Alcohol Detox Protocol and Process

Life is challenging. Life is scary. Life is painful. Life is unfair.

When ruminated, these thoughts can become dangerous and manipulative.

The human mind—as intricate and complex as it is— feeds off negativity like bacteria or mold on a piece of bread.

So, what do we do? We seek counseling. We talk with family or friends. We exercise and meditate. We learn to play an instrument and follow our passions. We travel and explore the mysteries of the world. We take medications. We do yoga, and deep breathing.

We drink.

The road to alcoholism is complex. It starts off innocently enough, but quickly gains momentum and strength. And as our negativity inclines and the pressures of life become overwhelming—that road seems to always leads back to alcohol. But the end to that road doesn’t always have to be another statistic; sometimes that road can lead to something positive, perhaps even beautiful, perhaps even life changing.

But like learning any new skill, it takes practice, and practice is a process.

Ultimately, the decision to not only recognize, but to also take corrective action (e.g., detoxification treatment) as an alcoholic is incredibly brave. It’s also incredibly frightening.

What will others think of me? Will my kids and loved ones ever take me seriously again? Will I have my job when I finish treatment? Will my parents ever talk to me again? Will I ever be able to attend a dinner party or social gathering again?

Will I ever be able to drink again?

These complex and daunting questions repeatedly stop alcohol sufferers from taking corrective action. The fear of social rejection, coupled with concrete consequences (e.g., loss of job, divorce, financial hardships, etc.) continually plague those that desperately need help. But the truth is, the alternative is far more severe.

Family, friends, money, sex, life, love, the pursuit of happiness, etc., is all irrelevant is you’re dead due to continual alcohol abuse. Recognizing that the choice of alcohol detoxification is not only important, but also the only option left to pursue, is a brave albeit frightening realization. However, it’s also the most important recognition you could ever make—if that is—you plan on keeping those things you’re so desperately trying to avoid from knowing the truth.

Alcoholism: Detox and Protocol

The first step to overcome and/or moderate alcoholism is via withdrawal and substance detox.

Detoxification is the process by which an individual with psychoactive substance dependence is monitored (often meticulously) and dissuaded from usage of alcohol in a safe and personalized manner. Alcohol detoxification can also be characterized as a time period in which a person suffering from consistent abuse is given the tools, support, advice and care to overcome the painful—and at times—debilitating side effects of alcohol separation. Usually, detoxification is the first phase of recovery; when the physical and emotional symptoms of alcohol withdrawal (AW) have subdued, the next course of action is for the patient to participate in a long-term program such as inpatient rehab, sober living, outpatient treatment, Alcoholics Anonymous (AA), etc., with the ultimate goal that the patient can live a productive and happy life without the constant and demanding need of alcohol or drugs.

Severity

Alcohol withdrawal can be debilitating and range in severity. From convulsions and night sweats, to seizures and extreme irritability—the symptoms of alcohol withdrawal can feel as though your world has crumbled below you. And as the hours pass and the toxins slowly begin to leave your body, the initial hurdle of alcoholism has been completed, but the road to recovery has just begun.

Is Detox Safe?

Depending on the individual’s severity in alcohol usage and/or physical condition, detoxification of alcohol is a potentially life threating procedure. Medical supervision and assessment is critical before detoxification begins.

The 3 Phases of Alcohol Withdrawal

Phase 1.) Irritability, restlessness, sleeplessness, dizziness and abdominal pain are the five most common symptoms associated with the first phase of AW; phase 1 of AW usually occurs 7-10 hours after last drink.

Phase 2.) Increased heart rate and blood pressure, higher body temperature, incomprehension and irregular heart rate most commonly correlate with phase 2 of AW; signs that phase 2 of AW usually occur one to three days after last drink.

Phase 3.) Profusely sweating, temperature/fever, deliria, night terrors, seizures and extreme irritability or anger; phase 3 symptoms occur day four of AW.

*After one week, symptoms of alcohol withdrawal should begin to decrease (severity varies).

Practice Recommendations

For patients with less severe symptoms of AW (usually experiencing mild to moderate signs), detoxification can be safely pursued in an outpatient environment. Diagnosis of mild to moderate alcohol withdrawal typically mandates patients to have little to no signs of mental psychiatric tribulations such as thoughts of suicide, hallucinations or thoughts of doing harm to others.

Pharmaceutical medications, such as benzodiazepines (e.g., Xanax, Klonopin, Valium, etc.) are commonly treated in conjunction with mild to moderate symptoms of AW as a means to reduce agitation, the risk of seizure or psychological delirium and confusion.

For patients experiencing mild to moderate symptoms of AW, but also evaluated to be emotionally and/or physically “healthy,” carbamazepine is a regularly used treatment option based on individual physician analysis.

What Makes Alcohol Addicting?

When a person drinks alcohol, their brain releases dopamine (the bodies natural chemical for reward, contentment and euphoria). The strong and mood elevating effects of alcohol are temporary and often increase self confidence, decrease feelings of social anxiety, reduce pain (both physical and emotional), and can decline a person’s willpower on decision-making. Approximately one to three hours after someone’s last drink, dopamine levels in the bloodstream will begin dissipate, which often leads to continual usage and abuse.

When consistently used, the brain begins to not only crave but also anticipate the consumption of alcohol. The longer the brain expects alcohol, the more the brain becomes irritated when neglected from alcohol. Because alcohol is a powerful depressant and catalyst for feelings of wellbeing, the brain will prohibit from producing dopamine without its presence.

Physiology

Consistent alcohol usage increases gamma-aminobutyric acid or GABA, which lowers the brain’s activity of neurons as the signal-receiving (process of neurons) becomes effected. The more an individual indulges in alcohol abuse, the less responsive GABA receptors are to neurotransmitters (i.e., tolerance). As the natural release of GABA loses its productivity over time, the larger the consumption of alcohol is needed to produce the initial effect of GABA being released in the brain.

Inpatient Vs Outpatient Alcohol Withdrawal Treatment

In most circumstances, all phases of AW can either be treated via an inpatient or outpatient environment. Physicians and AW professionals may work together to determine the best method of treatment based on vital signs, physiological analysis and consultation with friends and family. Finding the most effective, and most therapeutic course of action is imperative towards a patient’s likelihood in continual abuse.

Inpatient

Inpatient alcohol withdrawal treatment is widely considered to be the most effective and efficient method of AW or relapse. From as short as a month and as long as three months, time duration varies concerning inpatient treatment; in conjunction with physician consultation, court-order mandates, and based on individual preference and needs—detoxification treatment length and procedure varies on each individual situation.

What Happens Upon Entry of a Detox Inpatient Facility?

One of the most common reasons why alcoholics avoid inpatient detoxification treatment is because the process is thought to bring significant pain and unpleasant feelings (that are both emotionally and physically present). In reality, the inpatient detoxification treatment is meticulously and specifically designed to avoid such circumstances. Staff members and physicians are extensively trained to provide the most comfortable, secure and pleasant environment as possible.

When an individual does finally make the brave decision to enter an inpatient AW detoxification facility, the process mandates initial assessment. Logistics and first-analysis protocol allow staff members to design a personalized, tailored course of action to create the most effective treatment plan possible. In this step of the process, transparency and openness are monumentally important. Feelings of embarrassment, fear of judgment and social anxiety commonly contribute to inaccurate analysis, which can further delay AW symptoms and likelihood of recovery. It is in the patient’s best interest to fully disclose all issues, questions, concerns before treatment begins. Failure to successfully help inpatient AW detoxification patients typically occur because initial assessment is inaccurately documented. Further, nondisclosure of initial assessment paperwork can increase the risk of health complications, improper prescription(s) of medication and increase severity of AW symptoms.

Advantages of Inpatient Detoxification Treatment

For patients where outpatient treatment may not be appropriate, the assuredness of around the clock care and staff consultation is a major benefit. The setting of an inpatient setting also ensures that the patient has far less access to alcohol, which greatly increases the likelihood of detoxification and long-term abuse. Medical complications, such as delusions, seizures and thoughts of suicide can be more managed more efficiently due to the constant care that is provided with inpatient treatment.

Disadvantages of Inpatient Detoxification Treatment

When compared to outpatient detox cost, inpatient treatment usually carries a higher cost. Inpatient treatment may also increase the dependence on clinical care, which can insinuate a false sense of security when care is no longer provided. The dependence on clinical care may become a “crutch” to patients as means to prohibit the usage of alcohol. When a patient inevitably no longer has around the clock care or treatment, the patient may determine alcohol as the next best available option.

Disadvantages of Outpatient Detoxification Treatment

Outpatient treatment relies on the patient to take individual action, instead of having the leverage to rely on around the clock staff; always-available staff can help encourage patients to participate in counseling, meetings, best practice tools for sober living and in the management of prescriptions.

Access to alcohol is far easier to gain possession of, and reliance on personal restraint is highly unlikely due to the overwhelming chemical urge to indulge in alcohol. Family members may also take a heavier burden concerning the method of outpatient treatment; usually, family members don’t have the experience, resources or expertise to successfully restrain loved from alcohol usage, and due to the sensitive and highly delicate nature of the situation, verbal arguments can often lead to physical altercations. Police involvement, in situations where their presence is needed to restrain the patient, contains its own set of potentially debilitating consequences such as money, increasing agitation and potential harm to others or oneself, criminal indictment, etc.

Advantages of Outpatient Detoxification Treatment

Cost-wise, outpatient treatment is the far less expensive option; additionally, outpatient detox treatment, in some circumstances, gives the patient the opportunity to remain productive at: earning an income, studying for school, strengthening relationships with loved ones, and overall, remaining present with everyday life. Successfully detoxification in an outpatient environment may also improve the confidence and belief of the patient to overcome alcoholism due to the personal restraint shown in the duration of AW.

Conclusion

Finding the right treatment plan mandates careful, strategic planning into a patient’s behavior, medical condition and personal environment (work, friends, pressure to communicate, etc.).

It takes the combination of patient honesty and transparency, physician evaluation and consultation with friends/family to determine the best means of alcohol detoxification that has the highest percentage of success and alcohol separation. Detoxification is something that should never be rushed into, as the consequence of “misguided” treatment can prove to be more detrimental or dangerous than the previous circumstances.

For example, continual alcohol usage due to workplace hostility, financial uncertainty, and/or fear of loss of employment may be less of a psychological issue, and more of an environmental problem. Conversely, continual alcohol usage due to childhood abuse, chronic depression and/or debilitating phobias may be more of an emotional/mental problem than newly surfaced problems. Both situations call for immediate care, however, both situations require different treatment plans. Ultimately, realizing the underlining issue is the most important, and often, the most difficult component to successful detoxification and long-term separation from alcohol.

Sources:

“Alcohol Detox and Rehab Programs: What to Know.” WebMD. 14 Mar. 2019. https://www.webmd.com/mental-health/addiction/alcohol-detox-programs#1

“Alcohol Detox.” Alcohol Rehab Guide. 14 Mar. 2019. https://www.alcoholrehabguide.org/treatment/alcohol-detox/

T., Buddy. “Common Alcohol Withdrawal Symptoms.” Verywell Mind. 15 Dec. 2018. 14 Mar. 2019. https://www.verywellmind.com/symptoms-of-alcohol-withdrawal-63791