Medical Treatment of Alcoholism

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Acute Alcohol Intoxication: The first priority of acute alcohol intoxication is to be certain that vital signs are stable and there is no evidence of respiratory depression and change in blood pressure. The possibility of intoxication with other substances should be considered. For that blood and urine samples are taken and sent for investigation.

Patients who are stable should be asked to lie down on there side in order to minimize the risk of aspiration. If there is likely to be violent behavior from the patient, than the show of force with a team is advisable. The patient should be firmly and politely reminded that the aim of the treatment is to avoid problems and for the betterment of the patient. Still if the patient can not be controlled, CNS depressant should be used. But it should be kept in mind that, CNS depressant like lorazepam does not destabilize the patient.

Alcohol Withdrawal: The first step is a thorough physical examination of the patient, if the patient is planning to stop drinking. Liver failure, cardiac problems, gastrointestinal bleeding and electrolyte imbalance should be ruled out.

The next step is adequate nutrition and rest. Patient should be given vitamin B complex 2 to 3 tablets for about a week prior to stopping of drinking. Generally all the medicines can be given orally.

The third step is to recognize the withdrawal symptoms and treat them promptly. If the patient is treated with CNS depressant benzodiazepines like lorazepam, it should be gradually decreased in 3 to 5 days. But nowadays, longer acting drugs like diazepam is preferred by many doctors. Sudden withdrawal of longer acting CNS depressant has fewer side effects than shorter acting lorazepam. Shorter acting drugs can cause seizure if there is preexisting liver disease or if there is wide fluctuation of blood levels.

Treatment of severe alcoholism delirium tremens (DT) is very difficult. Symptoms of DT continue for 3 to 5 days even if appropriate therapy is instituted. So, aim of the treatment is to prevent injury. If electrolyte imbalance or dehydration is present, they should be corrected. Treat the symptoms as they appear. Some doctors prefer high dose of benzodiazepines (like chlordiazepoxide 800 mgs per day) to reduce agitation. Others prefer anti psychotics, which are not used in treatment of mild withdrawal symptoms.

Now days to reduce cost of hospitalization alcoholic patients are treated as outdoor basis as for as possible. In large number of mild to moderate alcoholics out door basis of treatments hospitalization is a must.

Rehabilitation:-At least 60% of alcoholics can maintain abstinence for more than a year and many can do it foe life ling. Patient should be motivated through counseling from time to time and follow up should be done. Relapse prevention is done by trying to identify satiations which causes relapse and managing these situation as for as possible.

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