Alcohol Detox

Withdrawal syndrome: The main obstacle in Alcohol Detox

In fact, the withdrawal syndrome is the main obstacle to recovery from the addiction. That is because for persons who are severely dependent on alcohol, abrupt, untreated cessation of drinking may result in withdrawal delirium, seizures (which may be recurrent), marked hyperautonomic signs, or death.

But risks to the patient and society are not limited to the severity of the patient's physical disturbance, particularly when the detoxification is conducted in an outpatient setting. Outpatients experiencing withdrawal symptoms give up treatment more often, may self-medicate, and the interaction between prescribed medication and self-administered drugs may result in an overdose or brain damage.

Alcohol withdrawal signs and symptoms may appear within hours of the patient's last drink and generally peak 24 to 36 hours after cessation. Early withdrawal signs and symptoms include anxiety, agitation, insomnia, diaphoresis, nausea, vomiting, tremor, tachycardia, and hypertension.

Alcohol withdrawal seizures can occur at various times, but most occur within 48 hours of cessation. Alcohol withdrawal delirium , or delirium tremens , typically begins 48 to 72 hours after the last drink and is preceded by the typical signs and symptoms of early withdrawal, although these may be masked or delayed by other illnesses or medications. Signs of sympathetic hyperactivity (such as tachycardia, hypertension, fever, and diaphoresis) are often profound and are hallmarks of alcohol withdrawal delirium. The mortality rate is thought to be between 1% to 5% and increases with delayed diagnosis, inadequate treatment, and concurrent medical conditions.

The signs and symptoms of alcohol withdrawal are the opposite of the direct pharmacological effects of alcohol. In the central nervous system, ethanol interferes with the processes that instruct certain nerve cells to activate or become excited. It also enhances those processes that instruct certain nerve cells to be restrained. Thus, ethanol acts as a nonspecific biochemical activity inhibitor in the central nervous system. During withdrawal, a person's central nervous system experiences a reversal of this effect: Excitatory processes are enhanced while inhibitory processes are reduced. Such changes can result in overactivation of the central nervous system when alcohol is withdrawn.

Clinical researchers have measured this overactivation in patients. Even patients with moderately severe alcohol withdrawal can experience sympathetic nervous system overactivity and increased production of the adrenal hormones: cortisol and norepinephrine. Both of these hormones can be toxic to nerve cells. Moreover, cortisol can specifically damage neurons in the hippocampus - a part of the brain that is thought to be particularly important for memory and control of affective states.

Thus, repeated untreated alcohol withdrawals may lead to direct damage to the hippocampus. Ballenger and Post (1978) did a retrospective chart review that led them to postulate that repeated inadequately treated withdrawals could produce future withdrawals of increased severity. Many investigators believe that chronic alcoholics who cannot maintain abstinence should receive pharmacotherapy to control withdrawal symptoms, thereby reducing the potential of further seizures and brain damage.

For these reasons, detoxification treatments without the appropriate medical management and level of care constitute a great health, and even life, risk of the patients. On the other hand, the hardness of the withdrawal syndrome leads to a very high risk of relapse during the early withdrawal period, in part because drug craving is easily triggered by encounters with or thoughts of drug-associated stimuli.

To avoid the risk of brain damage: Ultra rapid alcohol detox without withdrawal

As mentioned, withdrawal symptoms are a fundamental obstacle for alcohol detox treatment. This is because withdrawal from consumption of alcohol is not sufficient to eliminate the serious alterations that alcohol produces in brain cells. Moreover, current medications used in detox treatments do not restore damaged areas, but just mask the withdrawal symptoms.

Once in the brain, drugs affect chemicals called neurotransmitters. These are the chemicals that control the flow of information within the brain between the neurons or brain cells, forming a synapse. Neurotransmitters also alter people's moods and feelings.

Alcohol is a central nervous system depressant. It acts on many levels, including the reticular formation, spinal cord, cerebellum and cerebral cortex, and on many neurotransmitter systems.

To avoid withdrawal syndrome, it is necessary to restore brain functions that have been damaged by alcohol addiction. But this is not possible just by detoxification. Neurons must be recovered, so they can maximize the use of available oxygen and thus the neural membrane metabolism is normalized. Only this pharmacological intervention, to recuperate the normal neural functioning of the brain structures harmed by alcohol, allows a detoxification not only without withdrawal symptoms but also without craving. Moreover, it allows the recovery of higher cognitive and affective processes such as attention, reading abilities, conciousness or serenity.

Because there is a risk of serious adverse consequences for most patients who undergo withdrawal, it is paramount to have access to advanced pharmacological treatment in a medically-monitored inpatient detoxification. This is an organized service delivered by medical and nursing professionals, who provide 24-hour medically supervised evaluation and recovery management in a permanent facility with inpatient beds. Services are delivered under a defined set of physician-approved policies and physician-monitored procedures or clinical protocols.

Advantages of inpatient detoxification are that (1) the patient is in a protected setting where access to substances of abuse is restricted, (2) the management and monitoring of neural recovery eliminates craving, and allows a detoxification without withdrawal, and (3) detoxification can be accomplished more rapidly than it can in an outpatient setting. Besides, detox with hospitalization prepares the patient for ongoing treatment for his or her dependence on alcohol or other drugs. During detox, patients may form therapeutic relationships with treatment staff or other patients, and may become aware of alternatives to an alcohol- or drug-using lifestyle. Detoxification is an opportunity to offer patients information and to motivate them for longer-term treatment.

According to these needs, alcohol detoxification involves several procedures:

First of all, treatment of patients who are under the influence of, or experiencing withdrawal from, substance-related disorders requires an understanding of the natural history and variants of such syndromes; a complete assessment of the patient's individual, medical, psychiatric, and social issues. Detailed clinical exploration is necessary, as well as psycho-diagnostic and psychopathological examinations, to establish the characteristics of the addiction and its intensity, the existence of associated psychological illnesses, and the repercussions on the patient´s family, work, and friendships.  This medical assessment is important in order to determine the need for medication and medical management, and the patient assessment should identify coexisting medical and psychiatric conditions and alcohol-related medical complications. Besides, this information is necessary to design the psychotherapeutic strategy during hospitalization which is later continued on an out-patient basis after the patient's release.

Afterwards, oral and intravenous pharmacological interventions are performed to recuperate the normal neural functioning of the brain structures harmed by alcohol (NMDA, serotonergic, and GABA receptor systems, for example).  The goal of pharmacologic management is to provide the amount of medication necessary to ensure safe and comfortable detox, as these interventions allow a detoxification without withdrawal symptoms and without craving; by increasing the ability of the treated neurons to take advantage of available oxygen, neural membrane functions are normalized in a short period of time.

General management also includes maintaining adequate fluid balance, correction of electrolyte deficiencies, and attendance to the patient's nutritional needs. Brain nutrition involves enriching the patient's diet with salts, oligo-elements, and amino acids essential for neural recuperation and correcting nutritional deficiencies which frequently accompany this illness.

At the same time, a personalized psychotherapy action plan is design, based on the psycho-diagnostic examinations, to restore the harmony between personal and familial psychological functioning, clarify erroneous concepts regarding the illness, and promote attitude and lifestyle changes, all of which incorporate the patient as an active participant in his/her own rehab process.  This psychotherapy, as well as pharmacological control, are processes of the ambulatory follow-up phase, after the patient leaves the hospital.

Under these conditions, alcohol detox has four immediate goals: (1) to provide a safe withdrawal from alcohol dependence and enable the patient to become free of non-prescribed medications; (2) to provide a withdrawal from the drug that is humane and that protects the patient's dignity; (3) to provide a recovery of higher cognitive and affective processes, and (4) to prepare the patient for ongoing treatment of his or her new life.

	Detox Tradicional = Desintoxicación	Detox en TAVAD = Recuperación Neuronal
Treatment Duration	5-180 Days	2 Days
Anxiety	Yes	No
Tremor	Yes	No
Craving	Yes	No
Lack of Appetite	Yes	No
Insomnia	Yes	No
Depression	Yes	No
Irritability	Yes	No
Stress	Yes	No
Well-Being	No	Yes
Serenity	No	Yes
Cognitive Improvement	No	Yes
Improved Relationships	No	Yes
Retention	Low	Total

Alcoholism Detox Centre:

• TAVAD - Advanced Addiction Treatments
  Ultra Rapid Alcoholism Detox Treatment.
100% successful detoxification without Withdrawal in 48 hours.
  (Treatments evaluated by Ministry of Health)
  www.tavad.net

For further information about Alcohol Detox and Alcoholism:

American Society of Addiction Medicine (ASAM)
Brain & Mind. Electronic Magazine on neuroscience.

Cocaine Abuse and Cocaine Addiction