Alcohol detoxification

Alcohol detoxification or 'detox' for alcoholics is an abrupt stop of alcohol drinking coupled with the substitution of drugs that have similar effects in order to prevent alcohol withdrawal. Detoxification may or may not be necessary depending upon an individual's age, medical status, and history of alcohol intake. For example, a young man who binge drinks and seeks treatment one week after his last use of alcohol may not require detoxification before beginning treatment for alcoholism. Benzodiazepines are the most common family of drugs used for this, followed by barbiturates.

Benzodiazepines
Detoxes are performed in multiple ways:
 * 1) The first option takes into consideration the varying degrees of tolerance. In it, a standard dose of the benzodiazepine is given every half hour until light sedation is reached. Once a baseline dose is determined, the medication is tapered over the ensuing 3-10 days.
 * 2) Another option is to give a standard dose of benzodiazepine based on history and adjust based on withdrawal phenomenon.
 * 3) A third option is to defer treatment until symptoms occur. This method should not be used in patients with prior alcohol related seizures. This has been effective in randomized controlled trials.  A non-randomized, before and after, observational study found that symptom triggered therapy was advantageous.

Dosing of the benzodiazepines can be guided by the CIWA-Ar scale. The scale is available online.

Regarding the choice of benzodiazepine:
 * Lorazepam or diazepam are available parenterally for patients who cannot safely take medications by mouth.
 * Lorazepam and oxazepam may be best in patients with cirrhosis (shorter half life).

Sympatholytics
Randomized controlled trials have found benefit from atenolol and clonidine.

Carbamazepine
A randomized controlled trial has found benefit from carbamazepine.

Other drugs
Some hospitals administer alcohol to prevent alcohol withdrawal although there are potential problems with this practice.