Alcohol withdrawal involves stopping alcohol consumption. Withdrawal symptoms are typical; these are assessed by a doctor and treated with medication if necessary. A professional withdrawal programme combines physical detoxification with psychotherapeutic support.
A complicated course of withdrawal can cause severe neurological or psychological symptoms. Medical supervision enables such complications to be identified and treated in a targeted manner.
What is alcohol withdrawal and who is it suitable for?
During alcohol withdrawal, the person concerned abstains from alcohol. If symptoms arise as a result, doctors refer to this as alcohol withdrawal syndrome. They assess this on the basis of clinical symptoms.
Withdrawal initially addresses the consequences of stopping alcohol consumption. The underlying alcohol addiction often requires further alcohol therapy. In cases of alcohol dependence, physical withdrawal alone is often insufficient to prevent a relapse.
‘Cold turkey’ refers to the abrupt cessation of alcohol consumption without medication to alleviate withdrawal symptoms. Under medical supervision, symptoms can be systematically recorded and treated. This is important because a complicated withdrawal process can cause severe neurological or psychological symptoms.
Qualified alcohol withdrawal treatment should also be offered to people who are still unsure whether they wish to undergo further treatment afterwards. Anyone seeking help for an alcohol problem does not, therefore, need to have made a final decision to undergo rehabilitation before starting withdrawal.
What is assessed before detoxification?
Before detoxification begins, doctors assess the patient’s current condition and any symptoms they are experiencing. To do this, they measure breath alcohol levels and record withdrawal symptoms using a standardised procedure.
This assessment continues throughout the alcohol detoxification process. This allows staff to monitor whether symptoms are worsening or whether new ones are emerging.
How does alcohol detoxification work?
The process depends on the severity of the symptoms and the chosen form of treatment. Alcohol detoxification can take place on an outpatient basis or as an inpatient in a clinic. A doctor must assess which option is appropriate.
- At the start, doctors assess alcohol withdrawal syndrome based on the clinical symptoms.
- During withdrawal, the patient’s physical and mental condition is monitored continuously.
- If necessary, medication is used to manage withdrawal symptoms.
- In a properly managed withdrawal programme, psychotherapy complements the physical treatment of alcohol dependence.
- Following detoxification, further therapeutic support and close monitoring may follow.
Outpatient alcohol detoxification may be an option for selected patients. In a pilot project, around 94 per cent of the participants selected for this programme successfully completed detoxification. This result cannot be generalised to every person with alcohol dependence.
In the same pilot project, around 46 per cent of patients also completed the subsequent one-year outpatient treatment. However, completing treatment is not the same as achieving long-term abstinence.
What treatment options are available?
Benzodiazepines are among the medicines that can be used during alcohol withdrawal. The choice of pharmacological treatment depends on the symptoms and the clinical course.
Beta-blockers and clonidine may be considered as adjunctive treatments at most. The same applies to carbamazepine and neuroleptics. These medicines are not suitable as the sole treatment for alcohol withdrawal.
| Form of treatment | For whom and what does it involve? | Advantages and limitations |
|---|---|---|
| Specialist withdrawal treatment | For people with alcohol dependence | A comparative study found evidence of better outcomes than following purely physical detoxification. However, due to methodological limitations, it is not possible to make a reliable individual prognosis. |
| Purely physical detoxification | Treatment of immediate physical withdrawal symptoms | Treatment focuses on physical withdrawal. |
| Outpatient detoxification | Treatment outside an inpatient clinic for selected patients | Withdrawal takes place in the patient’s familiar surroundings. The results from selected groups do not allow us to conclude whether this approach is suitable for all those affected. |
| Inpatient treatment | Monitoring and treatment in a hospital or a specialist clinic | Clinical observation takes place on site. In a hospital, doctors specialising in internal medicine may be involved. |
What are the risks associated with alcohol withdrawal?
A complicated alcohol withdrawal can cause symptoms that require immediate medical assessment. These include:
- Hallucinations: Those affected perceive things that are not actually there.
- Seizures: Uncontrolled muscle movements may be accompanied by impaired consciousness.
- Withdrawal delirium: This acute disorder is one of the possible complications of alcohol withdrawal.
Alcohol withdrawal delirium is also known as delirium tremens. Delirium is an acute disturbance of consciousness and alertness. Standardised monitoring is used to detect changes so that treatment can be adjusted accordingly.
A review of six drug trials involving 664 participants reported one seizure in each of the two treatment groups compared and no deaths. These results relate to treated study groups. They do not indicate the level of risk associated with untreated or ‘cold’ withdrawal.
What helps after detoxification?
Following physical detoxification, further treatment focuses on alcohol dependence and preventing a relapse. For patients receiving psychiatric treatment, close monitoring is also important during aftercare.
A detoxification programme can form the basis for longer-term alcohol therapy. The appropriate therapeutic steps depend on the individual’s personal situation and their history to date. The treatment goal is also taken into account, such as abstinence – that is, a life without alcohol.
In a German observational study, around 46 per cent of the patients examined were consistently abstinent six months after receiving qualified inpatient withdrawal treatment. However, no reliable prediction can be made for an individual based on this.
Which doctors carry out alcohol withdrawal treatment?
Alcohol withdrawal should be managed by doctors who are able to assess alcohol withdrawal syndrome and treat any potential complications.
A suitable service should assess symptoms in a standardised manner and be prepared for complicated cases. In the case of qualified withdrawal treatment, psychotherapeutic treatment must also be available.
During the initial consultation, you could ask the following questions, for example:
- How will my withdrawal symptoms be assessed and monitored?
- How does the clinic deal with seizures or delirium tremens?
- Does the service include qualified withdrawal treatment?
- How is further therapy organised following detoxification?
You will find specialists in alcohol withdrawal at the end of this text.
Frequently asked questions about alcohol withdrawal
What is ‘cold turkey’ alcohol withdrawal?
In ‘cold turkey’ alcohol withdrawal, alcohol consumption is stopped abruptly without using medication to alleviate the symptoms. As serious complications can arise, medical supervision enables early assessment and treatment.
What tests are carried out before alcohol detoxification?
Doctors measure breath alcohol levels and assess withdrawal symptoms using a standardised procedure. These checks continue throughout the detoxification process.
What medicines are used during alcohol withdrawal?
Benzodiazepines may be used to treat alcohol withdrawal. Certain other medicines are only considered as a supplement and do not replace the actual withdrawal treatment.
What distinguishes qualified withdrawal from detoxification?
Physical detoxification primarily treats the immediate withdrawal symptoms. In cases of alcohol dependence, qualified withdrawal also includes psychotherapy.
Can alcohol detoxification take place on an outpatient basis?
Outpatient detoxification is possible for selected patients. However, the results of a pilot project cannot be generalised to every case of alcohol withdrawal.
What are the prospects of remaining abstinent after withdrawal?
In a German observational study, around 46 per cent of the patients studied had remained completely alcohol-free six months after undergoing inpatient, qualified withdrawal treatment. This result cannot be reliably extrapolated to individual patients.
