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Even though alcohol is legally available for individuals over the age of 21, it is also one of the most abused and potentially dangerous drugs available.
According to the National Institute on Drug Abuse, the number of individuals abusing alcohol and the cost of alcohol abuse in this country are second only to tobacco use and abuse. It is estimated that nearly 17 million people in the United States have an alcohol abuse issue and that the overall cost of alcohol abuse is over $220 million annually, with much of this cost associated with the medical aspects of alcohol use.
One of the issues with alcohol abuse is its potential to produce physical dependence (tolerance and withdrawal). This article will discuss the withdrawal management, or medical detox, process from alcohol in individuals who have developed a moderate to severe alcohol use disorder.
According to the American Psychiatric Association, which sets the standards regarding the clinical diagnostic criteria used in assessments of individuals with substance use disorders, and the American Society for Addiction Medicine, which outlines medical procedures in the treatment of substance use disorders, physical dependence consists of the development of tolerance and withdrawal, whereas detoxification (detox) and withdrawal management are separate entities.
The withdrawal symptoms that occur during alcohol withdrawal (sometimes termed alcohol discontinuation syndrome) will vary from individual to individual, depending on a number of different factors, such as how much alcohol an individual typically used, how long they abused alcohol, whether or not they commonly used alcohol in conjunction with other drugs, and individual differences in metabolism and psychological makeup.
A descriptive and informative article comes from American Family Physician articles was written in The American Family Physician regarding the symptoms and regarding the withdrawal process from alcohol. The withdrawal process consists of two syndromes, such that individuals who have mild forms of alcohol use disorders will most often experience mild withdrawal syndromes, whereas individuals who have moderate to severe alcohol use disorders will experience significantly more severe withdrawal symptoms. Typically, the designation of a mild, moderate, or severe alcohol use disorder is determined by the number of symptoms and the length of one’s period of abuse; however, sometimes individuals who would appear to have mild alcohol use disorders display severe withdrawal symptoms, and individuals with severe alcohol use disorders display milder withdrawal syndromes.
For the purposes of this article, we can classify the symptoms of alcohol withdrawal according to domains:
The withdrawal process may differ depending on the severity of the alcohol use disorder, such that some individuals display a mild withdrawal syndrome whereas others display more severe withdrawal syndrome. The timeline for the withdrawal process from alcohol in individuals who are displaying a mild withdrawal syndrome follows:
Moderate to severe alcohol withdrawal will typically present differently:
Because of the potential danger that may exist for individuals withdrawing from chronic alcohol abuse, it is recommended that anyone diagnosed with an alcohol use disorder only discontinue use of alcohol under the supervision of a physician. The detox process typically involves administering medications, most often benzodiazepines, to assist in controlling the symptoms of withdrawal. A number of medications can be used in the withdrawal process for alcohol, including:
While the majority of individuals with alcohol use disorders will not experience potentially fatal or severe withdrawal symptoms when they discontinue their use of alcohol, it cannot be overemphasized that anyone with an alcohol use disorder who wishes to quit using alcohol should consult with a physician because it is very difficult to predict who will develop severe alcohol withdrawal symptoms. In addition, significant risk for potentially serious issues can occur as a result of emotional, psychological, or cognitive issues that occur during withdrawal and the use of a withdrawal management strategy makes the withdrawal process easier to negotiate. Using a withdrawal management strategy reduces symptom severity and any potential complications during the early stages of recovery, including the potential for relapse.
Finally, the withdrawal management process is only the first step in a full recovery program. Individuals who go through withdrawal management and do not get involved in a professional and structured program of recovery for their alcohol use disorder are at a very high potential for relapse. The reason for this is that these individuals have not learned to understand the issues that drove them to their substance use disorder, have not developed a relapse prevention program, and have not developed a positive social support group that will assist them in their recovery.