Brief overview
- Outpatient or inpatient: Prerequisites for outpatient therapy include social integration, ability to abstain, absence of other mental and physical illnesses.
- Withdrawal symptoms: Sweating, trembling hands, increase in blood pressure, temperature, headaches, sleep disturbances, anxiety, restlessness, depressiveness, concentration disorders.
- Forms of withdrawal: cold turkey (without drug support), warm withdrawal (drug support), gradual withdrawal (slow reduction of consumption), turbo withdrawal (under anesthesia)
Alcohol withdrawal: inpatient or outpatient?
Alcohol withdrawal can occur on an outpatient or inpatient basis. Inpatient withdrawal is necessary when the mental or physical condition or social environment does not allow for outpatient withdrawal – that is, when one or more of the following factors apply:
- The patient is not supported in his abstinence by his home environment.
- Previous seizures or delirium tremens have occurred during withdrawal.
- Previous attempts at outpatient alcohol withdrawal have failed.
- The patient uses other (especially illegal) drugs.
- The patient suffers from severe cardiovascular disease, cirrhosis of the liver, or other serious physical illnesses.
- The patient suffers from other mental illnesses such as an anxiety disorder or depression.
- The patient is suicidal.
- The patient exhibits disorientation or suffers from hallucinations.
Even if the affected person himself clearly prefers an inpatient withdrawal, this is the better way than an outpatient withdrawal.
Inpatient alcohol withdrawal
If alcohol withdrawal is carried out on an inpatient basis, this has a major advantage: if serious or even life-threatening withdrawal symptoms (seizures, cardiovascular problems, delirium, etc.) occur during detoxification, medical help is immediately on hand.
Also, the home environment is usually linked to alcohol use and can provoke a relapse. Another advantage of inpatient withdrawal is that psychological support is already provided here, stabilizing the patient and laying the initial foundations for subsequent therapy.
Outpatient alcohol withdrawal
It is also important that the environment does not make withdrawal even more difficult. For example, because the person concerned lives or works in an environment where alcohol is consumed. In addition, the patient must already have a high level of self-motivation and be somewhat psychologically stable in order to be able to endure outpatient withdrawal. It is also helpful to have a social environment that supports him.
How long does alcohol withdrawal take?
The duration of alcohol withdrawal varies from patient to patient. As a rule, it takes a few days to a week to complete physical withdrawal. However, the risk of relapse is then still very high, as psychological dependence still exists. Together with psychological care, alcohol withdrawal takes about three to four weeks.
Alcohol withdrawal: symptoms
The first symptoms appear within 24 hours after stopping the addictive alcohol. Particularly severe alcoholics feel the withdrawal symptoms very quickly.
Typical physical symptoms of alcohol withdrawal are:
- heavy sweating
- Nausea and vomiting
- trembling of the hands, eyelids, tongue
- headache
- dry mouth
- general malaise and feeling of weakness
- Blood pressure increase
Mental signs of alcohol withdrawal include:
- Difficulty concentrating @
- Sleep disturbances @
- Anxiety
- Depressiveness
- Restlessness
Delirium tremens
Especially feared is the most severe form of withdrawal symptomatology – delirium tremens. At the beginning, the patient is anxious and very restless. This is usually followed by seizures, which usually occur during the first two days of abstinence.
Characteristic of delirium is severe disorientation and confusion of the patient. Hallucinations and delusions are often added.
The affected person is no longer responsive in this state. The seizures, palpitations and circulatory disturbances cause a life-threatening condition. Delir tremens ends fatally in 30 percent of cases if left untreated.
Different forms of alcohol withdrawal
Doctors distinguish between warm withdrawal with medication support and cold withdrawal without medication.
Cold turkey
Warm withdrawal
There are now medications that can significantly reduce withdrawal symptoms. Clomethiazole and benzodiazepines are the main drugs used in inpatient treatment. They have a sedative and anxiety-relieving effect and inhibit both seizures and delirium. However, both agents have a high potential for addiction. Some clinics therefore prefer withdrawal without these drugs.
Some patients need additional anticonvulsants to prevent seizures.
Gradual withdrawal (cut-down drinking).
As an alternative to abrupt withdrawal, alcohol consumption is now sometimes reduced slowly. To do this, the patient reduces his or her consumption by means of a drinking diary. Withdrawal should be regularly monitored and documented at short notice. To support this, the patient usually receives naltrexone, which significantly weakens the euphoric effect of alcohol and thus facilitates abstinence.
Turbo withdrawal
The advantage of turbo withdrawal is that it cannot be aborted and the patient does not experience withdrawal symptoms while fully conscious. However, withdrawal symptoms often persist after anesthesia, so treatment must be continued. Most importantly, this method has not become widely accepted in practice because of the risk of severe complications and because of the high cost.
What happens after alcohol withdrawal?
With the physical withdrawal, the dependence on beer, wine & Co. is not overcome. The body will continue to respond strongly to alcohol and demand larger quantities when consumed.
Physical withdrawal is followed by psychological withdrawal
The psychological withdrawal is by far the greater challenge for the patient than the physical withdrawal. Here it is necessary to overcome ingrained habits and rituals, to find out the causes for the slide into addiction and to uncover the functions that alcohol has in one’s own life (e.g. soul comforter, frustration reduction).
You can read more about the subsequent therapy of alcoholism in the article Alcoholism.
