A “new” outpatient treatment for alcohol withdrawal

The patient admitted his alcoholism and had been through “treatment” but rejected the 12 step approach, in the days before we had anything but Antabuse to reduce drinking.  He would stay dry for weeks or months, and relapse, then try to stop on his own, go into withdrawal, and come in for help.  Antabuse has to be taken every day and makes the user very sick if he/she drinks alcohol.  So, if you’re planning on relapsing, don’t take your Antabuse!  Easy to understand why Antabuse is not all that effective, and by the way, has some potentially serious adverse effects.

I was always surprised that traditional withdrawal treatment was to use another addictive chemical, namely a benzodiazepine, usually Librium, for an addict to alcohol.  One day, I ran across an article comparing 200 mg of carbamazepine, an anticonvulsant or seizure medicine, four times daily as needed for withdrawal symptoms, to the standard regime of benzodiazepines.  There was no measurable difference, except that it is illegal to drive with benzodiazepines, really, and not with carbamazepine, which is, by the way, not at all addictive.  Both classes prevent withdrawal seizures.  So, I decided to switch.  This is called evidence-based practice.  There is also no illegal market for carbamazepine, so I also didn’t have to worry my patient would sell pills for booze!

So, following the research, I tried it on him.  It worked well.  He liked NOT being loaded on benzodiazepines, and not having the intense withdrawal symptoms from alcohol, and although he kept relapsing from time to time, many months apart, I finally gave him a refillable prescription, to make it easier for him to choose to stop drinking and manage his withdrawal.  Creative, not standard, logical, plausible, and most importantly, effective.  The few other patients who asked for help with withdrawal always got the new drug, not the old one.

Today the old one is still in wide usage in the alcohol treatment community….

Follow the research!  CHANGE treatment when research shows it’s warranted.