Thursday, October 22, 2009

Outpatient Alcohol Detoxification

A lot of patients are coming to us because they are having a very hard time getting off alcohol. Detoxifying off alcohol is very uncomfortable, both physically and psychologically. It can also be very dangerous medically. For over two years now we have been providing an outpatient detoxification for alcohol that is comfortable, safe, and avoids the hassle and expense of an inpatient hospital stay. The program has been working very well.

Without our outpatient detoxification program almost all of the patients we have treated would have required an extensive inpatient detoxification in a hospital. We were able to quickly and successfully detox all the patients, usually in three days. We have not had any complications and have not had to transfer any patients into a hospital.

Alcohol detoxification can be very difficult and medically dangerous for a number of reasons. Firstly, alcohol is a very strong sedative. The body adjusts to regular use of alcohol by not producing its own calming down neurotransmitters – Gamma Amino Butyric Acid (GABA) and Glutamate. This means that when the alcohol is gone the body is in a very agitated state. The pulse and Blood Pressure are elevated and there can be lot of sweating. There are tremors and even violent shakes. The agitation can be so severe there are even seizures. There can also be confusion, memory loss, and even loss of touch with all reality (delirium). This condition of tremors, combined with the loss of reality, is called Delirium Tremens, or DTs. DTs are sometimes fatal.

Secondly, alcohol leaves the body very quickly, so that the withdrawal symptoms begin early and are very intense. The whole withdrawal process is concentrated in a short period of time, making it intense and dangerous.

Thirdly, alcohol is a very toxic substance that damages almost all parts of the body. This means that at the very point in time that the body is trying to recover from alcohol withdrawal it is in a much damaged state. Alcohol causes the stomach and the esophagus to develop ulcers. The pancreas can shut down, and the liver can get cirrhosis and frequently goes into liver failure. Alcohol poisons the blood cells, so it is harder to fight off infections. Alcohol damages the brain, causing confusion, memory problems and balance problems. The net effect of all this is that just as the patient needs a strong body to deal with the stress of withdrawal, the body is operating in a very weakened state. It is no wonder that without the right treatment complications can develop.

Our outpatient detox deals with all of these issues and helps the patient get though the detox safely and comfortably. We ask our patients to stop their alcohol by about 11 pm the night before the detox begins and then come to the office at 8.30 am. We perform a comprehensive History and Physical, get lab work, an EKG, and then we check a breath alcohol level. Next we star an IV solution with vitamins and nutrients to replenish all of the nutrients the body may be lacking. Then we give doses of IV Phenobarbital, which is a great medicine for alcohol withdrawal. It calms the person down, helps them relax, and it prevents seizures. It has a long half life, so it lasts a long time. After about 8 hours the patient is calm and relaxed and can be discharged home under the care of a support person. The patient continues to receive some oral medicines and they come back to the clinic each day for two more days. They are often able to return to work by the 4th day.

The patients we have treated with this outpatient alcohol detoxification process have done very well and have really enjoyed the process. They have been able to detox in the comfort of their own home instead of in a hospital room. The withdrawal symptoms they have experienced have been very manageable. Of course, during the time patients are with us we plan for their ongoing recovery. We usually recommend a Naltrexone implant because it helps so much with cravings. We often prescribe Antabuse or other medicines to prevent relapse. We also have our aftercare counselor, Chris Newcomb, meet with everyone to plan for a counseling program as part of their ongoing recovery plan.

Detoxification is necessary, but it is not sufficient for long term recovery.

Peter Coleman MD

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