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Using Benzodiazepines to Treat Alcohol Withdrawal
Benzodiazepines, also called Benzos, are a class of depressant medications. They are some of the most commonly prescribed drugs in America. The first Benzodiazepine released to the public in 1957 was Librium, which is used to relive anxiety. Today, Benzos are used for anxiety relief, as a muscle relaxant, a hypnotic, an anti-convulsant, or as a mild memory loss inducer. Common types of the medication include Xanax, Valium, Ativan, and still to this day, Librium. Benzodiazepines are also used to help patients going through alcohol withdrawal.
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Human’s brains have two Benzodiazepine receptors. One causes the sedative effect, the other causes the anti-anxiety effect. Different types of Benzos are separated as either short-acting or long-acting. Short-acting Benzos clear the body in a short amount of time while long-acting Benzos remain in the blood stream for a longer period of time. Users can build up a tolerance for Benzos and these drugs are sometimes abused.
People who are going through alcohol withdrawal can be prescribed Benzodiazepines to help with symptoms such as insomnia, seizures, and anxiety. The way Benzos are used, and which type depends on the severity of the withdrawal symptoms, and if the patient is part of inpatient or outpatient care.
What Is Alcohol Withdrawal?
About 16 million Americans have Alcohol Use Disorder (AUD). This is when an alcoholic is given a medical diagnosis that is characterized by compulsive alcohol use, loss of control over how much alcohol is consumed, and negative feelings when not drinking alcohol. Some users continue to drink when they know they shouldn’t so they can avoid uncomfortable withdrawal symptoms. Only 10% of people suffering from AUD receive treatment. Those who do seek out treatment have separate hurdles to overcome.
When someone drinks a lot of alcohol over an extended period of time, the central nervous system must adjust to the way alcohol affects the brain. Alcohol is a depressant, and the brain works hard to maintain an awake state when under the influence. When alcohol is removed, the brain remains in this keyed-up state which is the cause for withdrawal symptoms.
Alcohol withdrawal symptoms start as early as 6 hours after the last drink. Symptoms range from mild to severe and include anxiety, insomnia, sweating, headache, shaky hands, nausea, and vomiting. If these milder symptoms are left untreated, they can progress to severe and potentially life-threatening symptoms. More serious symptoms include seizures, hallucinations, and delirium tremens.
How Benzodiazepines Help for Alcohol Withdrawal
Long-acting Benzodiazepines are preferred for treating alcohol withdrawal and can help prevent the progression of symptoms and prevent seizures. Some commonly used medications include Chlordiazepoxide (Librium), Diazepam (Valium), Lorazepam (Ativan), and Oxazepam. The sedative effects of long-acting Benzos make them better at preventing delirium, while short-acting Benzos are better for patients who have liver failure. Patients can take Benzos (usually orally in a capsule form) at a fixed-dose, or when they are experiencing symptoms.
Whether a patient suffering from AUD detoxes as an outpatient or inpatient depends on the severity of their addiction. Outpatient detoxification is when patients travel to a facility or hospital during the week every day. These treatment sessions can last several hours and allow the patient to maintain employment during their detox period. The average timeframe for outpatient detoxification is 6 days. There is an increased risk of relapse compared to inpatient, because the patient can purchase alcohol whenever they want. Outpatient works best for patients with a mild AUD.
People with a serious AUD will have a better outcome with inpatient detoxification. They will receive constant medical care and supervision in case more serious symptoms arise and will be given their medications by professionals. It is more expensive than outpatient and the average time for detox is 9 days. Inpatient care is necessary for patients who are at risk of developing serious withdrawal symptoms, such as delirium tremens.
Delirium Tremens (DT) is relatively rare, affecting up to 5% of people who abuse alcohol. The prevalence is highest in adult men, Caucasian people, and younger people. Typically, DT occurs as early as 48 hours after the last drink and can last up to 5 days. The mortality rate of DT varies from 5 to 15% with appropriate therapy. Complications of DT include:
- Abnormally high blood pressure
- Overheated body
- Altered mental state
- Memory loss/confusion
- Irregular heartbeat
- Aspiration pneumonitis
- Respiratory failure
People who have a history of seizures, concurrent illness, and a prior history of detoxification are more at risk for developing DT. Most delirium tremens patients are severely dehydrated and have electrolyte abnormalities. Benzodiazepines aid in treatment for DT, aiming to decrease seizure risk and risk of mortality. Recognizing DT early and getting treatment improves the outcome for patients. DT usually lasts 2 to 3 days, but sometimes lasts much longer. There have been cases of prolonged delirium tremens lasting a month.
Prolonged Delirium Tremens
In one case from 2011, a 35-year-old man sought help for his AUD. He started having tremors 24 hours after his last drink and continued having tremors along with hallucinations the next day. After being admitted to the emergency room, he reported seeing snakes coming out of the window as his hallucination. After receiving treatment, he continued having visual and auditory hallucinations, disorientation, and fluctuating consciousness. He remained in treatment, receiving Benzos, and his DT finally subsided after 35 days.
In another case, a 45-year-old man came to the emergency department with tremors so bad he couldn’t walk. He had been a heavy drinker for 20 years and had gone through multiple detoxes. Doctors tried many different medication combinations, trying to ease his delirium tremens symptoms. Eventually they found a combination that ended his 28-day long DT. These cases are uncommon but is it not impossible for DT to last for weeks.
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Safe Alcohol Withdrawal
Benzodiazepines are just one of the resources that a treatment center can provide during a detox from alcohol. If you or someone you know is attempting to detox from alcohol, professional help will yield results and make the process less uncomfortable. After detox, people with AUD can fully recover and go on to live a life where alcohol is not controlling their mind and body. To learn more about options, contact a treatment provider who can explain available opportunities.
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