Benzodiazepines for Alcoholism Withdrawal
Benzodiazepines (or Benzos) are a class of man-made medications. There are a large number of drugs classified as Benzodiazepines, each of which is different. In general, however, Benzodiazepines depress the central nervous system (the nerves in the brain) to some degree and cause drowsiness and sleepiness. Although the exact mechanism by which each Benzodiazepine works is not fully understood, it involves enhancing the effects of the neurotransmitter gamma-aminobutyric acid (GABA) and therefore reducing brain activity.
Alcohol use impacts the way the brain functions. This rewiring becomes increasingly severe the longer and more severe alcoholism continues. By this point the alcoholic’s brain has become dependent on alcohol to function properly. When the addicted individual ceases consuming alcohol, the brain is thrown into disarray. This causes Alcohol Withdrawal Syndrome (AWS). Alcohol withdrawal can be extremely painful, cause seizures, restlessness, hallucinations, nightmares, heart palpitations, and vomiting, among other unpleasant effects. In some cases, alcohol withdrawal can even be fatal.
Various Benzodiazepines help reduce the impact of Alcohol Withdrawal Syndrome in a number of ways. Some of the symptoms Benzodiazepines treat include:
- Seizures and tremors
- Difficulty sleeping and restlessness
- Nausea and vomiting
- Chills and sweats
Benzodiazepines Commonly Used to Treat Alcohol Withdrawal
- Diazepam (Valium)
- Chlordiazepoxide (Librium)
- Oxazepam (Serax)
- Lorazepam (Ativan)
Proper Use of Benzodiazepines
Benzodiazepines carry a number of side effects, including addiction. Additionally, some may cause reactions when used in combination with other alcohol treatment medications. For these reasons, they should only be taken under the supervision and prescription of a licensed medical professional, preferably within an inpatient alcohol detox and rehabilitation setting. However, they are frequently prescribed successfully in outpatient settings as well.
The type of Benzodiazepine prescribed and the manner in which it is used will vary depending on a number of factors, including the setting of use, the severity of the alcoholism issue, and the symptoms presenting themselves during detox. In general, Benzodiazepines are used in three ways.
Fixed Tapering Dose Regimen (FTDR)
- Fixed dose not adjusted based on symptom severity
- Best suited for mild symptoms
- Ideal for outpatient recovery
Symptom Triggered Regimen (STR)
- Dosage is based on patient’s rating of pain – higher levels of pain get higher dosage
- Suited for mild to very severe symptoms
- Can only be utilized under direct medical supervision
- Only used in inpatient recovery
Loading Dose Regimen (LDR)
- Uses long-acting Benzodiazepines that stay in the body for several days
- Most impactful at reducing seizures
- Ideally only used in inpatient settings to allow monitoring