Alcohol Withdrawal Protocol
Updated: October 1, 2020
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Moderate drinking, which the Centers for Disease Control and Prevention (CDC) has defined as one drink per day for women and two per day for men, can be safe for people who are of legal drinking age and who do not have health conditions that make alcohol consumption dangerous. 

While moderate drinking is generally acceptable from a health standpoint, drinking more than a moderate amount can result in health consequences, such as injuries, increased risk of cancer, and even alcohol addiction. 

When a person develops an alcohol addiction, which medical professionals diagnose as an alcohol use disorder, he or she is likely to undergo alcohol withdrawal when alcohol consumption is reduced or stopped

In cases of alcohol withdrawal, it is important to seek the advice and care of a medical professional to prevent complications. Professionals who treat alcohol withdrawal will follow an alcohol detox protocol to ensure the best outcomes for patients. 

Diagnosis of Alcohol Withdrawal

The first step in the alcohol withdrawal protocol is a diagnosis of alcohol withdrawal syndrome, according to experts writing for the Industrial Psychiatry Journal. Diagnosis occurs when a person who has been drinking heavily for an extended period of time stops using alcohol and shows clear alcohol withdrawal symptoms, such as sweating, tremors, irritability, sleep problems, and anxiety.

To make a diagnosis of alcohol withdrawal, a medical professional will ask about a person’s history of alcohol use, such as the amount and frequency of alcohol consumption, and gather information about medical history. Before diagnosing alcohol withdrawal, it is important to rule out other medical conditions.

Assessing Withdrawal Severity

Following the initial diagnosis of alcohol withdrawal, a doctor or addiction professional will assess the severity of a patient’s alcohol withdrawal symptoms. Professionals commonly use a tool called the Clinical Institutes Withdrawal Scale for Alcohol (CIWA) as a part of the alcohol detox protocol.

According to the CIWA, alcohol withdrawal may be mild, involving symptoms such as sweating, upset stomach, headache, anxiety, and racing heart. These symptoms begin about six hours after a person stops drinking, and they last for a day or two. Moderate severity alcohol withdrawal may involve hallucinations, in which a person sees or hears things that are not really there. Despite hallucinating, someone with this level of alcohol withdrawal will remain oriented to reality.

On the other hand, alcohol withdrawal may be rated as more severe if a person experiences withdrawal seizures. Finally, the most severe form of alcohol withdrawal is a potentially fatal condition called delirium tremens, which causes extreme confusion and agitation, coupled with tremors, sweating, hallucinations, racing heart, and anxiety.

The specific alcohol withdrawal treatment protocol will depend on the severity of a person’s withdrawal. Some providers may use the Alcohol Withdrawal Scale (AWS) to assess withdrawal severity. Regardless of the specific scale used, the goal of withdrawal treatment is to make a patient as comfortable as possible and to reduce the risk of complications.

Alcohol Withdrawal Protocol for Mild to Moderate Withdrawal

According to the World Health Organization (WHO), the alcohol withdrawal protocol guidelines in cases of minor withdrawal symptoms is to ensure that patients consume adequate fluids and receive proper nutrition, including thiamine supplements. Medications may be used to treat mild withdrawal symptoms, such as insomnia, diarrhea, or headache.

If withdrawal is rated as moderate in severity, the above alcohol detoxification protocol will apply, but a patient will also receive a benzodiazepine drug like diazepam, commonly known by its brand name Valium, to treat withdrawal. A typical alcohol withdrawal protocol for diazepam administration, according to WHO, is to begin with 10 mg of the drug four times per day, tapering off to a 10 mg dose at bedtime by day five of treatment.

Severe Alcohol Withdrawal Protocol

As with moderate alcohol withdrawal, the alcohol detoxification protocol for severe cases also involves the administration of a benzodiazepine drug like Valium. In cases of severe withdrawal, however, a patient will typically receive larger quantities of Valium. WHO recommends that patients who are undergoing severe alcohol withdrawal receive a 20mg dose of Valium every one to two hours, until the severity of withdrawal symptoms declines. The goal of this alcohol withdrawal protocol is to prevent and manage life-threatening complications, such as seizures, extreme agitation, and dangerously-elevated blood pressure.

While benzodiazepines are typically the drug of choice for treating alcohol withdrawal, experts writing for the Industrial Psychiatry Journal have explained that some cases of severe alcohol withdrawal may not improve with the benzodiazepines. If this is the case, patients may be treated with a type of sedative drug called a barbiturate. Antipsychotic drugs may also be helpful for treating severe forms of alcohol withdrawal, such as delirium tremens. In addition, while Valium is commonly used in the alcohol withdrawal protocol, some experts recommend using Ativan, another type of benzodiazepine, to treat withdrawal seizures.

Regardless of the specific type of medication used, what is important to understand is that moderate to severe alcohol withdrawal can involve complications that require acute alcohol withdrawal treatment with prescription medications. Benzodiazepines and other drugs are necessary to keep patients safe and to prevent life-threatening problems during alcohol (ETOH) withdrawal. While some patients with mild withdrawal symptoms may be able to undergo withdrawal at home, those who have more severe symptoms like seizures or delirium tremens often require hospital treatment, where medical staff can administer medications and assess symptoms around the clock.

Regardless of the severity of alcohol withdrawal symptoms, it is important to seek treatment. Even if symptoms initially appear mild, they may progress in severity. It is essential to undergo an assessment with an addiction professional, who can monitor symptoms and administer the proper AWS protocol to address symptom severity. After a person undergoes alcohol withdrawal treatment, it is important for him or her to receive ongoing psychological care to address the underlying issues that led to alcohol abuse.

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