Alcohol Detoxification

Alcohol detoxification, otherwise known as detox, for individuals with alcohol dependence is the abrupt stop of alcohol consumption 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

Benzodiazepines are the most common type of drugs used for detox, followed by barbiturates.

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.

Choices 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).