Let’s say you have a disease. One that’s treatable, although no one can cure it. Diabetes or chronic lung disease, for example. Both conditions are serious. Either one can cause severe disability. Either one can kill you. Would you seek professional medical advice if you knew you had one of those disorders? Most likely you would. Most people with a realistic view of the world would go to a doctor and start trying to control the disease.
Alcoholism is a disease, just like diabetes or COPD. You cannot control this disease by yourself, any more than you could control diabetes.
What Is Alcoholism and How Is It Treated?
Alcohol and its interactions with the brain
- Alcohol binds to inhibitory neurons that decrease activity in the brain. This explains why you get sleepy when you drink and why your brain does not function well on alcohol.
- If the decrease in excitation state of the brain is long term, the brain begins to produce more excitatory neurotransmitters, trying to return to the normal state.
- When alcohol is withdrawn, the brain has an abnormally high level of excitatory neurotransmitters.
- The excessive state of excitation can result in hallucinations and seizures, even cardiovascular collapse and death.
As much as 5 to 10% of the population of the United States has alcoholism and a large percentage of those people, although not all, is likely to go into withdrawal upon cessation of alcohol intake. Withdrawal severity varies considerably.
- Mild withdrawal consists of symptoms of anxiety, insomnia, tremors, especially of the hands, nausea, and vomiting. Symptoms usually appear within 24 hours of the last drink.
- Severe withdrawal involves major tremors, involving the whole body, both visual and auditory hallucinations, cold sweats, vomiting and elevated blood pressure. If the person has a history of severe withdrawal symptoms in the past or low platelet values and a low serum potassium, the risk for severe withdrawal is much greater.
- Delirium tremens is the worst withdrawal syndrome. The person becomes totally confused and disoriented, agitated, with fever, cold sweats, hallucinations, and markedly elevated blood pressure and tachycardia. Seizures can occur.
- The mortality rate for untreated delirium tremens is 20%. With treatment, the death rate drops to below 5%.
In order to avoid significant morbidity and possible mortality, every person in alcohol withdrawal needs to be evaluated carefully
- Mild withdrawal symptoms can usually be handled on an outpatient basis.
- Anyone with moderate to severe withdrawal symptoms or any signs of delirium tremens must be hospitalized.
- Treatment with sedatives, usually of the benzodiazepine class, controls the symptoms of anxiety, insomnia, agitation.
- Medications are administered either on a fixed schedule or on an as needed basis.
- If the treatment is being done on an outpatient basis, the patient needs to be seen daily.
Other medications have been shown assist in withdrawal.
- Carbamazepine (Tegretol) has been shown to reduce the craving for alcohol.
- Haloperidol (Haldol) is sometimes used to help with agitation and hallucinations.
- Clonidine reduces the autonomic symptoms of withdrawal.
- A beta blocker may help in people with underlying coronary artery disease.
Treatment of alcohol withdrawal should be followed by addressing the issue of dependence. Only in this way can the disease itself be evaluated and treated. If you think about a diabetic patient who develops diabetic ketoacidosis and spends several days in an ICU, getting the blood sugars under control, you wouldn’t expect that patient’s doctor to discharge him from the ICU, once the DKA is under control. The patient will spend another day or two on a regular floor, talking to counselors and nurses and dieticians who have expertise in diabetes.
Alcohol dependence needs even more intensive counseling and teaching. The greatest success in achieving and maintaining sobriety is obtained through followup with a comprehensive treatment facility. If you are among the millions of Americans who abuse alcohol, think about getting help. There are treatment facilities everywhere. Talk to your family doctor for advice on where to go. Now is the time to change your life around and make your future brighter and healthier. Give us a call today at 833-846-5669 to find out more.