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Clinician’s Corner: Alcohol Detox

Prevalence of Drinking:

https://www.niaaa.nih.gov/alcohol-health/overview-alcohol-consumption/alcohol-facts-and-statistics

Who’s’ drinking? According to the 2015 National Survey on Drug Use and Health (NSDUH),

  • 4 percent of people ages 18 or older reported that they drank alcohol at some point in their lifetime
  • 1 percent reported that they drank in the past year
  • 0 percent reported that they drank in the past month.

Prevalence of Binge Drinking and Heavy Alcohol Use: defined as NIAAA defines binge drinking as a pattern of drinking that brings blood alcohol concentration (BAC) levels to 0.08 g/dL. This typically occurs after 4 drinks for women and 5 drinks for men—in about 2 hours

  • in 2015, 26.9 percent of people ages 18 or older reported that they engaged in binge drinking in the past month;
  • 0 percent reported that they engaged in heavy alcohol use in the past month

Alcohol Use Disorder (AUD):  defined a chronic relapsing brain disease characterized by an impaired ability to stop or control alcohol use despite adverse social, occupational, or health consequences

  • Adults (ages 18+): According to the 2015 NSDUH, 15.1 million adults ages 18 and older (6.2 percent of this age group) had AUD.
  • This includes 9.8 million men (8.4 percent of men in this age group) and 5.3 million women (4.2 percent of women in this age group).
  • About 6.7 percent of adults who had AUD in the past year received treatment. This includes 7.4 percent of males and 5.4 percent of females with AUD in this age group.5

Alcohol Use Disorder in the Youth:

  • Youth (ages 12–17): According to the 2015 NSDUH, an estimated 623,000 adolescents ages 12–17 (2.5 percent of this age group) had AUD.
  • This number includes 298,000 males (2.3 percent of males in this age group) and 325,000 females (2.7 percent of females in this age group).
  • About 5.2 percent of youth who had AUD in the past year received treatment. This includes 5.1 percent of males and 5.3 percent of females with AUD in this age group.

TREATMENT OF ALCOHOL DETOXIFICATION

Benzodiazepines are the mainstays of treatment for alcohol withdrawal, particularly inpatient, however anticonvulsants are becoming increasingly popular for outpatient detox due to good efficacy and a lower potential for abuse.

  • The doses of benzodiazepines used for alcohol detox are much higher than those used to treat anxiety.
  • IV therapy required for ALL patients with seizures or DT (delirium tremors). Convert to oral dosing as soon as possible. Avoid IM due to erratic absorption.
  • Adverse effects: Sedation, dizziness, delirium, hypotension, respiratory depression

Anticonvulsants

  • Becoming increasingly popular for outpatient detox due to good efficacy and a lower potential for abuse
  • Use of anticonvulsants for alcohol detox should be considered in patients where there is a high potential for abuse, or for whom sedation poses a serious concern
  • Detox using anticonvulsants may be used in outpatient settings where withdrawal symptoms are less severe, and patients are at a lower risk for serious complications
  • Phenobarbital: works synergistically with benzodiazepines, which increase the frequency of GABA chloride channel opening, and barbiturates, which increase the duration of channel opening. Used for refractory DT’s

Carbamazepine (Tegretol)

  • Less sedating, and less abuse potential than benzos
  • May be OK for outpatient alcohol withdrawal, little effect for DT’s
  • Many drug interactions (enzyme inducer)-speeds up metabolism of other drugs
  • Watch for blood dyscrasias, liver failure, Stevens Johnson syndrome

Gabapentin (Neurontin)

  • Less sedating, and less abuse potential
  • Fewer drug interactions than carbamazepine

WHERE TO GET HELP:

Blair County Drug and Alcohol Prevention’s experienced staff is proud to offer effective prevention, education, intervention, and referral to treatment services to individuals and families in our county. They work closely with state, county and local agencies to prevent and reduce substance abuse. Their vision for the future is the elimination of substance abuse and the devastating impact it has on the community.

LOCATION: 3001 Fairway Drive, Suite D  Altoona, PA 16602

PHONE:  814.381.0921

HOURS: Monday – Friday   8:00AM – 4:00PM

In Case of Emergency: 814.889.2141

Next week we will discuss Alcohol Relapse Prevention Agents