The prospect of an alcohol withdrawal syndrome (AWS) provokes fear in patients and their family members, as well as in many healthcare professionals. This is understandable given how distressing and dangerous it can be, particularly when it is not treated properly. For the patient, the fear can perpetuate continued drinking and delay seeking treatment. Nevertheless, there is a bright side.
First of all, AWS is remarkably easy to treat, especially on an outpatient basis. Two key elements of effective withdrawal management are to:
1) begin treatment when symptoms first start to emerge – ideally in the first 12 hours
2) use a protocol in which medications are given in sufficiently high dose and frequency
Complicated alcohol withdrawal is usually the result of waiting too long to start treatment and then medicating too slowly with doses that are too low. At Kolmac, we instruct our prospective patients to stop drinking in the evening and come to our office the next morning in a state of early withdrawal. Shortly after arrival, they are given medication, which is then repeated every 30 to 60 minutes until they are comfortable – a process that usually takes three to four hours or less.
The second positive element is that the onset of withdrawal symptoms can be a unique motivating force to seek treatment. Although effective treatment is available, most people with alcohol problems, for a variety of reasons, never receive this treatment. Experiencing morning tremors can get one’s attention in a more powerful way than hearing the complaints and suggestions of family members and friends.
The key to capitalizing on this window of opportunity is to begin psychosocial treatment services simultaneously with the withdrawal medication. The good news is that current medicating protocols are so effective that this can almost always be accomplished. At Kolmac, we do not provide “stand alone” withdrawal management. The relapse rate when there is no follow up treatment is extremely high and contributes to a “revolving door syndrome” of repeated hospitalizations. Because the medication protocols that we use take effect so rapidly, our patients begin outpatient rehabilitation at the same time that they are waiting for the medication to take full effect.
Despite the fact that providing detoxification in an outpatient setting is a mainstream procedure that we have been providing at Kolmac for over 50 years, many people are still not aware that this is possible. This article is written in the hope of increasing awareness of not only its possibility but also of its advantages.