When is a medically assisted alcohol detox needed?

Dr Niall Campbell, based at Priory Hospital Roehampton, is a highly experienced consultant psychiatrist, specialising in mental health and addiction.

Addiction to alcohol continues to be a significant problem in our society. At Priory, we continue to see a significant number of people who drink heavily on a daily basis, with increasingly negative consequences on their physical and mental health, as well as their relationships and performance at work.

During an initial assessment, we can help heavy drinkers to acknowledge the consequences of their drinking and make the decision to stop.

However, there is a significant risk that if chronic heavy drinkers stop drinking suddenly they may experience withdrawal seizures, like an epileptic seizure, which can be fatal.

Withdrawal symptoms from alcohol detox

Withdrawal seizures from alcohol detox may also be a symptom of delirium tremens. Those who have been drinking particularly heavily for a long time are at an increased risk of developing delirium tremens which also includes symptoms of extreme confusion (delirium) uncontrollable tremor (tremens), fast heartbeat, dangerously high blood pressure, disturbing dreams, visual and auditory hallucinations and epileptic type seizures. Untreated delirium tremens are classed as a medical emergency and can be fatal.

For this reason, we recommend that heavy drinkers do not stop suddenly, but try to cut down gradually. This is, of course, very difficult to do. Ideally, these kind of patients need to be detoxed in a hospital inpatient setting. Priory addiction treatment units are licensed as hospitals and are staffed by doctors and nurses who have been trained in the management of alcohol withdrawal. 

After a planned admission, and a detailed history of their recent drinking, patients are observed on the Clinical Institute Withdrawal Assessment for Alcohol (CIWA) regime. This involves monitoring physical signs and symptoms such as nausea, tremors, sweating, anxiety and other vital signs such as pulse and blood pressure. When a patient’s breath alcohol is below 0.35, they will be able to commence on a detox regime. 

If patients do not have a history of withdrawal seizures, the medication involved in detox is likely to consist of benzodiazepines, either chlordiazepoxide or oxazepam. However, if patients have had a history of withdrawal seizures, this medication is likely to be diazepam or carbamazapine. 

The benzodiazepines will usually be administered in reducing doses, typically over a period of several days and in accordance with the patient’s clinical presentation. In the event that the patient develops delirium tremens, they will be transferred to A&E for management in an emergency medical setting. In our experience, this is a rare occurrence, but we are always prepared for this eventuality.

The first 24 to 48 hours of detox is normally the worst. Typically, a detox regime for heavy drinkers lasts for five to seven days.

Medically assisted detox at Priory

We encourage all patients with addiction problems to engage in the 28-day Addiction Treatment Programme. We say that stopping drinking is relatively easy, but working out the emotions behind drinking and not picking up a drink in the future to relieve these emotions is the hard bit, which takes time. 

Patients are usually well enough within 48 hours to commence the group Addiction Treatment Programme. Usually, they are very glad to do this as being on their own in a room can be frustrating, boring and anxiety-inducing.  Being with other patients who they identify with, can help them to begin to address the reasons behind their addiction.

It is important to emphasise that Priory hospitals have 24-hour nursing and medical care and our experts possess extensive clinical experience in the alcohol detoxification process.