evaluation, and management of AWS in the hospital setting. Alcohol withdrawal is caused by the abrupt cessation of alcohol consumption in patients with alcohol dependence or chronic alcoholism. If you already have alcohol use disorder, it’s important to seek counseling and medical care as soon as possible.

Table of Contents

Over weeks or months, you’ll have smaller or fewer drinks until you reach a point where you don’t have any at all. Eating healthy foods, trying to get exercise, and getting enough sleep can help reduce some withdrawal symptoms, such as mood swings. If you take prescription medication, continue to take it as directed. Your healthcare provider will recommend and encourage treatment for alcohol use disorder. The main management for severe symptoms is long-acting benzodiazepines — typically IV diazepam or IV lorazepam. At Renaissance Recovery our goal is to provide evidence-based treatment to as many individuals as possible.

Common Symptoms of PAWS

Baclofen seems to be an easily manageable drug, without significant side effects. At the prescribed doses, there have not been any reports of euphoria or other pleasant effects caused by the drug. Although these data are encouraging, further confirmatory studies are needed to establish the role of baclofen in AWS. Baclofen showed its efficacy in alcohol relapse prevention 100, 101 suggesting that it could represent a promising drug in the treatment of both AWS and post-withdrawal 102.

Clinical management of alcohol withdrawal: A systematic review

The sooner you start treatment (which often includes both medication and therapy) the better your outcome. Your risk of having a seizure is highest within the first 12 hours after stopping or reducing alcohol. You’re also at a higher risk if you have a history of epilepsy, hypoglycemia, or an electrolyte imbalance. If you’re getting through alcohol withdrawal at home, here’s what can help.