Alcohol

Symptoms of Withdrawals

Symptoms can start to appear in as little as six hours. In an emergency, if someone is unable to access rehab immediately they will need to continue drinking. Sudden cessation can, not only be very dangerous, but can also be fatal.

Withdrawal symptoms can be physical and psychological, and range in severity from mild to severe.

Typical symptoms of alcohol withdrawal can include:

Milder symptoms usually start within eight to 24 hours from the last alcoholic drink.

A condition known as delirium tremens can set in,it is the most severe form of alcohol withdrawal, manifested by altered mental status (global confusion) and sympathetic overdrive (autonomic hyperactivity), which can progress to cardiovascular collapse. Minor alcohol withdrawal is characterized by tremor, anxiety, nausea, vomiting, and insomnia. Major alcohol withdrawal signs and symptoms include visual hallucinations and auditory hallucinations, whole body tremor, vomiting, diaphoresis, and hypertension (high blood pressure).

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Alcohol

Kindling effect

Many callers ask for treatment at home because they have been in treatment before but, sadly, have relapsed. They will often say that they "just need a detox" and that they "know what they are doing." The difficulty is that withdrawal symptoms can increase if someone needs repeated treatment. This is what is called the Kindling effect. This occurs when a weak electrical or chemical stimulus , which ordinarily would not be of concern, causes seizures when someone stops drinking. The evidence suggests that those who seek repeated treatment actually need to be treated with a more aggressive course of medication than those seeking treatment for the first time.

Alcohol

Treatments for alcohol use disorder

When someone presents with alcohol use disorder, medical intervention is needed. Depending on the severity of the symptoms and other factors a course of benzodiazepines will be needed to ensure a safe withdrawal. This could take several days, or even longer. Vitamin B replacement therapy may also be required which may need to be in the form of a series of injections over a period of three to five days. During the initial period of medical treatment, aside from benzodiazepines, adjunctive medication may sometimes be offered to assist with symptom control. Clients in treatment centers will be given sufficient medication, not only to ensure safety, but also to provide a comfortable as possible transition from dependency to sobriety.

As with all those seeking residential treatment, medical intervention is a small, but important part of the process and runs seamlessly alongside a recovery plan that is based around either a twelve step or SMART based recovery programme. Most centers will augment this with allied therapies including exercise, yoga, mediation, music and art therapy and for those in treatment for more than a week, individual sessions.

Getting into treatment requires the right centre within a budget that is not going to cause additional problems. Admission can, on occasion, be arranged the same day, if not within 24 hours.

• How many people have AUD?

  In 2021, a survey in the United States of America suggested that over 28.6 million adults aged over 18 had Alcohol Use Disorder: That is over 11% of the population.
  What Increases the Risk for Alcohol Use Disorder?
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  The risk of someone developing AUD depends in part on several factors, namely what they drink, how much they drink and how often they drink. There are other factors that also contribute:
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  * Starting drinking at an early age.
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  Research has shown that those who drink from the age of 15, on wards, are more than three times more likely to develop symptoms of AUD by the age of 26 than those who did not start drinking until they were 21.
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  * Women are, statistically more likely than men, to develop AUD.
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  * Genetic predisposition/family history:
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  60% of people with diagnosed AUD are genetically pre-disposed to it However, as with other chronic health conditions, there is a interplay between genetics and environment. Thus someone with a very stressful lifestyle who drinks to relieve stress , and who has a family history of AUD is more prone than someone who has a family history but is not drinking to relieve stress.
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  *Mental illness/psychological trauma.
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  Those with underlying mental health conditions and/or a history of trauma. ADHD, PTSD and other related conditions are common amongst those with AUD.

• What Are the Symptoms of Alcohol Use Disorder?

  Doctors and other healthcare professionals use criteria from established diagnostic criteria to determine if someone is experiencing AUD. The severity is based on multiple criteria which is linked to symptoms. A person who shows two or three symptoms is said to have a mild episode, four to five is considered moderate and any more than six is considered to be severe.
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  A health care provider might ask the following questions to assess a person’s symptoms, based on a persons drinking history for the last calendar year:
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  Have there been occasions where you drank more than you intended to for longer than you intended to?
  Have you tried to stop, or cut down, but have been unable to?
  Does drinking take up a lot of your time and/or have you been physically unwell as a result of drinking?
  Has the desire to drink alcohol taken control of your thinking to the degree that you can not think about anything else?
  Has drinking affected your job? your relationship? Your studies?
  Despite the trouble caused by drinking, have you continued to drink?
  Due to alcohol, have you cut back on social activities?
  Because of drinking, have you put yourself in a dangerous situation such as drink driving, risky sexual behavior? Have you been hurt, as a result?

• What is Wernicke–Korsakoff syndrome?

  Wernicke-Korsakoff is a serious medical condition that is a form of dementia caused, 99% of the time, due to excessive consumption of alcohol. In essence, Alcohol prevents the body from absorbing vitamin B1, which can have catastrophic and life long changes to the brain.Alcohol prevents thiamine from being absorbed properly in the gastro intestinal tract, stops it from being absorbed properly in the body, and increases the amount of thiamine that is excreted in urine. This devastating condition has two, distinct, separate stages:
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  Firstly, there will be a brief period where the person has intense swelling on the brain: This is Wernicke’s encephalopathy.
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  Secondly, if this first stage is left untreated, Korsakoff’s syndrome develops. This, irreversible condition, has many of the same symptoms as dementia.
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  Around 25% of those with Wernicke’s who access the appropriate medical care will make a good recovery. 50% will make a partial recovery and be able to live with some social care support. However, the remaining 25% will need lifelong care, normally in a residential care setting.

• How is it diagnosed?

  If someone with alcohol use disorder is still intoxicated, it can be a challenge to diagnose, this is because some of the symptoms can often be confused with alcohol withdrawal.

  The signs to look out for are:

  * Being disorientated, appearing confused or having problems with your memory

  * Difficulty with eye movements

  * Poor balance, being unsteady and walking with legs very wide apart

  * Either being very underweight or recent unexplained weight loss within the last few months.

  It is unusual for someone with present with all of these symptoms but nearly all will show signs of confusion and disorientation.

  Without appropriate medical treatment, Wernicke’s will, undoubtedly, lead to Korsakoff’s and permanent brain damage. Intravenous Thiamine is needed, with oral supplements for several weeks as well as re hydration and enhanced nutrition.

• What help is available?

  As explained above, there is no “detox” for cocaine. However, many centers will offer, if clinically appropriate, adjunctive medication to assist with the symptoms of withdrawal. That said, the most important element of treatment for cocaine, as with any substance of abuse, is a comprehensive programme of intense therapy. All centers run on either a 12 STEP programme, a SMART programme or an eclectic mix of the two. These programmes run seven days a week meaning that someone can enter treatment on any day of the week, if necessary Christmas day.
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  As soon as someone is physically able to do so, they are expected to attend all therapy sessions which are often augmented with additional therapies such as:
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  * music therapy
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  * yoga
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  art therapy
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  * gentle exercise and group walks
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  * mindfulness
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  * individual therapy sessions (for those staying for more than one week)
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  Close medical monitoring is important for the first few days and it may be necessary to share information (with consent) between the client in treatment and their GP surgery. However, a medical summary can be requested from a GP surgery and they are not entitled to know what it is for or who the intended audience is.
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  As with any effective period of treatment , effective discharge planning starts from the pre-admission assessment. This needs to be done by an experienced clinician in a collaborative fashion working with the users treatment goals in mind. While there are some centers that will admit clients for a week in cases of cocaine addiction, most will not and a week is not much time to get to grips with the therapy programme or to build up the psychological tools and techniques to prevent relapse.
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  The centre will, not only provide at least twelve months aftercare, will also link the user in with local support groups: both voluntary and statutory (if applicable).
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  Not all centers are the best fit for every person seeking treatment. While bolt on therapies are useful, they may not be necessary, in every case. As such, it may be possible to keep costs down by making an informed choice about the centre someone is going to be receiving treatment in. All centers must be registered with the Care Quality Commission (CQC). It is imperative that the registration of any centre you are proposing to use is checked, on the CQC website or by calling them:directly. If a centre has been open for a period of time there may be inspection reports published on the CQC website. Centers, if they have a website, are legally required to post the inspection reports within twenty one days of it’s publication by the CQC.