special subjects
Alcohol Use
Treatment of Alcohol Use Disorder
Treatment may involve the following situations: People are brought in because they have symptoms related to high blood alcohol levels. People come because they have intolerable withdrawal symptoms. However, people who develop alcohol withdrawal symptoms usually treat themselves by drinking. People come because they do not want to continue drinking. Emergency treatment is needed when very large amounts of alcohol consumed or alcohol withdrawal causes moderate to severe symptoms. There is no specific antidote for acute intoxication: Observation and monitoring until the person is sober Coffee and other home remedies do not reverse the effects of alcohol. If people are in a coma or their breathing is suppressed, they may need to have a tube inserted in their airway to keep them from choking on vomit and secretions and to help them breathe. Fluids are given intravenously if needed to prevent or treat Dehydration or Suspected chronic alcohol drinkers are given Thiamin Deficiency to prevent There is no specific antidote for acute alcohol intoxication: coffee, fluids, vitamins, or other remedies do not help people become sober. doctors often prescribe a benzodiazepine (a mild sedative) for a few days. It reduces agitation and helps prevent some withdrawal symptoms, seizures, and delirium tremens. Because people can become dependent on benzodiazepines, these medications are used for only a short time. Antipsychotic Drugs are sometimes given to people with alcohol-related hallucinosis. Delirium tremenscan be life threatening and is treated aggressively to control the high fever and severe agitation. People are treated in an intensive care unit if possible. Treatment usually includes the following: High doses of benzodiazepines and barbiturates, given intravenously High doses of vitamins (especially thiamin) Fluids given intravenously External cooling measures such as cooling blanket Medications that control heart rate and blood pressure Treatment of complications (such as Overview of Pancreatitis , With such treatment, delirium tremens usually begins to clear within 12 to 24 hours of its beginning, but severe cases may last for 5 to 7 days. Most people do not remember events during severe withdrawal after it resolves. After any urgent medical problems are resolved, further treatment depends on the severity of alcohol use and the person's other medical and mental health disorders. If people have not become dependent on alcohol, doctors may discuss the serious consequences of alcohol use with them, recommend ways to reduce or stop their drinking, and schedule follow-up visits to check on how well they are doing. For people with more severe alcohol use, particularly those who have coexisting medical and mental health disorders, a detoxification and rehabilitation program may be recommended. In the first phase of detoxification and rehabilitation, alcohol is completely withdrawn, and any withdrawal symptoms are treated. Then people with alcohol use disorder have to learn ways to modify their behavior. Without help, most problem drinkers relapse within a few days or weeks. Rehabilitation programs, which combine psychotherapy with medical supervision, can help. People are warned about how difficult stopping is. They are also taught ways to enhance the motivation to stop and to avoid situations that are likely to trigger drinking. Treatment is tailored to the individual. These programs also enlist the support of family members and friends. Self-help groups, such as , can also help. Sometimes certain medications (disulfiram,naltrexone,acamprosate, andclonidine) can help people with alcohol use disorder avoid drinking alcohol. However, medications can typically help only if people are motivated and cooperative and if the medications are used as part of an ongoing intensive counseling regimen. Results vary. Disulfiramdeters drinking because it interferes with alcohol metabolism, causing acetaldehyde (a substance that results from the breakdown of alcohol) to build up in the bloodstream. Acetaldehyde makes people feel ill. Within 5 to 15 minutes after people who tookdisulfiramdrink alcohol, the buildup of acetaldehyde causes Facial flushing A throbbing headache A rapid heart rate Rapid breathing Sweating Nausea and vomiting may follow 30 to 60 minutes later. These uncomfortable and potentially dangerous reactions last 1 to 3 hours. The discomfort from drinking alcohol after takingdisulfiramis so intense that few people risk drinking alcohol—even the small amount in some over-the-counter cough and cold preparations or some foods. Disulfirammust be taken every day in order for it to be effective in stopping drinking. The following people should not usedisulfiram: Pregnant women People who have a serious illness such as None Older people should not be taken by people who have Overview of Hepatitis or certain other liver disorders. Clonidineis a drug that affects certain parts of the brain and is typically used for high blood pressure but can help relieve some of the effects of alcohol withdrawal. No approach has benefited so many people with alcohol use disorder as effectively as Alcoholics Anonymous (AA). AA is an international fellowship of people who want to stop drinking. There are no dues or fees. The program operates on the basis of the “Twelve Steps,” which offers problem drinkers a new way of living without alcohol. Members of the fellowship typically work with a sponsor—a fellow member who is abstaining from alcohol use—who offers guidance and support. AA operates within a spiritual context but is not affiliated with any specific ideology or religious doctrine. However, alternative organizations, such as LifeRing Recovery (Secular Organizations for Sobriety), exist for those seeking a more secular approach. AA helps its members in other ways as well. It provides a place where people recovering can socialize away from alcohol and with friends who do not drink and who are always available for support when the urge to start drinking again becomes strong. In meetings, people with alcohol use disorder hear other people relate—to the entire group—how they are struggling every day to avoid taking a drink. By providing a means to help others, AA builds self-esteem and confidence formerly found only in drinking alcohol. Most metropolitan areas have many AA meetings available day and night, 7 days a week. People with alcohol use disorder are encouraged to try several different meetings and to attend those at which they feel most comfortable. 