Alcohol dependence and detoxification Information for patients who are admitted to hospital for help with withdrawal from alcohol The information in this leaflet advises people who are physically dependent on alcohol about their treatment during an inpatient stay to allow safe withdrawal from drinking alcohol. It also provides information about support services after discharge from hospital. What is alcohol dependence? Alcohol dependence develops in people who have a sustained period of continuous and heavy intake of alcohol. If you are alcohol-dependent you have a strong desire to drink alcohol and therefore your body becomes used to lots of alcohol. Someone who is physically dependent will typically drink alcohol every day and will often need to drink within a few hours of waking up in the morning. However, the most important indicator of alcohol dependence are the withdrawal symptoms that happen if you suddenly stop drinking or reduce the amount of alcohol you normally drink too quickly. Alcohol withdrawal can be seen in a cluster of signs observed in persons who stop, or markedly reduce, their alcohol consumption following continuous and heavy drinking. Mild forms of withdrawal include tremor, sweating, craving for alcohol, and feeling sick. Sometimes there are seizures and hallucinations. Typically these occur within six to 48 hours after the last drink and may last five to seven days without treatment. In a minority of patients a more severe form of withdrawal can develop called delirium tremens (DTs) in which there are marked tremors (shaking), hallucinations, and confusion. DTs can be fatal without the correct treatment. Alcohol withdrawal develops because alcohol in high concentrations depresses the activity of the central nervous system (brain). Withdrawal of alcohol leads to an over activation of the central nervous system and results in the physical problems described above. 1 of 3 Alcohol dependence and detoxification (September 2019) Why has this treatment been recommended? We have recommended this treatment for you to allow a safe and continued withdrawal from alcohol. Detoxification, or ‘detox’, refers to the process of clearing the alcohol from your system and of your body adapting to being alcohol free. What happens during detoxification? During assisted detoxification a short course of medicine is given which helps to prevent withdrawal symptoms when you stop drinking alcohol. The most commonly used medicine for detox is a member of the benzodiazepine family called chlordiazepoxide. This does not make you stop drinking but will help you to feel better while your body adjusts to not having alcohol. A detoxification programme is only the first step in your treatment. The next stage is not drinking anymore alcohol (remaining abstinent). The medicines we give to help the detox are: • Vitamin supplements, particularly vitamin B1 (thiamin) because drinking alcohol causes certain vitamins to become dangerously low, especially during a detox. These vitamins can be given as tablets or by being injected into a vein (a ‘drip’). The drip is given one to three times a day, taking 30 minutes each time. • Chlordiazepoxide substitutes for alcohol in your brain and offers your body the chance to adjust gradually to the lack of alcohol. It helps to reduce the risks of shakes, agitation, visual illusions, and withdrawal fits. The dose will be reduced over a few days so you will not be on it for long. We will monitor you closely to determine how much chlordiazepoxide you need and, to help us with these assessments, we ask that you remain on the ward at all times. Will I have to stay in hospital? To start with, the medication will be given to you as an inpatient and we will assess you to determine if this can be safely continued and completed as an outpatient. You will be referred to the substance misuse team and one of the team nurses will meet with you to discuss the available support services that will give you the best chance of remaining abstinent from alcohol or, at least, markedly reducing the amount you drink. What will happen when I arrive at hospital? On admission you will be greeted by a member of the ward staff and introduced to your named nurse. They will discuss with you the care you will receive whilst you are in hospital. Your named nurse or their colleague will perform the assessments to decide how much and how often you need chlordiazepoxide. Are there any alternatives to this treatment? Without alcohol or chlordiazepoxide you will continue to physically withdraw from alcohol which is potentially dangerous and can lead to DTs as described above. As an alternative to chlordiazepoxide you can gradually reduce the amount of alcohol you drink over two weeks to prevent withdrawal symptoms. However, many patients find this difficult to do. 2 of 3 Alcohol dependence and detoxification (September 2019) Are there side effects of any drugs used? Side effects with the drip form of B vitamins are uncommon but can include dizziness or pins and needles. Allergic reactions occur in one in 1000 people, so we will monitor you very carefully. Occasionally chlordiazepoxide can cause side effects of drowsiness, dizziness, and being unsteady on your feet. We do not recommend any time off the ward until the doctors and nurses feel you are safe, that you are free of side effects, and do not need frequent assessments (hourly to start with) to decide on the correct dose of chlordiazepoxide. If you decide to leave the ward against medical advice, this may be taken as a ‘self discharge’. It is absolutely essential that you do not take chlordiazepoxide with alcohol as this is a dangerous combination. In the event that you drink alcohol during the detox we would consider stopping the chlordiazepoxide and discharging you from hospital. Will I need a follow-up appointment? During and after your hospital stay you will be put in touch with Forward Trust (community services) to help you remain abstinent from alcohol, or reduce your consumption, once you are discharged from hospital. What should I do if I feel unwell at home? After discharge from hospital you should call or visit your GP if you feel unwell. Your GP can then decide if this is related to your hospital visit/alcohol problems and, if appropriate, contact the substance misuse team. Driving and alcohol dependence We will discuss with you during your admission the implications of alcohol dependence and detoxification in relation to driving. The Driving and Vehicle Licensing Agency (DVLA) has provided guidance for fitness to drive for people who are dependent on alcohol.The licence holder, or licence applicant, has a legal duty to tell the DVLA of any condition which may affect their fitness to drive. Alcohol dependence requires licence revocation or refusal until a one year period free from alcohol problems has been attained. Drinking no alcohol will normally be required, with normalisation of blood results, if relevant. Vocational licensing (bus or lorry) will not be granted where there is a history of alcohol dependence within the past three years. If you would like this information in another language, audio, Braille, Easy Read, or large print please ask a member of staff. Any complaints, comments, concerns, or compliments please speak to your doctor or nurse, or contact the Patient Advice and Liaison Service (PALS) on 01227 783145 or 01227 864314, or email [email protected] Further patient leaflets are available via the East Kent Hospitals web site www.ekhuft.nhs.uk/patientinformation Information produced by the Substance Misuse Team Date reviewed: September 2019 Next review date: January 2022 Web 241 3 of 3 Alcohol dependence and detoxification (September 2019).