Substance Use

Medications for Alcohol Withdrawal Syndrome: What You Need to Know

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People who are suffering from alcohol addiction are often afraid to stop drinking or seek professional help because of the overwhelming symptoms of alcohol withdrawal. The good news is there are several medications approved to help mitigate the worst effects of alcohol withdrawal. (1)

This can allow people to detox from alcohol comfortably without feeling like their only option to counter the effects is to pick up the bottle. Luckily, we will take a look at the different medications to treat the side effects of alcohol withdrawal and how to seek treatment for alcohol use disorder.

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What is Alcohol Withdrawal Syndrome?

Alcohol withdrawal syndrome (AWS) is a complex condition that arises when individuals who have been heavy alcohol consumers or have developed alcohol dependence suddenly discontinue or reduce their alcohol intake. This syndrome includes a range of both physical and emotional symptoms. (2) (3)

Symptoms of Alcohol Withdrawal

These symptoms, both physical and emotional, can be detrimental for many. Some of the most common symptoms include: (4)

  • Nausea
  • Vomiting
  • Excessive sweating
  • Tremors
  • Anxiety
  • Headache
  • Disorientation
  • Increased heart rate
  • High blood pressure
  • Irritability
  • Confusion
  • Insomnia

If any of these severe symptoms appear during alcohol withdrawal, it’s crucial to immediately call 911 or go to the emergency department for prompt medical attention.

The Risks Of Alcohol Detox

Alcohol detox is the process of eliminating alcohol from the body. For many, it’s the first step in overcoming alcohol dependence. While it may be tempting to attempt detox independently, it’s essential to know the potential dangers and complications associated with alcohol withdrawal. 

In many cases, medical intervention plays a huge role in ensuring a safe and successful detoxification process.

  • Delirium Tremens (DTs): One of the most severe and life-threatening consequences of alcohol withdrawal is delirium tremens. (5) DT typically occurs in individuals with a long history of heavy alcohol consumption and can emerge within 2 to 5 days after their last drink. Symptoms of DT include severe agitation, disorientation, fever, seizures, and hallucinations. Without immediate medical intervention, DT can lead to severe health complications and, in some cases, be fatal. (6)
  • Severe Dehydration: During alcohol detox, it’s common to experience symptoms like nausea, vomiting, and excessive sweating. These symptoms can lead to severe dehydration, which, if left unaddressed, can be dangerous.
  • Electrolyte Imbalance: Chronic alcohol use can lead to significant imbalances in essential electrolytes like sodium, potassium, and magnesium. When individuals suddenly stop drinking, their bodies may struggle to regulate these electrolyte levels, which can result in cardiac arrhythmias, muscle weakness, and other serious health issues. (7)
  • Worsening Psychological Symptoms: Alcohol withdrawal can lead to intense psychological symptoms. This can include anxiety, irritability, and disorientation. Without medical guidance, individuals may struggle to manage these symptoms. Thus, potentially leading to a worsening mental health condition.
  • High Blood Pressure and Tachycardia: Alcohol withdrawal often accompanies elevated blood pressure and a rapid heart rate (tachycardia), increasing the risk of cardiovascular issues. (8)

The Role of Medical Intervention

Seeking medical intervention during alcohol detox to treat alcohol withdrawal is essential for several reasons:

  1. Assessment and Personalized Care: Healthcare providers can assess an individual’s unique situation. This includes the severity of alcohol dependence and any co-occurring health issues. They can then create a personalized detox plan to ensure safety and comfort.
  2. Medication-Assisted Treatment: In some cases, medications like benzodiazepines are prescribed to manage severe withdrawal symptoms and prevent the development of DT.
  3. Monitoring: Medical professionals can continuously monitor an individual’s vital signs and offer medical advice. This will provide early intervention if complications arise.
  4. Hydration and Nutritional Support: Healthcare providers can address dehydration and nutritional deficiencies, ensuring that individuals receive the necessary fluids and nutrients.
  5. Psychological Support: Detox can be emotionally challenging. Medical intervention often includes psychological support to help individuals manage anxiety, depression, and other emotional symptoms.

Acute Alcohol Withdrawal Treatment

The Clinical Institute Withdrawal Assessment for Alcohol is a screening tool commonly used by physicians to rate a patient’s dependence on alcohol and symptoms of withdrawal. With this tool, the provider will gain a better understanding of which medication to prescribe to help with the symptoms of withdrawal.

The most commonly used medications to treat the symptoms of alcohol withdrawal include the following:

1. Benzodiazepines

Benzodiazepines are a class of medications frequently used in the treatment of alcohol withdrawal symptoms for those with alcohol addiction. They work by calming the overactive central nervous system, which is common during withdrawal. (9)

Although researchers do not fully understand the exact way that benzos work, they know the medication enhances the effects of the neurotransmitter gamma-aminobutyric acid (GABA) in the brain, a process that slows down nerve impulses in the body and reduces the brain’s output of neurotransmitters that are necessary for: (10)

  • Alertness
  • Memory
  • Coordination
  • Emotional responses
  • Heart rate
  • Blood pressure

Benzodiazepines, or “benzos,” are known for their sedative effects and are commonly prescribed to treat conditions like:

  • Anxiety
  • Panic attacks
  • Panic disorders
  • Withdrawal seizures
  • Insomnia

Ativan (lorazepam), chlordiazepoxide, diazepam, Librium, Valium, Oxazepam (Serax), and Xanax are common examples of benzos and are often used as part of alcohol detox programs.

It’s important to note that benzodiazepines are considered highly addictive, and therefore, the use of benzos must be carefully monitored during detox, especially for people with a history of addiction. (11)

Due to the risk of addiction associated with long-acting benzodiazepines, many medical professionals recommend a symptom-triggered regimen of administering them. The guidelines recommend that the medications are dosed on objectively measured symptoms instead of a fixed dose regimen.

2. Barbiturates

While less common than benzodiazepines, barbiturates are occasionally employed for severe alcohol withdrawal cases. These medications, like phenobarbital, operate as central nervous system depressants, effectively reducing anxiety, seizures, and agitation. (12

However, they carry a higher risk of overdose and addiction, making them a secondary choice in treatment.

Barbiturates’ benefits: (13)

  • Effective in managing severe withdrawal symptoms
  • Can prevent seizures and delirium tremens
  • Rapid onset of action and excitability

Barbiturates’ considerations:

  • High risk of addiction and overdose
  • Reserved for severe withdrawal cases
  • Strictly administered under medical supervision or inpatient care

3. Anticonvulsants

Anticonvulsant medications, such as carbamazepine or valproate, are used to prevent and manage seizures during alcohol withdrawal. (14) They may not manage anxiety as effectively as benzodiazepines, but can be a safer alternative for individuals with a history of substance abuse.

Anticonvulsants’ benefits:

  • Effective in preventing alcohol withdrawal seizures
  • Lower risk of dependence compared to benzodiazepines.
  • Safer for individuals with a history of addiction

Anticonvulsants’ considerations:

  • May be less effective for managing anxiety and agitation.
  • Strictly used under medical supervision.
  • Not a primary choice for managing other withdrawal symptoms

4. Thiamine

Thiamine, also known as vitamin B1, is an important supplement during alcohol withdrawal and recovery. (15)  Excessive alcohol consumption often leads to thiamine deficiency, which can cause a severe condition called Wernicke-Korsakoff syndrome. (16)

Thiamine supplementation helps prevent or treat this deficiency and its associated neurological complications.

Thiamine’s benefits:

  • Prevents or treats thiamine deficiency
  • Reduces the risk of Wernicke-Korsakoff syndrome
  • Supports overall neurological health

Thiamine’s considerations:

  • Routine supplementation during alcohol withdrawal
  • Easily accessible as an over-the-counter vitamin
  • A necessary component of comprehensive withdrawal treatment

5. Antipsychotics

Antipsychotic medications like haloperidol may be used during alcohol withdrawal to manage severe agitation, hallucinations, and delirium. They work by stabilizing the brain’s neurotransmitters. (17) However, they are typically reserved for cases where other medications have been ineffective.

Antipsychotics’ benefits:

  • Control severe agitation, hallucinations, and delirium
  • Maintain overall safety during withdrawal
  • Reduce the risk of injury or harm

Antipsychotics’ considerations:

  • Only used when other treatments are unsuccessful
  • Medical supervision is necessary
  • May be part of a comprehensive treatment approach

6. Clonidine

Clonidine is an alpha-2 adrenergic agonist primarily used for managing high blood pressure. (18) It can also aid in controlling some alcohol withdrawal symptoms, especially when combined with other medications.

Clonidine may help reduce anxiety, tremors, and autonomic hyperactivity. (19)

Clonidine‘s benefits:

  • Reduces anxiety and certain physical symptoms
  • Complements other medications
  • Suitable for individuals with both hypertension and alcohol withdrawal

Clonidine‘s considerations:

  • Used as part of a comprehensive withdrawal plan
  • May not be effective for all withdrawal symptoms
  • Requires medical oversight and proper dosing

The choice of medication for alcohol withdrawal depends on the individual’s unique circumstances, the severity of their withdrawal symptoms, and any co-occurring medical conditions. Medical supervision and a personalized approach to treatment are vital in achieving the best results while minimizing potential risks.

Relapse Prevention and Maintenance Treatment

1. Naltrexone

Naltrexone is an opioid receptor antagonist that can aid in preventing relapse for individuals with alcohol use disorder. (20)  It works by blocking the rewarding effects of alcohol, reducing cravings and the desire to drink. Naltrexone is available in both oral and extended-release injectable forms (Vivitrol).

Naltrexone’s benefits:

  • Reduces alcohol cravings
  • Minimizes the pleasurable effects of alcohol
  • Lower risk of relapse

Naltrexone’s considerations:

  • Requires medical supervision
  • May not be effective for everyone
  • Should be part of a comprehensive treatment plan

2. Disulfiram

Disulfiram is a medication that creates an aversion to alcohol by producing unpleasant reactions if alcohol is consumed. It blocks the breakdown of alcohol, leading to symptoms like nausea, vomiting, liver disease, and severe discomfort. (21) This discourages individuals from drinking.

Disulfiram’s benefits:

  • Strong deterrent to drinking
  • Encourages abstinence
  • Acts as a psychological deterrent

Disulfiram’s considerations:

  • Can lead to severe side effects if alcohol is consumed
  • Requires strong motivation to abstain from drinking
  • Regular medical monitoring is necessary in an outpatient setting

3. Acamprosate

Acamprosate works by stabilizing the brain’s chemical balance during early abstinence. It reduces alcohol-related withdrawal symptoms and helps to maintain abstinence by alleviating protracted withdrawal symptoms. (22) This medication is more effective for individuals who have already detoxed.

Acamprosate’s benefits:

  • Eases protracted withdrawal symptoms
  • Promotes continued abstinence
  • Helps prevent relapse

Acamprosate’s considerations:

  • Typically used in combination with other treatments
  • Requires compliance with the prescribed regimen
  • Works best when a person has already stopped drinking

4. Suboxone

Suboxone is a medication that combines buprenorphine and naloxone. While primarily used to treat opioid use disorder, it has shown some potential in managing alcohol use disorder. (23) Buprenorphine, a partial opioid agonist, may help reduce alcohol cravings and withdrawal symptoms.

Suboxone’s benefits:

  • May reduce alcohol cravings
  • Offers a dual approach for co-occurring disorders
  • Reduces the risk of overdose when opioids are involved

Suboxone’s considerations: (24)

  • Off-label use for management of alcohol withdrawal syndrome
  • Requires careful medical monitoring
  • Not a stand-alone treatment for alcohol dependence

5. Baclofen

Baclofen is a muscle relaxant that has garnered attention for its potential in treating alcohol use disorder. It is believed to help reduce cravings and the pleasurable effects of alcohol. (25) While not FDA-approved for this purpose, some clinicians prescribe it off-label.

Baclofen’s benefits:

  • May reduce alcohol cravings
  • Suggested to decrease alcohol dependence
  • Potential to promote abstinence

Baclofen’s considerations:

  • Off-label use for alcohol use disorder
  • Variable effectiveness among individuals
  • Should be part of a comprehensive treatment approach

The selection of medication for relapse prevention and maintenance treatment depends on an individual’s specific needs and response to the medication. In many cases, medications are most effective when combined with counseling and behavioral therapies, offering a comprehensive approach to sustained recovery.

Medical guidance is vital in determining the most suitable medication for each person, which is what we will discuss in the next section.

How to Choose the Right Medication

Selecting the right medication for alcohol withdrawal and treatment is a decision that should be made in consultation with a medical professional. Several factors need to be carefully considered.

  1. Severity of Alcohol Use Disorder: The severity of an individual’s alcohol use disorder plays a significant role in medication selection. Those with moderate to severe AUD may benefit from medications specifically approved for treating alcohol dependence.
  2. Co-Occurring Conditions: Co-occurring conditions, such as depression, anxiety, or other substance use disorders, need to be addressed. Some medications can target both AUD and co-occurring disorders effectively, while others may exacerbate these conditions.
  3. Medical History: A comprehensive medical history is vital in determining which medications are safe and suitable. Individuals with specific medical conditions or sensitivities may need tailored treatment plans.
  4. Previous Treatment Experiences: Consider an individual’s history with alcohol treatment, including prior medications, their effectiveness, and any adverse reactions. This information can guide the choice of a new medication.
  5. Medication Tolerance: Some individuals may have a higher tolerance for certain medications, requiring adjustments in dosage or a different choice of medication.
  6. Medication Side Effects: Potential side effects and their tolerance by the individual should be discussed. Some may be willing to accept certain side effects in exchange for the benefits of a particular medication, while others may not.
  7. Treatment Goals: Establish clear goals for alcohol treatment. Some may aim for complete abstinence, while others may be working toward reducing their alcohol consumption to a safer level. The chosen medication should align with these goals.
  8. Support System: Consider the availability of a support system. The presence of a strong support network, including family and friends, can be a valuable asset during treatment.
  9. Response to Medication: Monitoring and adjusting the medication based on the patient’s response is important. Regular check-ins with a healthcare provider can help fine-tune the treatment plan for optimal results.
  10. Safety and Monitoring: Ensure that the selected medication is safe when used as part of an alcohol treatment plan. Regular medical monitoring is often necessary to assess progress and adjust treatment as needed.
  11. Cost and Accessibility: Consider the financial aspect of medication. Some medications may be costly or have limited accessibility. Discuss these factors with the healthcare provider to identify affordable and available options.

Customizing the treatment approach at treatment centers close to you is essential to a successful recovery.

Personalized Medication-Assisted Treatment at Zinnia Health

Addiction and alcohol use disorder are complex conditions that affect the mind, body, and spirit. Recovery is not only about ceasing substance use but also about rebuilding your life and achieving lasting wellness.

Medication-assisted treatment is the term for the use of FDA-approved medications in combination with counseling and behavioral therapies to treat addiction and alcohol use disorder.

At Zinnia Health, our team of experienced addiction specialists works with patients struggling with alcohol abuse to create custom treatment plans using the therapies and medications that work best for each patient. To learn more about our treatment options, click here.


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